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Borderline personality disorder

Borderline personality disorder (BPD) is a long-term mental illness. It is type of cluster B personality disorder. People diagnosed with BPD are often very impulsive, and generally have a low self-esteem. Moods often change quickly. For these reasons, these people often have trouble keeping a stable relationship. Frequently, people with BPD also suffer from other conditions, such as clinical depression or they show self-harming behavior. Treating people with BPD is difficult, and is usually done using a combination of therapy and drugs.

Adolf Stern gave a description of some of the symptoms in 1938.[1]

Symptoms

People diagnosed with BPD have strong mood swings. They see things as "all good" or "all bad" (splitting), and are frequently confused about their identity. They usually have a lot of trouble with relationships with people. They have strong emotions which often change quickly. They are often reckless, destructive or self-destructive.

Emotions

People with BPD feel emotions more easily, more deeply and for longer than others do.[10][11] Emotions may repeatedly return and last a long time.[11] Because of this, it may take longer than normal for people with BPD to return to a normal and stable emotional state.[12] This can have both positive and negative effects.[12] People with BPD are often very joyful and loving.[13] However, while people with BPD feel joy intensely, they are very prone to feelings of mental and emotional distress. They may feel overwhelmed by negative emotions, experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance and panic instead of nervousness.[13] People with BPD are especially sensitive to feelings of being rejected, being alone, and being a "failure".[2] They are often aware of how intense their emotions are, and, since they cannot regulate them, they sometimes shut them down entirely.[12]

Along with their emotions being intense, their emotions are quick to change. The most common mood swings they have are between anger and anxiety and between depression and anxiety.[17]

Behavior

People with BPD often act impulsively, which means they act on a whim without thinking things through, often times in a dangerous or risky way.[3]Impulsive behavior may also include leaving jobs or relationships, running away and self-injury.[19] Many are imprisoned.[4]

People with BPD sometimes act impulsively because it gives them instant relief from their emotional pain.[19] However in the long term people with BPD go through more pain from the shame and guilt that follow these actions.[19] A cycle often begins where people with BPD feel emotional pain, act impulsively to relieve that pain, feel shame and guilt over their actions, feel emotional pain from the shame and guilt and then feel stronger urges to act impulsively to relieve the new pain.[19] As time goes on, impulsive behavior may start to be an automatic response to emotional pain.[19]

Self-harm and suicide

Self-injury is common for people with BPD and may happen with or without suicide as the goal.[5][6] Common methods include cutting, burning, head banging, and drug overdose. The reasons people with BPD give for non-suicidal self-injury (NSSI) are different from their reasons for suicide attempts.[7] Reasons they give for hurting themselves include expressing anger, punishing themselves, creating normal feelings, and distracting themselves from emotional pain or difficult situations.[7] On the other hand, they usually attempt suicide with the belief that others will be better off without them.[7] Both suicidal and non-suicidal self-injury are a response to feeling negative emotions.[7]

Interpersonal relationships

People with BPD can be very sensitive to the way others treat them. They can feel very joyful and grateful when they feel someone has been kind to them, and very sad or angry when they feel someone has criticized them or been hurtful to them.[8] Their feelings about others often shift from positive to negative if there's a disappointment, if they feel like there's a threat of losing someone, or if they think they've lost value in the eyes of someone that they value. They think in extremes, seeing things or people as "all good" or "all bad" at any given point in time, with no middle ground. This is a defense mechanism sometimes called splitting, or black-and-white thinking. It includes a shift from idealizing others (feeling pure admiration and love) to devaluing them (feeling pure anger or dislike).[28] The way they see themselves can also change quickly from positive to negative.

While strongly wanting to feel closeness, people with BPD tend to be insecure, have mixed feelings, or be fearfully preoccupied when it comes to their relationships.[9] They often view the world as dangerous and bad.[8] BPD is linked to high levels of recurring stress and conflict in romantic relationships, low satisfaction of romantic partners, abuse, and unwanted pregnancy. However, these factors appear to be linked to personality disorders in general.[10]

Sense of self

People with BPD tend to have trouble seeing a clear picture of their identity. In particular, they tend to have difficulty knowing what they value and enjoy.[35] They are often unsure about their long-term goals for relationships and jobs. They often have trouble making decisions and can change their minds quickly and often. These difficulties can cause people with BPD to feel "empty" and "lost".[35]

Cognitions

People with BPD are easily bored and it is hard for them to control the focus of their attention—to concentrate.[35] People with BPD may tend to dissociate, which can be thought of as an intense form of "zoning out".[36] Dissociation often happens in response to a painful event (or something that triggers the memory of a painful event). Although the mind's habit of blocking out intense painful emotions may provide temporary relief, it can also have the unwanted side effect of blocking ordinary emotions, keeping people with BPD from the information they would normally get from those emotions, which helps guide decision-making in everyday life.[36] Sometimes it is possible for another person to tell when someone with BPD is dissociating, because their voice or facial expressions may become flat, or they may appear to be distracted; at other times, dissociation may be barely noticeable.[36]

