Borderline personality disorder is a mental illness where the person has difficulty handling their emotions appropriate to social standards. Even minor situations can trigger major reactions. They have unstable mood, behavior, object relations, and self-image. They stand on the border between neurosis and psychosis. A person with neurotic illness will have an insight into his illness. He understands that he has some illness and that he should seek medical help, while a person with psychotic illness does not have any insight into his illness. He has lost touch with reality and usually, they do not seek medical help.
Over the years, the different names that have been given to this disorder are:
- Excessive efforts to avoid real or imagined abandonment. They fear abandonment and will do anything to avoid it.
- Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. In their view, a person is either all good or all bad.
- Identity confusion. Marked and persistently unstable self-image or sense of self.
- Impulsivity in areas that are potentially self-damaging. For example, money spending, sex, substance abuse, reckless driving, and binge eating.
- Repeated suicidal behavior, gestures, threats, and self-mutilating behavior such as cutting
- Unstable moods and extreme reactions.
- Feeling of emptiness that is longstanding.
- Intense anger and difficulty controlling anger. There is frequent displays of temper, constant anger, and recurrent physical fights.
- Abrupt and short-term stress-related paranoid ideation or severe dissociative symptoms.
Behavior and Traits
These persons have an extremely unstable psychic organization. They quickly become attached to somebody and easily make friends. They have a problem with their identity and cannot understand what life means to them. So, they are dependent on others and need emotional support. When they become dependent on others, their expectations about them go very high and when that person tries to move away from them, they have an emotional breakout. They try to convince that person to live with them and can do whatever they want.
On one occasion they may say that you are a very nice person and identifies with you but when there is a conflict, they devaluate you in front of others. They are very impulsive as given in the symptoms.
They give repeated suicidal threats, make suicidal gestures and try to gain attention. They often feel that their life is empty. One moment, they may be happy but another moment they are sad and suicidal. Sometimes, they may become paranoid whenever there is an emotional breakout.
Some psychiatrists call this personality 'black and white phenomenon' because of the sudden changes and fluctuations in mood, emotions, behavior and they are usually at an extreme level. Functionally, patients with borderline personality disorder distort their relationships by considering each person to be either all good or all bad.
Also, they use a defense called as splitting. Meaning, persons towards whom the patient's feelings are undecided are divided into good and bad. For example, in an inpatient setting, a patient may idealize some staff members and uniformly disparage others. This defensive behavior can be highly disruptive in a hospital ward and can ultimately provoke the staff to turn against the patient. When staff members anticipate the process, discuss it at staff meetings, and gently confront the patient with the fact that no one is all good or all bad, the phenomenon of splitting can be dealt with effectively.
Genetics seems to play a great role in causing borderline personalities. A person with a close family member who has this disorder is much likely to have it too.
Also, this disorder is linked to a history of abuse, neglect or separation early in life. In young adulthood, some situations, people and scenarios trigger the development of this personality in them.
- Medication is generally not used unless specific symptoms such as depression and mood swings need to be treated. In that case, antidepressants, mood stabilizers, and antipsychotics are used.
- Counselling for the patient as well as friends, caregivers, and family members are necessary so that there is awareness in their circle about why they behave the way they do, what to expect and accordingly support them when necessary.
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