Facts on Borderline Personality Disorder
- Borderline personality disorder (BPD) is a mental illness that is marked by a chronic pattern of unstable relationships, poor self-image, and mood changes.
- It is also characterized by severe impulsivity. As with other personality disorders, BPD usually begins in early adulthood. Similar to the prevalence of schizophrenia in the population, BPD is thought to affect about 1% of the population and 15% of patients in psychiatric hospitals. In contrast to how often women seek treatment for schizophrenia, women tend to seek treatment for BPD at a rate much higher than men, so the estimates on how many men suffer from this disorder may be lower than the actual numbers.
- Individuals with BPD struggle with many difficulties. For example, women with the disorder are at risk for feeling less satisfied by, and more often coerced into, sexual relationships.
- One in 10 people with BPD commits suicide,and frequently engages in self-injurious behaviors like cutting themselves or overdosing on medication. People with this disorder who attempt suicide are more likely to have a history of sexual abuse compared to the general population.
- Adults with BPD also might have other personality disorders like
- histrionic personality disorder,
- narcissistic personality disorder, and
- antisocial personality disorder.
- In addition to those mental health problems, children with BPD seem to be specifically at risk for having several other personality disorders, including passive aggressive personality disorder and schizotypal personality disorder.
- Although BPD has been thought by some to be a variation of bipolar disorder, research suggests that each of these disorders is indeed distinct. In contrast to bipolar disorder, which is classically characterized by emotions alternating between elation and depression, BPD tends to be associated with marked changes in mood between anxiety and anger or anxiety and depression.
- There are a lot of similarities between BPD an posttraumatic stress disorders (PTSD), leading to a belief that BPD might be an actual form of PTSD.
What Causes Borderline Personality Disorder?
Like most other mental disorders, BPD has no one specific cause but tends to have a number of biological, psychological, and social contributing factors. Biological risk factors for BPD include a family history of this diagnosis, substance abuse, antisocial personality disorder, impulsivity, or mood instability. Many consequences of being the victim of childhood abuse can be features of BPD. Specifically, childhood abuse can result in the sufferer having difficulty regulating their own emotions, a tendency to harm oneself, and problems forming healthy bonds with others. Other symptoms that childhood abuse victims and individuals with BPD have in common may include trouble understanding their thoughts and feelings and those of others, having an unstable self-image, trouble expressing both positive and negative feelings, and having trouble understanding and managing their feelings about themselves and others, also called splitting.
Although a history of being the victim of child abuse (for example, physical, sexual, or emotional) is a psychological risk factor for BPD, it is also a contributing factor for a number of other emotional problems. Socially, being part of what is considered to be a modern or rapidly changing culture is thought to be associated with the development of BPD as well.
What Are the Symptoms and Signs of Borderline Personality Disorder?
Symptoms of BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM) and include
- desperate attempts to prevent real or imagined abandonment;
- unstable and intense relationships with others that alternate between seeing the other person as flawless and as worthless;
- highly unstable self-image;
- potentially self-damaging impulsive behaviors, like drug abuse or reckless driving;
- repeated suicidal thoughts or behaviors, or self-mutilation (for example, cutting or burning themselves);
- unstable emotional states, usually lasting a few hours to a few days;
- persistent feelings of emptiness;
- inappropriately intense anger or trouble controlling anger;
- short-lived episodes of paranoia (extreme suspiciousness) or dissociation (disconnecting from sense of self and reality) that are caused by stress.
Of the above symptoms, mood instability and impulsivity (the tendency to act without thinking) tend to be the most specific to BPD. These two symptoms are thought to be the driving force behind the unstable relationships and chronic suicidal thoughts that are hallmarks of this disorder. In men, BPD tends to include more explosive anger and co-occur with substance abuse and antisocial personality disorder, while in women, this disorder more often co-occurs with eating disorders, as well as mood and anxiety disorders. People who suffer from a number of the above symptoms but not enough to qualify for having BPD are described as having borderline personality traits.
When Should I Call the Doctor about Borderline Personality Disorder?
As with any other mental health issues, the time to seek medical care for BPD is when the symptoms meaningfully interfere with the sufferer's life. Individuals with BPD often enter care when they experience negative changes in their lives, like divorce or another relationship loss or job loss. Other symptoms that indicate the need for treatment include, but are not limited to, eating disorders, sleep problems, significant depression, anger, anxiety or mood swings, self-injurious behaviors like cutting, and thoughts of dying or killing oneself.
How Is Borderline Personality Disorder Diagnosed?
There is no specific definitive test, like a blood test, that can accurately assess that a person has borderline personality disorder. Therefore, practitioners conduct a mental health interview that looks for the presence of the symptoms previously described. The professional also usually asks questions to explore (screen) whether or not other emotional problems like clinical depression, anxiety, alcohol abuse, dependence, and/or other addictions are present. Mental health professionals will also likely explore whether the individual is a safety risk by having homicidal thoughts, suicidal thoughts, or other thoughts of self-harm. As certain medical conditions can influence how BPD manifests (presents), the mental health examiner will likely refer the individual for a complete physical examination and any tests they may need to better understand their medical situation.
