Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is a serious psychological condition that’s characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning and an individual’s sense of identity. It is a state of the brain and mind. It’s the most commonly recognized personality disorder that:

• makes it hard for a person to feel comfortable in themselves.
• causes problems controlling emotions and impulses.
• causes problems relating to other people.

Why is it called ‘borderline’?

In the past, mental illnesses were categorized as ‘psychoses’ or ‘neuroses’. When psychiatrists first jotted down about BPD, it didn’t fit into either category. They came to the conclusion that it existed on an imaginary line between these two groups of illnesses.

It’s one of several personality disorders recognized by the American Psychiatric Association (APA). Personality disorders are psychological conditions that commence in adolescence or early adulthood, persist over many years and when left untreated, can lead to high amplitude of distress. Fortunately, the treatment that’s aimed at BPD can help significantly.

People with BPD suffer from difficulties with emotional regulation. While lesser known than schizophrenia or bipolar disorder BPD affects two percent of adults.

Signs & Symptoms

People with BPD:

• have high levels of distress and anger. They are easily offended at things other people do or say.
• might struggle with painful thoughts and beliefs about themselves and other people. This can affect their work life, family life and social life adversely.
• find it hard to return to a stable baseline after an emotionally triggering event. This complication can lead to spontaneous, poor self-image, heated relationships and intense emotional responses to stressors. Fighting self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).
• exhibit high rates of self-injurious behavior, such as cutting and in severe cases, significant rates of suicide attempts and completed suicide. Impairment from BPD and suicide risk is greatest in the young-adult years and tends to decrease with age. BPD is more prevalent in females than in males with 75 percent of cases diagnosed among women.

If someone has BPD, it is neither their fault nor did they cause it. They often need extensive mental health services.

In general, someone with a personality disorder will differ significantly from an average person in terms of how he or she thinks, perceives, feels or relates to others.

Other symptoms may include:

• Attempts to keep away from real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being ditched.
• A pattern of intense and unstable relationships with family, friends, and loved ones often oscillating from extreme closeness and love (idealization) to extreme dislike or anger (devaluation).
• Distorted and unstable self-image or sense of self
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.
• Self-harming attitude, such as cutting.
• Repetitive thoughts of suicidal activities or threats.
• Profound and highly inconstant moods with each session lasting from a few hours to a few days.
• Chronic feelings of emptiness.
• Inappropriate and extreme anger or problems steering anger (e.g. having fits of temper or getting into fights).
• Trust issues followed by wild fear of other people’s intentions.
• Feelings of disconnection such as feeling isolated from oneself, seeing oneself from outside one’s body or feelings of hallucinations.

Many people confront one or more of the above symptoms on a regular basis but a person with borderline personality disorder will experience a majority of the symptoms listed above consistently throughout adulthood.

The term “borderline” refers to the fact that people with this condition tend to “border” on being diagnosed with additional mental health conditions in their lifetime, including psychosis.

One of the acerbities of this disorder is that people with BPD may yearn for closeness but their acute and shaky emotional responses tend to alienate others causing unending feelings of isolation.

Causes

Even though the cause of borderline personality disorder is obscure, both environmental and genetic factors are believed to play a role in making people vulnerable to BPD symptoms and traits. BPD is approximately five times more common among people with close biological relatives with BPD.

Contributing factors that may increase the risk include:

• Genetics. While no specific gene or gene profile has been appeared to directly cause BPD, studies involving twins suggest this illness has significant hereditary links. BPD is approximately five times more common among people who have an acute relative with the disorder.
• Environmental factors. People who experience traumatic life events — such as physical or sexual abuse during childhood or neglect and separation from parents — are at increased risk of developing BPD.
• Brain function. The emotional regulation system may be different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate optimally with one another.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies have shown that people prone to impulsive aggression have damaged regulation of the neural circuits that modulate emotion. The brain’s amygdala is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a recognized threat, it escorts fear and arousal, which may be more noticeable under the influence of stress or drugs like alcohol. Regions in the front of the brain (prefrontal area) act to dampen the activity of this circuit. Recent brain-imaging studies suggest that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the potential to suppress negative emotion.

Serotonin, norepinephrine, and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions including sadness, anger, anxiety and irritability. Drugs that magnify brain serotonin function may improve emotional symptoms in BPD. Similarly, mood-stabilizing drugs that have proven to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be controlled with the help of behavioral interventions and medications, much as people manage susceptibility to diabetes or high blood pressure.

Tests and Diagnosis

A licensed mental health professional — such as a psychiatrist, psychologist, or clinical social worker — experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder by:

• Completing a detailed interview comprising a discussion about symptoms.
• Performing a careful and in-depth medical exam which can help eliminate other possible causes of symptoms.
• Asking about family medical histories including any history of mental illness.

Treatment

An effective treatment plan should include your preferences while also addressing any other co-existing conditions you may have. Instances of treatment options encompass psychotherapy, medications and group peer and family support. The underlying goal of treatment is for a person with BPD to increasingly self-direct their own treatment plan as they learn what works and what doesn’t.

• Psychotherapy such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy is the picked over the choice for BPD. Learning ways to cope with an emotional imbalance in a therapeutic setting is often the solution to long-term improvement for those suffering from BPD.
• Medications may be instrumental to a treatment plan, but there is no one medication specifically made to treat the core symptoms of BPD. Rather, several medications can be used off-label to treat various symptoms. For example, mood stabilizers and antidepressants help with mood swings and dysphoria. And for some, low-dose antipsychotic medication may help control symptoms such as disorganized thinking.
• Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.

Tips for Family and Caregivers

• To help a friend or relative with the disorder:
• Offer emotional support, understanding, patience, and encouragement — change can be difficult and frightening to people with BPD, but it is achievable for them to improve over time.
• Gather information about mental disorders including borderline personality disorder so you can understand what the person with the disorder is experiencing.
• Motivate your loved one to ask about family therapy.
• Seek counseling for yourself from a therapist. Make sure it should not be the same therapist that your loved one with borderline personality disorder is seeing.