Understanding Borderline Personality Disorderby Natasha Tracy - May 14th, 2015
Borderline personality disorder (often shortened to BPD) is a mental illness that negatively affects one’s thoughts, feelings, mood, functioning, and relationships. In short, people with borderline personality disorder often have very strong emotions such as anger, despair, or anxiety that cause them to overreact or act-out in a variety of ways. In relationships, a person with BPD is likely to idealize the other person initially, and then devalue them in time, causing intense and unstable relationships. People with this disorder often turn to drugs and alcohol to handle these strong emotions. Borderline personality disorder is rarely diagnosed in those of 40 or those under 18.
These very strong emotional states and dysfunctional ways of dealing with them often lead to self-harm (in between 70-75% of cases) or even suicide. About 9% of people with BPD die by suicide.
What is a Personality Disorder?
Your personality is comprised of your personality traits, and, according to Medscape Reference, your personality traits are, “enduring patterns of perceiving, relating to, and thinking about the environment and oneself." Thus, your personality affects every aspect of your life including your personal relationships, work, school, and general functioning.
A person is said to have a personality disorder when a wide range of their personality traits cause dysfunction or extreme distress. A personality disorder contains the features of:
• Impairment in self-concept and personal relationships
• Inflexible traits causing impairment in personal and social situations
• Pathological personality traits
For any particular disorder, a person must meet the criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
How is Borderline Personality Disorder Diagnosed?
This DSM-5 diagnosis of borderline personality disorder requires that:
1. A person with borderline personality disorder must show a pervasive pattern of instability of interpersonal relationships, self-image, and emotions.
2. A person with borderline personality disorder must show marked impulsivity beginning by early adulthood and present in a variety of contexts.
In addition to the above two criteria, to be diagnosed with BPD, a person must exhibit at least five of the following:
1. Frantic efforts to avoid real or imagined abandonment (this does not include suicidal or self-mutilating behavior covered in criterion five)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating) (this does not include suicidal or self-mutilating behavior covered in criterion five)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, or recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
Psychosis is also occasionally present in BPD.
Borderline personality disorder is diagnosed by a mental health professional, most commonly a psychiatrist.
Comorbidity in Borderline Personality Disorder
Sometimes BPD is difficult to diagnose correctly as many people with this disorder have comorbid (co-occurring) disorders. Frequent comorbid disorders include eating disorders, anxiety, mood disorders, substance use disorders, and somatoform disorders. In fact, when compared to psychiatric patients without BPD, those with borderline personality disorder have about a two times greater chance of being diagnosed with three or more disorders and have a four times greater chance of being diagnosed with four or more disorders.
Treatment of Borderline Personality Disorder
Treatment costs for BPD are very high and treatment dropout rates are also significant. However, treatment has shown to be effective in many individuals.
Frontline treatment for BPD is dialectical behavior therapy (DBT) which is a psychotherapy that was developed specifically to treat borderline personality disorder. It combines cognitive behavioral therapy with mindfulness training and stress tolerance skills. Currently, it is the only treatment that is supported with clinical evidence.
In severe cases where serious self-harm or suicidality is present, hospitalization may be required.
Borderline Personality Disorder, Medscape Reference, accessed January 27, 2015 http://emedicine.medscape.com/article/913575-overview#showall
Natasha Tracey is a professional writer and author for Bipolar Burble. She currently worked as a freelancer for Kingsblog and pharmacy in Canada.