Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a mental health condition characterized by severe and short-lived mood swings, a distorted self-image, impulsive behaviors, feelings of emptiness, and intense and rocky relationships. It is chronic and incurable, but with an accurate diagnosis by a trained professional, commitment to a treatment plan, and positive support, borderline personality disorder can be treated and managed successfully.
What is Borderline Personality Disorder?
Borderline personality disorder is a serious mental health condition that causes unstable moods, behaviors, and self-image, as well as impaired functioning in everyday life. Mood changes can be intense and last for a few hours or a few days. BPD may cause impulsive behaviors and lead a person to have unstable and difficult relationships with others. It is not uncommon for someone with BPD to have co-occurring mental illnesses, like an anxiety disorder or depression. They may also struggle with eating disorders and substance use disorders.
BPD Facts and Statistics
- Estimates place the occurrence of BPD at 1.6 percent of U.S. adults, but the real rate may be as high as 6 percent.
- Three quarters of people diagnosed with BPD are women.
- Men may be affected by BPD just as much as women, but may be more likely to be misdiagnosed with depression or post-traumatic stress disorder.
- BPD is not often diagnosed in children, but research has shown that signs of the disorder can be seen at a young age.
- People diagnosed with BPD have a 50 times higher suicide rate than the general population.
- One study found that the rate of BPD among incarcerated men and women was nearly 30 percent, much higher than in the general population.
Symptoms and Diagnosis of BPD
The most prevalent symptoms of BPD in most people are related to mood swings and instability and an uncertain self-image. While the condition can manifest in different ways in different individuals, there are important commonalities that define it. The diagnostic criteria include nine symptoms. To be diagnosed with BPD, an individual must show at least five of these symptoms, and they must be long-standing and pervasive:
- A fear of abandonment. Someone with BPD is typically terrified of being alone or of being abandoned. They may come off as very needy and desperate to the people with whom they have relationships.
- Instability in relationships. Behaviors like neediness, but also intensity that is short-lived, tends to result in short, unstable relationships, romantic and otherwise.
- An unstable or confusing self-image. With BPD it is difficult to create an internal sense of self. Someone with this condition tends to look to others to define themselves and often changes jobs, relationships, hobbies, even sexual orientation, and other aspects of their lives in an attempt to determine self-image.
- Impulsive behaviors that may be self-destructive. People with BPD are impulsive and often engage in risky behaviors that are self-destructive. This may include overspending, binge eating, gambling, risky sex, or abusing drugs or alcohol.
- Self-harm, which may include suicidal behaviors. Suicidal behaviors and self-harm, like cutting, are common in people with BPD. They may think about suicide, exhibit warning signs, or even attempt suicide.
- Extreme swings in emotions. Instability in emotions is typical with BPD. A person with this condition may swing rapidly and extremely from happiness to depression to despair and back again. The mood swings are often intense but pass quickly. This is different from the mood swings experienced by someone with bipolar disorder, which tend to last much longer.
- Persistent feelings of emptiness. People diagnosed with BPD often describe a sense of feeling empty that just won’t go away. It may cause a person to feel as if they have no identity or are nothing. They may try to fill that void with things like drugs or excessive eating, but it doesn’t help.
- Excessive anger. Intense anger and a short fuse are common in BPD. A person with BPD may have trouble controlling these feelings and may throw fits, yelling, throwing things, and acting as if filled with rage. Sometimes this anger is directed inward rather than at others.
- Suspicion and paranoia. Sometimes BPD can cause symptoms of psychosis, or a break with reality. A person may feel paranoid about someone else’s intentions or about someone being out to get them. BPD can also cause dissociation, a feeling of being outside of one’s body and not connected to reality.
To be diagnosed with BPD, a mental health professional will conduct a psychiatric evaluation that involves asking questions and observing behaviors and responses. A full diagnosis should also include a medical evaluation to rule out any physical health issues that may be causing symptoms as well as a review of family history of mental illness. A diagnosis should be made or confirmed by a psychiatrist.
