What is BPD?
A pervasive pattern of instability of interpersonal relationships, self- image, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self- damaging. Examples: spending, sex, substance abuse, reckless driving, binge eating. Note: Do not include suicidal or self- mutilating behavior covered in Criterion 5.
- Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
Source: DSM IV-V
How is it diagnosed?
It is difficult to diagnose a personality disorder quickly because it is a long-term pattern of behavior. To be identified, other mental illnesses have to be eliminated as well as the possibility of a change in behavior due to a life change or other outside source. It can take many years and a person may have a few misdiagnoses before a PD is identified.
To diagnose a personality disorder, the following criteria must be met:
- Significant impairments in self-identity and interpersonal functioning.
- One or more of the following personality trait aspects:
- Emotional Instability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
- Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
- Separation Anxiety: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.
- Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
- Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
- Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
- Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
- The impairments in personality functioning are relatively stable across time and consistent across situations.
- The impairments in personality functioning and the individual’s personality trait expression are not better understood as normal or common for the individual’s developmental stage or socio- cultural environment.
- The impairments in personality functioning are not exclusively due to the direct effects of a substance abuse or a general medical condition.
Source DSM VI-V
What causes Borderline Personality disorder?
Personality disorders are thought to be caused by a combination genetic and environmental influences. Some studies have shown that some people with BPD have a number of regions in the brain with abnormal structure and function. Researchers have used magnetic resonance imaging (MRI) scans to study the brains of people with BPD. The scans revealed that in many people with BPD, three parts of the brain were either smaller than expected or had unusual levels of activity.
These parts were:
- the amygdala – which plays an important role in regulating emotions, especially the more “negative” emotions, such as fear, aggression and anxiety
- the hippocampus – which helps regulate behavior and self-control
- the orbitofrontal cortex – which is involved in planning and decision making
The development of these parts of the brain is affected by your early upbringing. These parts of your brain are also responsible for mood regulation, which may account for some of the problems people with BPD have in close relationships.
Childhood trauma, neglect, abuse or unstable family life.
Early childhood trauma, neglect, abuse, or unstable family life are a consistent factors in persons with personality disorders. One of the most reported types of abuse is verbal abuse. The development of a negative internal voice is often a reflection of what was learned in early childhood years from parents or other trusted adults. Children who had experienced verbal abuse were three times more likely than other children to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.
Borderline Personality Disorder Quick Facts:
- Affects 2% of the population.
- Chronic feelings of emptiness and fear of abandonment.
- Short but intense episodes of emotional disregulation, dysphoria, depression, and anxiety.
- Black and white thinking.
- Unstable interpersonal relationships often caused by boundary confusion and splitting.
- Negative inner voice that fuels feelings of self hate and self loathing.
- Engage in destructive behaviors and self injury.
- 70% will have one suicide attempt, 8-10% will be successful; which is 50% higher than the general population.
- Changing sense of self or role absorption.
- Identity diffusion may lead to multiple identity crisis, a quick succession of careers paths or participation in various religious traditions.
- Experience disassociation or fragmentation of self.
Although BPD is not curable it is treatable and with the right therapy can be very manageable. There is no medication currently available for BPD, instead doctors treat the symptoms of the disorder with:
- Anti depressants
- Anti anxiety medication
- Anti psychotics
The most common forms of treatment therapies are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). The goal of therapy is to unlearn unhealthy life skill and relearn healthy life skills.
75% of people who go through a treatment program will see a vast reduction is symptoms in 2 years and will no longer qualify for BPD after 5 years.