BORDERLINE PERSONALITY DISORDER

Borderline Personality Disorder (BPD) is a mental condition in which a person has long-term pattern of unstable or turbulent emotions. These inner experiences often result in impulsive actions and chaotic relationships with other people.

Borderline personality disorder is also called as emotionally unstable personality disorder. People with BPD tend to be extremely sensitive. Small things can trigger intense reactions. And once they become upset, they have trouble calming down. They may also say hurtful things to others or act out in dangerous or inappropriate ways that make them feel guilty or ashamed afterwards.

Research shows that around 1 in 100 people live with BPD. About 75% of patients diagnosed with this disorder are female, but in the general US population, the ratio of men to women is 1:1.

What causes Borderline Personality Disorder (BPD)?

Most mental health professionals believe that borderline personality disorder (BPD) is caused by a combination of inherited or internal biological factors and external environmental factors, such as traumatic experiences in childhood.

You may be more vulnerable to BPD if a close family member also lives with BPD. There is no evidence though of a particular gene being responsible for BPD. Problems with levels of your brain chemicals, particularly serotonin can also develop BPD. A number of environmental factors seem to be common with people who live with BPD which includes: experiencing abuse, experiencing long-term fear or distress as a child, being neglected by one, or both, of your care givers as child, growing up with a family member who had a serious mental health condition such as bipolar disorder or a problem with alcohol or drugs.

What are symptoms of Borderline Personality Disorder (BPD)?

🔵 People with BPD often feel that they are being abandoned or left neglected, they feel intense fear or anger. For example: They may become panicky or furious when someone important to them is a few minutes late or cancels an engagement. They think that this abandonment means that they are bad.

🔵 People with BPD have a pattern of unstable and intense relationships. They may fall in love quickly believing that each new person is the one who will make them feel complete but they quickly get disappointed and devaluate others, feeling that the other person does not care or love enough. These individuals are prone to sudden and dramatic shifts in their view of others.

🔵 People with BPD have a typically unclear and unstable sense of self. Sometimes they may feel good about themselves but other times they hate themselves. They don’t have a clear idea of who they are or what they want in life. They may frequently change their jobs, friends, lovers, goals, values, etc.

🔵 People with BPD display impulsivity and engages in self-destructive behaviors. They may gamble, spend money irresponsibly, binge eat, drive recklessly, engage in unsafe sex or abuse drugs and alcohol.

🔵 Individuals with BPD display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Suicidal behavior includes thinking about suicide, making threats or actually carrying out a suicide attempt. Self-mutilation behavior includes cutting or burning oneself.

🔵 Individuals with BPD often feel unstable emotions or moods. They may feel happy at one moment and the next they are despondent. These mood swings are intense, but they tend to pass quickly, usually lasting just a few minutes or hours.

🔵 Individuals with BPD may be troubled by chronic feeling of emptiness. They may often talk about feeling empty, as if there is a hole or void inside them. This feeling is uncomfortable, so they may try to fill the void with things like food, sex or drugs but nothing feels truly satisfying to them.

🔵 Individuals with BPD frequently express inappropriate, intense anger or have difficulty controlling their anger.

🔵 People with BPD often struggle with paranoia or suspicious thoughts about others motives. They may even experience dissociative symptoms such as depersonalization (feeling disconnected or detached from one’s body and thoughts), during the period of extreme stress.

How common is Borderline Personality Disorder (BPD)?

The median population prevalence of BPD is estimated to be 1.6% but may be as high as 5.9%. The prevalence of borderline personality disorder is about 6% in primary care settings, about 10% among individuals seen in outpatient mental health clinics and about 20% among psychiatric inpatients. It seems to affect men and women equally, but women are more likely to have this diagnosis because men are less likely to ask for help.

How is Borderline Personality Disorder (BPD) diagnosed?

A licensed mental health professional such as a psychiatrist, psychologist or clinical social worker- experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder by: completing a thorough interview, including a discussion about symptoms, performing a careful and thorough medical exam which can help rule out other possible causes of symptoms and asking about family medical histories, including any history of mental illness.

What is the treatment of Borderline Personality Disorder (BPD)?

Many people with BPD can benefit from psychological or medical treatment. Identifying and treating coexisting disorders is important for effective treatment of borderline personality disorder and it may last more than a year.