Diagnosis

Psychiatrists and other mental health professionals diagnose people with BPD using a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). They look at a person's behaviour and how they are feeling. If the person has five or more of the following signs, the DSM-IV-TR says that they have BPD.[11]

  1. Fearing and trying very hard to prevent being left or rejected
  2. A pattern of trouble in relationships, often thinking that other people are much better or much worse than they really are and changing quickly between the two views.
  3. Being confused about their own personal identity
  4. Being impulsive in ways that are dangerous (such as casual sex, drinking too much alcohol or abusing drugs, not eating or eating too much, driving dangerously)
  5. Trying to commit suicide, or hurting themselves
  6. Mood swings - suddenly feeling very happy, sad or anxious, and feeling that way for hours at a time
  7. Feeling empty inside or constantly feeling bored
  8. Having intense anger problems, getting into many fights
  9. Having severe paranoid thoughts

Comorbidity

Nearly all people with BPD also have other mental health problems, such as: mood disorders, attention-deficit hyperactivity disorder, eating disorders, anxiety disorders (especially post-traumatic stress disorder), and other personality disorders. Most have or have had substance abuse and/or addictions. Self-harm and suicidal behavior are also common.[12]

Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia.

Cause

The cause for BPD is not known. There may be several causes for people developing BPD. Some researchers think that it might be caused by trauma in childhood, such as sexual abuse, physical abuse and neglect.[13][14][15][16] Many people with BPD were abused when they were children.[17]Modern thinking as demonstrated by functioning MRI scans is that neurotransmitters within the brain are faulty and messages are not conducted in the usual way.

Treatment

Treating BPD is very difficult and takes a long time. Today, most people with BPD are treated with different kinds of psychotherapy. One of these is called dialectical behavioral therapy. In addition to therapy, drugs such as antidepressants, antipsychotics or mood stabilizers are often used.

References

  1. ↑ Stern, A. (1938). "Borderline group of neuroses". The Psychoanalytic Quarterly. 7: 467–489.
  2. ↑ Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M (May 2005). "Aversive tension in patients with borderline personality disorder: a computer-based controlled field study". Acta Psychiatr Scand. 111 (5): 372–9. doi:10.1111/j.1600-0447.2004.00466.x. PMID 15819731.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ↑ National Education Alliance for Borderline Personality Disorder. "A BPD Brief" (PDF). p. 4. Retrieved 2013. {{cite web}}: Check date values in: |accessdate= (help)
  4. ↑ BPD in prisoners
  5. ↑ Soloff P.H., Lis J.A., Kelly T.; et al. (1994). "Self-mutilation and suicidal behavior in borderline personality disorder". Journal of Personality Disorders. 8 (4): 257–67. doi:10.1521/pedi.1994.8.4.257. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  6. ↑ Gardner D.L., Cowdry R.W. (1985). "Suicidal and parasuicidal behavior in borderline personality disorder". Psychiatric Clinics of North America. 8 (2): 389–403. PMID 3895199.
  7. ↑ 7.0 7.1 7.2 7.3 Brown MZ, Comtois KA, Linehan MM (February 2002). "Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder". J Abnorm Psychol. 111 (1): 198–202. doi:10.1037/0021-843X.111.1.198. PMID 11866174.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ↑ 8.0 8.1 Arntz A (September 2005). "Introduction to special issue: cognition and emotion in borderline personality disorder". Behav Ther Exp Psychiatry. 36 (3): 167–72. doi:10.1016/j.jbtep.2005.06.001. PMID 16018875.
  9. ↑ Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF (2005). "Attachment and borderline personality disorder: implications for psychotherapy". Psychopathology. 38 (2): 64–74. doi:10.1159/000084813. PMID 15802944.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ↑ Daley SE, Burge D, Hammen C (August 2000). "Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity". J Abnorm Psychol. 109 (3): 451–60. doi:10.1037/0021-843X.109.3.451. PMID 11016115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ↑ 301.83 Borderline Personality Disorder" in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. DOI: 10.1176/appi.books.9780890423349.3831. Retrieved on 2007-09-21.
  12. ↑ "BPD Fact Sheet". National Educational Alliance for Borderline Personality Disorder. 2013.
  13. ↑ Kluft, Richard P. (1990). Incest-Related Syndromes of Adult Psychopathology. American Psychiatric Pub, Inc. pp. 83, 89. ISBN 0880481609.
  14. ↑ Zanarini MC, Gunderson JG, Marino MF, Schwartz EO, Frankenburg FR (1989). "Childhood experiences of borderline patients". Comprehensive Psychiatry. 30 (1): 18–25. doi:10.1016/0010-440X(89)90114-4. PMID 2924564. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ↑ Brown GR, Anderson B (1991). "Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse". Am J Psychiatry. 148 (1): 55–61. PMID 1984707. {{cite journal}}: Unknown parameter |month= ignored (help)
  16. ↑ Herman, Judith Lewis; Judith Herman MD (1992). Trauma and recovery. New York: BasicBooks. ISBN 0-465-08730-2.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Zanarini M.C.; F.R. Frankenburg (1997). "Pathways to the development of borderline personality disorder". Journal of Personality Disorders 11 (1): 93-104.

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