Borderline Personality Disorder

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Dr. Arindam Mondal

Posted By : Dr. Arindam Mondal - MBBS, MD (Psychiatry)

Posted On : Mar 16, 2010 (Views : 3409)

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What is Borderline Personality Disorder (BPD)?

BPD is a psychiatric diagnosis characterized by an abnormal pattern of thoughts, feelings and behavior in a person.



BPD is also called Emotionally Unstable Personality Disorder.  BPD affects about 0.5% of the general population. About 3/4th with this diagnosis are women. This condition is usually diagnosed in early 20s.



How would a clinician make this diagnosis?



There are no blood or physical tests to tell whether someone does or doesn't have BPD. Different criteria are used to diagnose BPD. usually, if 5 or 6 of the symptoms below are present for a year or more, the diagnosis of BPD is made. Note: many people experience some of these symptoms occasionally, but with BPD the experience is much more intense and prolonged.



  • Self-harm (for example, cutting themselves) or repeated attempts or expressions of the desire to commit suicide.

  • Frantic efforts to avoid being alone, due to an intense fear of being abandoned. Others may not see this fear as justified, but patients may go to great lengths to avoid being alone.

  • A pattern of unstable and intense relationships. Feelings often alternating between idolizing the other person and then thinking they are really awful.

  • A very uncertain, shaky self-image or sense of self. One may feel good while he/she feels loved by someone one thinks is wonderful. If he/she later sees it as bad, he/she own sense of self could be affected. One may also have doubts about his/her sexual identity.

  • Two or more areas of their life where their behavior could cause them harm and be seen as impulsive. Examples would be: spending money extravagantly and having huge debts, having unprotected sex, abusing drugs or alcohol, driving without due care, or binge-eating. One may do these things because he/she is trying to deal with awful feelings of pain or emptiness.

  • One may have moods that are very difficult to come out of. For example, one may go through long periods (usually lasting a few hours) of extreme irritability, restlessness, unhappiness or anxiety.

  • Terrible feelings of emptiness.

  • Anger that's inappropriate, intense or difficult to control. One may lose he/she temper a great deal, experience constant anger or be involved in physical fights. One may feel particularly angry when he/she thinks he/she is being criticized. Anger is often a very difficult feeling for people to acknowledge and deal with, but may cause particular problems in the life of someone diagnosed with BPD.

  • Periods of paranoia or feeling unreal when under stress. This might be accompanied by an almost complete lack of physical sensation. At difficult times, one may experience him/her-self as having more than one personality or feel oneself is in a trance-like state.


As a result of confusion about he/she personal identity and a terror of being left alone, he/she may find him/her-self clinging to very damaging relationships. Many people who have BPD also have histrionic, narcissistic or antisocial personality disorder. They may suffer from bouts of depression or have alcohol or drug abuse problems.



 

People with BPD have a greater risk of committing suicide than the general population. Usually 8-10% of those diagnosed with BPD commit suicide. If one is diagnosed with BPD, it's important to know where to seek help if he/she is feeling suicidal.



While some people may see themselves in the symptoms of BPD and feel relieved to have a label to apply to the problems they experience, others may be devastated at the idea that their personality is disordered. It is important that one gets the help he/she needs. A medically qualified person should make the diagnosis. Self-diagnosis should not be made.



 

Will a person with BPD get better?



People with BPD get better as they get older. Talking treatments and medication can reduce the behavior problems associated with the problem.



 

What causes borderline personality disorder?



The causes of BPD are still not clear.



Often, people with BPD turn out to have had very traumatic experiences in childhood. He/she may have experienced the early loss of a parent, or be a survivor of childhood sexual or physical abuse. One may have been neglected as a child. Such difficult life events are very common in those diagnosed with BPD. The problems associated with BPD may become much worse following a stressful experience, for example, the loss of a loved one or an established routine, such as a job.



 

What treatment is available?

 

Talking treatments




Psychotherapy is a relatively long-term talking treatment that aims to find the roots of present feelings and behavior in the patient’s childhood. The relationship he/she has with the therapist is seen as an important reflection of patient’s past and present relationships. Exploring this relationship can help to break unhelpful patterns of behavior. The in-depth nature of psychotherapy can make it particularly appropriate for those diagnosed with BPD.



Some forms of counseling are quite similar to psychotherapy. Psychodynamic counseling, for example, places great emphasis on childhood experience.



Cognitive Behavior Therapy (CBT) is a more short-term treatment that aims to tackle practical, everyday difficulties with problem-solving techniques. It works towards identifying negative thinking patterns and replacing them with more positive ones.



New therapies have been developed which combine elements of cognitive therapy and psychotherapy. Dialectical Behavior Therapy (DBT) and Cognitive Analytical Therapy (CAT) have been found to be particularly useful for people diagnosed with BPD.



People often have high expectations when they enter a talking treatment. Such change can take time. There may be times when one thinks his/her therapist is wonderful and times when he/she may hate the therapist. It may help to express these feelings, so that one can look at them together.



Do medications help?



Antidepressants



The chemical serotonin is low in people with BPD who have committed impulsive acts of violence. Some of the antidepressants work to increase levels of serotonin. Also help in symptom of feelings of emptiness.



Antipsychotics



Antipsychotics (also referred to as major tranquillisers) help with feelings of unreality or paranoia and reduce anger outbursts.



Mood Stabilizers



Mood Stabilizers (like Sodium Valproate, Carbamazepine, Oxcarbazepine & Lithium) help to reduce mood swings & impulsive acts.



Hospitalization



At times of great distress, one may feel that he/she needs to be somewhere safe. This could mean going into hospital. It can be upsetting to be around others who are in pain, however, and one may feel a lack of privacy and support.



Most admissions are voluntary. However, if one is regarded as a danger to him/her-self or to others, but he/she doesn't wish to be admitted, he/she may be admitted involuntarily under the Mental Health Act, 1987.



 

What should family and friends do?



People with BPD can have very low self-esteem, and it can help them enormously if one can emphasize the positive parts of their personality.



It can be extremely difficult caring for someone with BPD. They may try very hard to control others, because they feel so out of control of themselves. There may be periods when they refuse to talk to family/friends or are angry with them. This can be very painful and may make caregivers feel powerless.



Caregivers may find that the patient panics and reacts very angrily when they want to leave or to go somewhere. They may beg caregivers to stay, or hurl words of abuse. It can help if caregivers focus on how they are feeling, rather than trying to argue with them.



Caregivers looking after themselves



It's very important that caregivers look after themselves and remember that they need time for themselves, if they are to care for the patient. If caregivers are experiencing problems - for example, if the patient calls them many times a day at work - it's vital to set down some boundaries. It might be important to decide how often one will be available. This can be hard to stick to, especially if one is being threatened, and one may need to enlist other people's help.



A person diagnosed with BPD may feel that they have no control over their feelings; they may blame others for everything. Caregivers should make sure that they have someone they can turn to, to help them look at what is happening and make sure they don't take the blame for everything.



In an emergency




If family/friends feel that the person they care for is a serious danger to themselves or others, they might need to think about possibility of involuntary admission to hospital. The 'nearest relative' as defined under the Mental Health Act 1987 can request for the same.


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