The main treatment for borderline personality disorder is psychotherapy. Many psychotherapeutic interventions are effective in reducing suicidal behaviors, depression and improving function in patients with this disorder.

🔵 Dialectical Behavior Therapy (DBT) is a type of therapy specifically designed to treat people with borderline personality disorder. DBT usually involves weekly individual and group sessions. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. It also teaches skills that can help control intense emotions, reduce self-destructive behaviors and improve relationships.

🔵 Mentalization Based Therapy (MBT) is a type of therapy which helps people to understand their own state of mind and the state of mind of others. MBT helps patients to effectively regulate their emotions (e.g., calm down when upset), understand how they contribute to their problems and difficulties with others, reflect on and understand the mind of others. MBT helps people to relate to others with empathy and compassion.

🔵 Transference Focused Psychotherapy centres on the interaction between patient and therapist. The therapist asks questions and helps patients think about their reactions so that they can examine their exaggerated, distorted and unrealistic images of self during the session. The current moment (e.g., how patients are relating to their therapist) is emphasized rather than the past.

🔵 Schema Focused Therapy is an integrative therapy that combines cognitive-behavioral therapy, emotion-focused therapies, attachment theory and psychodynamic concepts. It focuses on lifelong maladaptive patterns of thinking, feeling, behaving and coping (called schemas), affective change techniques, and the therapeutic relationship, with limited re-parenting. Limited re-parenting involves establishing a secure attachment between patient and therapist (within professional limits), enabling the therapist to help the patient experience what the patient missed during childhood that led to maladaptive behavior.

🔵 Medications are not typically used as the primary treatment for borderline personality disorder. But your doctor may offer you medication to treat specific symptoms such as mood swings, depression and other co-occurring mental disorders.

Tips for people with BPD

🔵 If you are feeling angry, frustrated or restless, you can try to rip up a newspaper, hit a pillow, throw ice cubes into the bath so they smash, do some vigorous exercise, listen to loud music or do a practical activity like gardening or woodwork.

🔵 If you are feeling depressed, sad or lonely, you can wrap up in a blanket and watch your favourite TV show or a movie, you can cuddle a pet or a soft toy, write all your negative feelings on a piece of paper and tear it up, etc.

🔵 If you are feeling anxious, panicky or tense, you can make yourself a hot drink and drink it slowly, noticing the taste and smell, the shape of mug and its weight in your hand or you can take a warm bath or shower- this can help change your mood by creating a soothing atmosphere and a distracting physical sensation.

🔵 If you want to self harm, you can run ice over where you want to hurt yourself, stick cello tape on your skin and peel it off or take a cold bath.

🔵 Try to get enough sleep. Getting a proper sleep will provide you with the energy to cope with difficult feelings and stressful situations.

🔵 Exercise regularly as it will helpful for your mental wellbeing.

🔵 You can create a self-care box where you can put together some things that might help you when you are struggling such as a stress ball, a soft blanket, a nice smelling candle, pictures or photos you find comforting, favourite books, films or CDs, etc.

Tips for partners, families and carers

🔵 Try to be patient and avoid involving in arguments with your loved ones when they are struggling to deal with their emotions. You can talk to them about your thoughts when you both feel calmer.

🔵 Try to listen to your loved ones without telling them that they are overreacting or that they shouldn’t feel the way they do. Try to acknowledge their feelings without judging them.

🔵 Being calm and consistent when your loved one is experiencing a lot of overwhelming emotions, could help them feel more secure and will help in moments of conflict.

🔵 Help remind them of all their positive traits. If your loved one finds it hard to believe anything good about them self, it can be reassuring to hear all the positive things you see in them.

🔵 Talk to your loved one and try to find out what sort of situations or conversations might trigger negative thoughts and emotions.

🔵 It is important to look for your mental wellbeing too. It could be quite distressing seeing someone you care about experiencing borderline personality disorder. You can talk to someone if you are struggling to cope. Try to take some break and make time for yourself too.

Myths v/s Facts about Borderline Personality Disorder (BPD)

References

https://www.rcpsych.ac.uk/

• https://www.helpguide.org/articles/mental-disorders/borderline-personality-disorder.htm
• https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/borderline-personality-disorder/
• https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/about-bpd/
• https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/borderline-personality-disorder-bpd
• https://www.therecoveryvillage.com/mental-health/borderline-personality-disorder/related/bpd-myths/
• American Psychiatric Association. Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.