Borderline Personality Disorder -
Raising questions, finding answers
Borderline personality disorder (BPD) is a serious mental illness
characterized by pervasive instability in moods, interpersonal
relationships, self-image, and behavior. This instability often disrupts
family and work life, long-term planning, and the individual's sense of
self-identity. Originally thought to be at the "borderline" of psychosis,
people with BPD suffer from a disorder of emotion regulation. While less
well known than schizophrenia or bipolar disorder (manic-depressive
illness), BPD is more common, affecting 2 percent of adults, mostly young
women.(1) There is a high rate of self-injury without suicide intent, as
well as a significant rate of suicide attempts and completed suicide in
severe cases. (2), (3) Patients often need extensive mental health services,
and account for 20 percent of psychiatric hospitalizations.
Symptoms
While a person with depression or bipolar disorder typically endures the
same mood for weeks, a person with BPD may experience intense bouts of
anger, depression, and anxiety that may last only hours, or at most a day.
(5) These may be associated with episodes of impulsive aggression,
self-injury, and drug or alcohol abuse. Distortions in cognition and sense
of self can lead to frequent changes in long-term goals, career plans, jobs,
friendships, gender identity, and values. Sometimes people with BPD view
themselves as fundamentally bad, or unworthy. They may feel unfairly
misunderstood or mistreated, bored, empty, and have little idea who they
are. Such symptoms are most acute when people with BPD feel isolated and
lacking in social support, and may result in frantic efforts to avoid being
alone.
People with BPD often have highly unstable patterns of social relationships.
While they can develop intense but stormy attachments, their attitudes
towards family, friends, and loved ones may suddenly shift from idealization
(great admiration and love) to devaluation (intense anger and dislike).
Thus, they may form an immediate attachment and idealize the other person,
but when a slight separation or conflict occurs, they switch unexpectedly to
the other extreme and angrily accuse the other person of not caring for them
at all. Even with family members, individuals with BPD are highly sensitive
to rejection, reacting with anger and distress to such mild separations as a
vacation, a business trip, or a sudden change in plans. These fears of
abandonment seem to be related to difficulties feeling emotionally connected
to important persons when they are physically absent, leaving the individual
with BPD feeling lost and perhaps worthless. Suicide threats and attempts
may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive
spending, binge eating and risky sex. BPD often occurs together with other
psychiatric problems, particularly bipolar disorder, depression, anxiety
disorders, substance abuse, and other personality disorders.
Treatment
Treatments for BPD have improved in recent years. Group and individual
psychotherapy are at least partially effective for many patients. Within the
past 15 years, a new psychosocial treatment termed dialectical behavior
therapy (DBT) was developed specifically to treat BPD, and this technique
has looked promising in treatment studies.(6) Pharmacological treatments are
often prescribed based on specific target symptoms shown by the individual
patient. Antidepressant drugs and mood stabilizers may be helpful for
depressed and/or labile mood. Antipsychotic drugs may also be used when
there are distortions in thinking.(7)
Recent Research Findings
Although the cause of BPD is unknown, both environmental and genetic factors
are thought to play a role in predisposing patients to BPD symptoms and
traits. Studies show that many, but not all individuals with BPD report a
history of abuse, neglect, or separation as young children.(8) Forty to 71
percent of BPD patients report having been sexually abused, usually by a
non-caregiver. (9) Researchers believe that BPD results from a combination
of individual vulnerability to environmental stress, neglect or abuse as
young children, and a series of events that trigger the onset of the
disorder as young adults. Adults with BPD are also considerably more likely
to be the victim of violence, including rape and other crimes. This may
result from both harmful environments as well as impulsivity and poor
judgement in choosing partners and lifestyles.
Continued....
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