Borderline Personality Disorder

What Is Meant by Borderline Personality Disorder?

Borderline personality disorder (BPD) is characterized by significant mood swings, instability in relationships, and impulsive behavior, constituting a mental health condition. Individuals with BPD experience a profound fear of abandonment and struggle with managing their emotions, particularly feelings of anger. Additionally, they often exhibit impulsive and risky behaviors, such as dangerous driving and making self-harm threats. These behaviors pose challenges for individuals with BPD in maintaining relationships. Borderline personality disorder belongs to a category of conditions known as "Cluster B" personality disorders, characterized by dramatic and unpredictable behaviors. Personality disorders are enduring patterns of dysfunctional behavior that are inflexible, and pervasive, and result in social difficulties and distress over the long term. Numerous individuals living with borderline personality disorder may be unaware of their condition and might not recognize the existence of healthier behavioral and relational alternatives.

Over the years, the different names that have been given to this disorder are:

• Ambulatory schizophrenia.

• As-if personality.

• Pseudoneurotic schizophrenia.

• Psychotic character disorder.

What Are the Symptoms of Borderline Personality Disorder?

1. Excessive efforts to avoid real or imagined abandonment. They fear abandonment and will do anything to avoid it.

2. Unstable and intense interpersonal relationships are characterized by alternating between extremes of idealization and devaluation. In their view, a person is either all good or all bad.

3. Identity confusion. Marked and persistently unstable self-image or sense of self.

4. Impulsivity in areas that are potentially self-damaging. For example, money spending, sex, substance abuse, reckless driving, and binge eating.

5. Repeated suicidal behavior, gestures, threats, and self-mutilating behavior such as cutting.

6. Unstable moods and extreme reactions.

7. The feeling of emptiness is longstanding.

8. Intense anger and difficulty controlling anger. There are frequent displays of temper, constant anger, and recurrent physical fights.

9. Abrupt and short-term stress-related paranoid ideation or severe dissociative symptoms.

What Are the Behaviors and Traits of Borderline Personality Disorder?

These persons have a volatile 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 identify with you but when there is a conflict, they devalue a person 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, and 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 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.

What Are the Causes of Borderline Personality Disorder?

Healthcare providers hold the belief that BPD arises from a combination of factors, which may include:

• Childhood Abuse and Trauma: Approximately 70 percent of individuals diagnosed with BPD have encountered sexual, emotional, or physical abuse during childhood. Maternal separation, inadequate maternal attachment, parental substance use, and blurred family boundaries disorder are also linked to BPD.

• Genetics: Research indicates a familial predisposition to borderline personality disorder. Having a family history of BPD increases the likelihood, though it does not guarantee, the development of the condition.

• Brain changes Individuals with BPD exhibit improper communication among the regions of the brain responsible for regulating emotion and behavior, leading to dysfunction in brain functioning.

What Is the Diagnostic Process for Borderline Personality Disorder?

As personality continues to develop throughout childhood and adolescence, healthcare providers typically refrain from diagnosing borderline personality disorder until after the individual reaches the age of 18. In rare instances, individuals under the age of 18 may receive a diagnosis of BPD if their symptoms are substantial and persist for a minimum of one year.

Diagnosing personality disorders, such as borderline personality disorder, can be challenging due to the lack of insight most individuals with these disorders have into their disruptive behavior and thought patterns. When individuals do seek assistance, it is often prompted by conditions like anxiety or depression stemming from the issues caused by their personality disorder, such as divorce or ruptured relationships, rather than the disorder itself.

A licensed mental health practitioner like a psychologist, psychiatrist, or clinical social worker, can diagnose borderline personality disorder by assessing the diagnostic criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. They achieve this by conducting a comprehensive interview and engaging in discussions about symptoms.

How Is Borderline Personality Disorder Treated?

• Psychotherapies such as dialectical behavior therapy and cognitive behavioral therapy are the mainstay of treatment.

• 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.

• Counseling for the patient as well as friends, caregivers, and family members is 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.