Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships.  Individuals with Borderline Personality Disorder feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.  These intensely emotional episodes of anger, depression, and anxiety can last from a few hours to days.

The resulting difficulties can lead to impulsivity, poor self-image, stormy relationships and intense emotional responses to stressors. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).

Borderline Personality Disorder Stats

It’s estimated that 1.6% of the adult U.S. population has Borderline Personality Disorder, but that number may be as high as 5.9%. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD but are commonly misdiagnosed with PTSD or depression.

People with BPD experience wide mood swings and can display a great sense of instability and insecurity. According to the Diagnostic and Statistical Manual diagnostic framework, some key signs and symptoms include:

  • Frantic efforts to avoid real or imagined abandonment by friends and family
  • Intense and unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate him”).  Also known as “splitting” people are viewed in extremes – all good or all bad.  An individual who is seen as a friend one day may be considered an enemy or traitor the next. 
  • Distorted and unstable self-image, which affects/changes moods, values, opinions, goals and relationships. Mood swings increase uncertainty about how they see themselves and their role in the world. 
  • Impulsive behaviors that can have dangerous outcomes – excessive spending, unsafe sex, substance abuse and reckless driving.
  • Self-harming behavior including suicidal threats or attempts
  • Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days
  • Chronic feelings of boredom or emptiness
  • Inappropriate, intense or uncontrollable anger—often followed by shame and guilt
  • Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.

There is no definitive medical test to diagnose BPD, and a diagnosis is not based on one specific sign or symptom. BPD is best diagnosed by a mental health professional following a comprehensive clinical interview that may include talking with previous clinicians, reviewing previous medical evaluations and, when appropriate, interviews with friends and family.

An effective treatment plan should include your preferences while also addressing any other co-existing conditions you may have. Examples of treatment options include Lifespan Integration; psychotherapy; medications; and group, peer and family support. The overarching goal of treatment is for a person with BPD to increasingly self-direct their own treatment plan as they learn what works and what doesn’t. 

  • Lifespan Integration Therapy (LI) – gentle body-based, right brain therapy that has shown to be effective in clearing out past trauma, often childhood trauma. Individuals report feeling more capable, competent, lovable, and solid self, as the body-mind system is convinced the trauma is over, reducing reaction to emotional triggers and promoting a healthier more empowered life.  
  • Psychotherapy—Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT) and psychodynamic psychotherapy—are helpful first-line therapies for Tx of BPD. Learning ways to cope with emotional dysregulation in a therapeutic setting is often the key to long-term improvement for those experiencing BPD.
  • Medications may be instrumental to a treatment plan, but there is no one medication specifically made to treat the core symptoms of BPD. Rather, several medications can be used off-label to treat various symptoms. For example, mood stabilizers and antidepressants help with mood swings and dysphoria. And for some, low-dose antipsychotic medication may help control symptoms such as disorganized thinking.
  • Group, peer and family support networks – developing and maintaining healthy supportive networks of important people can provide stability and support during difficult times and transitions.  
  • Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.

NIMH-funded studies show that people with borderline personality disorder who don’t receive adequate treatment are:

  • More likely to develop other chronic medical or mental illnesses
  • Less likely to make healthy lifestyle choices

Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public.

Sources:

  • National Alliance on Mental Illness (nami.org)
  • National Institute of Mental Health (nimh.nih.gov)
  • Diagnostic Statistic Manual of Mental Disorders: DSM-IV-TR and DSM-4

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