Borderline Personality Disorder
Borderline personality disorder is a mental condition that can be devastating both for the people who have it and for those around them. The cause may be a combination of painful childhood experiences or brain chemistry/dysfunctions. Individuals with the disorder live in a constant state of inner turmoil. This is outwardly exhibited by the inability to regulate emotion. This inability to regulate raw emotion leaves them in a constant state of dramatic upheaval.
They typically feel worthless and fundamentally damaged. They enter relationships quickly and feel very strongly about wanting a loving relationship. However the closeness becomes threatening and they typically end up pushing others away with their explosive anger, impulsiveness, mood swings and all or nothing tendencies.
Once thought a hopeless condition, over the past decade, increasing awareness and research are helping improve the treatment and understanding of borderline personality disorder. Contrary to perceptions that still linger about the disorder, it is becoming clear that individuals with BPF often can get better with time and live productive, happy lives. It occurs 3 times more frequently in women than men and some controversy remains round the disorder regarding gender bias.
Signs and Symptoms
Borderline personality disorder affects how people feel, relate to others and how they behave. People with BPD often have an unstable sense of who they are, and they sometimes feel as if they don’t exist at all. When threatened by intimacy and a perceived threat of abandonment they may literally feel as if they are dying and lash out in anger. This unstable self-image, clingy and subsequent attack can lead to frequent changes in jobs, friendships, goals, values and gender identity.
People in relationship with individuals with BPD also experience turmoil. Individuals with BPD often experience a black and white, love-hate relationship with others. They may idealize someone and come on very strong one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even misunderstandings. This is because people with the disorder have difficulty accepting gray areas and tolerating ambiguity. To those with BPD, someone is either good or evil, and that same person may be good one moment and evil the next. This rollercoaster of emotion is difficult for those who care about individuals with BPD to ride.
Individuals with BPD often engage in impulsive and risky behavior. This behavior often carries an emotional, financial or physical cost. Their impulsiveness and risk-taking may show up by driving recklessly, engaging in unsafe sex, taking drugs or going on spending or gambling sprees. People with BPD also often engage in suicidal behaviors or self-injurious behaviors for emotional relief.
Other signs and symptoms of borderline personality disorder may include:
- Strong emotions that drastically shift frequently
- Intense yet short periods of anxiety or depression
- Explosive anger, sometimes escalating to violence
- Inability to regulate or control emotions or impulses
- Fear of being alone or abandoned
Treatment
Treatment for borderline personality disorder has improved in recent years with the adoption of therapy techniques specifically designed for people with this disorder.
Treatment includes:
Psychotherapy is the core treatment for BPD. Specifically, Dialectical behavior therapy (DBT) was designed specifically to treat the disorder. Generally conducted through individual, group and phone counseling, DBT is a skills-based approach to teach people how to regulate their emotions, tolerate distress and anxiety and therefore improve relationships.
Dialectical behavioral therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan. The treatment itself is based largely in cognitive therapy techniques. However it also incorporates mindfulness practice as a central component of the therapy. Mindfulness is an Eastern technique of staying in the present moment and focusing on only the present moment. This technique is helpful when someone with BPD begins to escalate and feel they are spinning out of control emotionally. In individual and group therapy, participants are assisted in developing what is called “wise mind” that can accept and validate the intense raw emotions present and incorporate them with the logical voice inside. This leads to the ability to live in shades of grey and tolerate strong emotions. Many individuals with BPD will seek out therapy, the challenge is getting them to remain in treatment.
Medications cannot cure BPD, but they can help with any co-occurring disorders such as depression, impulsivity and anxiety. Medications may include antidepressant, antipsychotic and anti-anxiety medications.
At times, individuals with BPD may need more intense treatment in a psychiatric hospital. Hospitalization may also be necessary at times to keep them safe from self-injury.
Because treatment can be intense and long term, individuals face the best prognosis for success when they find mental health providers with experience treating BPD.