Diagnosis of BPD is challenging because many of the symptoms overlap with other mental health issues, like depression. An individual being evaluated may have certain characteristic symptoms of BPD but not draw attention to them. Research into better ways to diagnose BPD and distinguish it from other conditions is underway.
Causes and Risk Factors of BPD
As with so many mental health conditions, the exact cause of borderline personality disorder is not known with certainty. It does seem to have a genetic component, as studies with families and identical twins suggest. It also may be related to environmental factors, like the experience of trauma. Researchers have found that abnormalities in the brain are also implicated, including changes in parts of the brain that regulate emotions and brain chemicals related to mood that don’t function correctly.
While the exact reason that one person is diagnosed with BPD and another isn’t cannot be pinpointed, there are known risk factors. These include a family history, especially an immediate family member with BPD, trauma or stressful experiences in childhood, such as neglect, and having certain personality traits, like impulsiveness and aggression.
Co-Occurring Disorders and Complications
There are several other mental illnesses that commonly occur with borderline personality disorder. It is often difficult to make accurate diagnoses because many of the symptoms of these different conditions overlap. Commonly co-occurring disorders include major depression, anxiety disorders, substance use disorders, bipolar disorder, and eating disorders.
BPD can also cause or contribute to a number of complications in a patient’s life. These may include other physical or mental illnesses or may be difficulties with otherwise normal activities, such as work or school:
- Suicidal behaviors or thoughts, including suicide attempts
- Injuries caused by self-harm, such as cuts, infections, and burns
- Physical harm from abusive relationships
- Sexually transmitted diseases or unplanned pregnancies
- Physical injury from car accidents or fights, triggered by mood swings and impulsive behaviors
- Unstable and broken relationships, including family relationships
- An inability to hold down a job
- An inability to complete school
- Poverty or homelessness
- Legal problems and incarceration
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BPD Treatment and Prognosis
BPD is a treatable condition. With the expertise of mental health professionals, a person diagnosed with BPD can participate in a treatment plan that helps them manage symptoms. Treatment can also help an individual have more stable relationships with loved ones. Psychotherapy is one important component of treatment for BPD and can take several forms. Two types of therapy have been found by the Substance Abuse and Mental Health Services Administration to have the most evidence backing effectiveness:
- Family Psychoeducation. This is a family-based type of therapy and educational program in which therapists work with the entire family of the person diagnosed with BPD or another mental illness. It is not the same as family therapy, but is a more integrated approach to involving all family members in learning about the illness and how to support a member in recovery from it. It includes problem solving, training in managing mental illness, and training in how to provide emotional support.
- Dialectical Behavior Therapy. DBT is a therapy that was specifically designed for treating BPD, and it can go hand-in-hand with family psychoeducation because it can be conducted one-on-one or as a group. The purpose of the therapy is to teach the patient skills that can be used to manage moods, emotions, and relationships.
In addition to therapy, patients with BPD can benefit from medications. There are no drugs specifically approved to treat this condition, but those used for certain mental health symptoms can be used. Mood stabilizers, for instance, help manage mood swings, as they do for patients with bipolar disorder. Antidepressants can also alleviate mood symptoms, and antipsychotics may help as well. In some situations, a person with BPD may benefit from hospitalization or intensive residential treatment.
Being diagnosed with BPD may feel devastating, but it should also provide a sense of hope. It can be frustrating and scary to have some of the feelings that go with this illness, but to have a diagnosis explains those feelings and actions and can lead to treatment. The prognosis over the long-term for BPD is good, as long as a patient gets treatment and sticks with it over time. With support and treatment a patient can recover quickly and go back to normal activities. The illness is chronic, though, so even when feeling better, treatment must be maintained.
Borderline personality disorder is a very serious mental illness with significant repercussions. There is no cure and it is chronic, but on the other hand it is possible for most patients to be treated in such a way that the illness can be successfully managed. Getting an accurate diagnosis is a crucial first step, and most patients can go on to live normal and productive lives with the right treatment and support.