Nov 9th 2022
Borderline personality disorder (BPD) is a mental illness characterized by an intense fear of abandonment, problems with self-image, and impulsive behavior. This disorder usually begins in adolescence or early adulthood. While causes are not well understood, it is thought that trauma, genetics and brain chemistry and development problems can all increase the risk. Medical professionals can treat it with different forms of therapy, and people with BPD may also be prescribed medication.
Borderline personality disorder is a mental illness that affects a person’s relationships and self-image and causes impulsive behavior. It is also known as emotionally unstable personality disorder (EUPD), emotional intensity disorder (EID), and borderline pattern personality disorder. It belongs to a group of diagnoses – personality disorders – which are all illnesses in which a person’s thoughts, emotions and behavior are different from those of the average person and significantly impact their quality of life.
Symptoms of BPD include a deep fear of abandonment, unstable relationships, problems with self-image, impulsive behavior, extreme anger, suicidal behavior, and self-harm.
According to the Diagnostic and Statistical Manual of Mental Disorders , used by mental health professionals in the U.S. to diagnose mental health problems, medical professionals can diagnose borderline personality disorder if a person meets at least five of the symptoms listed above. A diagnosis is made by a doctor or other mental health professional following a psychological evaluation, which includes a discussion of signs and symptoms, a review of medical history, and sometimes questionnaires.
A diagnosis of BPD can be difficult for some people to come to terms with. For others, it can be a relief to understand the underlying reasons for how they think, feel, and behave. In addition, a diagnosis can help unlock access to treatments such as therapy and medication.
The list of borderline personality disorder symptoms is also associated with other mental health conditions, which means people with BPD are often misdiagnosed. These conditions include:
A person can also experience BPD alongside other mental health problems, further complicating the diagnosis.
Misdiagnosis can be challenging. Feeling misdiagnosed can be difficult to cope with and set you down the wrong treatment path. If you think you have been misdiagnosed, discussing this with your doctor or mental health professional is essential.
The causes of borderline personality disorder are not well understood. However, the main risk factors are trauma, genetics, brain chemistry, and development.
Trauma can result from several experiences, including physical abuse, sexual abuse, experiencing long-term distress as a child, parental neglect, losing a parent, and growing up in a family where there were mental health problems or substance misuse. Our childhood experiences, in particular our relationships with parents or caregivers, can shape how we view the world and our relationships with others.
There is no proof that a specific gene exists for BPD. However, research has suggested that genetics may play a part in putting some people at a higher risk of developing BPD. For example, you are more likely to be diagnosed with BPD if a close family member is also diagnosed. However, it’s unclear at this stage whether this is because of genetics or because people raised in the same environment often experience the same traumas and difficulties.
Research has found that some people with BPD have problems with their brain chemistry. Neurotransmitters – the chemicals that send signals between brain cells – play a part in controlling our mood and physical processes, including heart rate, breathing, and sleep. Research has found that abnormal levels of the neurotransmitter serotonin – a natural mood stabilizer – may be an underlying cause of BPD in some people.
Researchers have also examined the brains of people with BPD using MRI scanners. MRI scans produce images of the brain that show where activity is taking place at different times. Scans have shown differences in the brains of some people with BPD, revealing either difference in size or levels of activity in three key areas:
Our current understanding of the causes of borderline personality disorder doesn't give us simple ways to prevent BPD from developing. As with most mental health problems, prevention begins in childhood and relies on reducing the causes of poor mental health. These include traumatic childhood experiences, for example, and giving children the knowledge and tools to help them understand their emotions and talk about them with trusted adults who look after their well-being.
There is no known cure for borderline personality disorder, but medical professionals can successfully treat it. Treatment primarily includes psychotherapy and medication. The goal is to help minimize BPD symptoms, help you cope better with difficult thoughts and feelings and develop new ways to react and behave in response to triggering situations.
There are several different therapeutic approaches to BPD.
Dialectical behavior therapy (DBT) is related to the better-known cognitive behavioral therapy (see below) and is designed specifically for people experiencing intense emotions. It helps with accepting feelings and improving reactions and behavior.
DBT is delivered in group or 1-2-1 settings and guides people with BPD through four key areas:
Mentalization-based therapy (MBT) helps us understand our thoughts and emotions and those of others. MBT is about questioning our thoughts and beliefs and exploring whether they are valid and based on fact. It also helps us understand how others behave, by exploring where their thoughts and ideas come from and questioning our assumptions about why people treat us the way they do.
Cognitive behavioral therapy (CBT) is a typical therapy for various mental health problems and may be helpful for people with BPD. It helps us understand the links between our thoughts, emotions, reactions and behavior and challenge negative thought patterns. CBT courses are often short, but clients leave therapy with practical tools to use in daily life.
A schema is a concept that allows us to take in and interpret information or circumstances. Schemas are developed from a young age and will enable us to define and understand things. For example, our schema for a chair might be that it generally has a seat, four legs, and a back – it’s how we know without consciously thinking about it that a chair is a chair. We also develop schemas about ourselves and our interpersonal relationships, which can be negative if we grow up in difficult circumstances. For example, if a parent abandoned us as a child, we may grow up believing that we are at a high risk of being left by anyone we love. Schema-focused therapy helps us to understand our schemas and the link between childhood experiences and how we react to situations in the present.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week course that draws on many the techniques and approaches listed above. The critical difference with STEPPS is that it involves not just the person with BPD but also their loved ones to help them understand the condition and support them to use the skills they learn once they leave therapy.
Transference-focused psychotherapy (TFP) is a type of psychodynamic therapy that, similar to others, looks at the underlying events and relationships from childhood that underpin how we think, feel and behave in the present. With TFP, the role of the therapist – and the relationship between the therapist and the client – is vital. It is based on the theory that a person’s feelings about their loved ones are transferred onto the therapist, which then allows the therapist to support them in developing better personal relationships.
The Food and Drug Administration hasn’t approved any medications to date for the specific treatment of BPD. However, medical professionals can prescribe several drugs to help manage particular symptoms or to treat co-existing mental health problems, including antidepressants, antipsychotics, mood stabilizers and sleeping pills.
Patients with BPD should only take medication for mental health problems with support and guidance from a professional and you should not stop taking the medication suddenly. Side effects can be significant and should be discussed with your doctor or a mental health professional before and during medication use.
As with most mental health problems, looking after your physical and psychological well-being is a good idea. Eating healthily, exercising regularly, developing good sleeping habits and avoiding stress can all go a long way in helping you stay well.
Here are some practical tips for dealing with the intense emotions associated with BPD, such as anxiety, anger, dissociation and the urge to self-harm:
Living with someone with any mental illness can be challenging. If you are close to someone with borderline personality disorder, you may struggle to understand what they are thinking and how they are feeling. You may also find yourself on the receiving end of angry outbursts or the impact of their innate fear that you will abandon them.
There are many things you can do to support your loved one:
There is no absolute cure for borderline personality disorder, but it is treatable. People with BPD can and do recover with the proper treatment and support. Even if some symptoms persist, it is possible to reach a point where the impact on day-to-day life is minimal.
The term ‘borderline personality’ has been around since the 1930s . ‘Borderline’ refers to the fact that BPD symptoms didn’t fit neatly into the (now somewhat outdated) definitions that existed at the time.
According to the National Association of Mental Illness , borderline personality disorder is estimated to affect 1.4 percent of adults in the U.S. Around 75 percent of those diagnosed are women.
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