Initial Treatment for Borderline Personality Disorder
Initial treatment depends on how bad your condition is. When borderline personality disorder is diagnosed, you most likely will begin treatment with professional counseling (psychotherapy). The first goal of therapy is to help you control destructive behaviors, especially if you are feeling suicidal or self-destructive. When you are less likely to harm yourself and you are able to function more normally, treatment will focus on managing your emotions, such as controlling feelings of anger or unhappiness.
What Is the Treatment for Borderline Personality Disorder?
Although psychiatric hospitalization may often be used to address the suicidal and other safety crises of individuals with BPD, it is unclear how beneficial that intervention is. In contrast, partial hospitalization has shown some promise as an intervention for individuals with BPD who are not in imminent danger of mortally harming themselves or others. Partial hospitalization involves the sufferer receiving intensive mental health treatment for several hours per day then returning home each afternoon or evening. Therapeutic communities are living arrangements that provide a safe, nurturing, and structured environment for individuals with BPD that they may not have received as a child. Those communities can play an important role in the care for these individuals.
Most practitioners will use some form of psychotherapy to treat BPD. Dialectical behavior therapy (DBT) addresses problems that individuals with borderline personality disorder often have relating to others and managing their behaviors and feelings. Psychoanalytic psychotherapy involves the mental health professional helping the person with BPD explore deep feelings and the ways they manage those feelings (defenses) in ways that are not constructive. Interpersonal psychotherapy focuses on helping people with BPD relate to others in healthier, more appropriate ways.
Psychotherapy remains the mainstay of treatment for BPD. Many practitioners use techniques to help BPD sufferers better regulate their emotions and interact with others. Given the constraints of health insurance-funded treatment, mental health providers are often limited to supporting patients in their daily emotional and interpersonal struggles rather than directly treating their symptoms.
What Are the Medications for Borderline Personality Disorder?
While medications can be helpful in reducing some of the specific mood symptoms of BPD, they by no means cure the disorder. Given the high number of mood problems that characterize this illness, practitioners take care to try and minimize the number and doses of medications in order to avoid exposing the person with BPD to numerous side effects. Using multiple medications at the same time, also called polypharmacy, can also put the person at risk for attempting to use their supply of medications to commit suicide.
Despite these risks, careful use of medications can help achieve some symptom relief in certain people with BPD. Examples of antidepressants include medications that affect the activity of the chemical serotonin in the brain (serotonergic medications) like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). They are often used due to the combinations of high effectiveness and relatively low occurrence of serious side effects. Other antidepressants that practitioners frequently use to address mood symptoms for individuals with BPD include antidepressants that impact the activity of serotonin as well as epinephrine and norepinephrine, like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as those that affect the activity of dopamine in the brain like bupropion (Wellbutrin). Older antidepressants like tricylics are not used as often as they used to be due to difficulties with possible side effects and the possibility of overdose.
Are There Home Remedies for Borderline Personality Disorder?
Individuals who suffer from BPD can take steps to help their own progress in mental health treatment. Rearranging their schedule such that they are able to attend psychotherapy sessions regularly over a long period of time is key to making progress in a timely way. Promoting their own healthy lifestyle may also include minimizing any access they have to weapons or other dangerous household items so they may be less likely to act on self-injurious, suicidal, or homicidal urges when they occur. That may include entrusting medication supplies to a trusted adult in the household to decrease the opportunity for overdose. Daily steps that people with BPD can take to further promote healthy living include avoiding states of physical depletion. Maintaining good nutrition, regular exercise, and adequate sleep, as well as learning and using stress-management techniques are examples of such steps.
How Can I Prevent Borderline Personality Disorder?
As the development of BPD is highly associated with a history of childhood abuse, prevention and early appropriate treatment of abuse are often considered in preventing this disorder. Prevention of child abuse has societal, parental, and child components. Examples of societal risk factors include high rates of crime and unemployment with low levels of social services. Parent-related risk factors of abuse and therefore of BPD include lack of social support and parenting skills and the presence of domestic violence. In children, risk factors include premature birth, low birth weight, or child handicap.
What Is the Prognosis for Borderline Personality Disorder?
Although individuals with BPD have a one in 10 chance of completing suicide, and adults with this disorder are at risk for having difficulty functioning in many aspects of their lives, many tend to regain much of their functioning by 40 years of age. Therefore, the BPD sufferer who is able to work with the professionals who care for them can be optimistic about the prognosis for their recovery over time.
Reviewed on 11/21/2017
Medically reviewed by Marina Katz, MD; American Board of Psychiatry & Neurology
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