Borderline Personality Disorder
Borderline personality disorder, also known as BPD or emotional dysregulation disorder, is marked by uncontrollable emotions and causes problems in daily life, especially with relationships. It is classified as a mental disorder that affects self-image and behavior. People with BPD can have episodes of intense anger, depression, and anxiety that can last anywhere from hours to days. The person is unable to regulate their emotions, and it is very difficult for them to return to a stable baseline. Struggling with self-behavior can result in the affected person causing harm to themselves.
1.4% of the U.S. population experiences BPD and 75% of those are women. Men are often misdiagnosed with having PTSD or depression.
According to the Diagnostic and Statistical Manual, some key symptoms people may experience are:
Frantic efforts to avoid real or imagined abandonment by friends and family.
Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”). This is also sometimes known as “splitting.”
Distorted and unstable self-image, which affects moods, values, opinions, goals, and relationships.
Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse, or reckless driving.
Self-harming behavior including suicidal threats or attempts.
Periods of intense depressed mood, irritability, or anxiety lasting anywhere from 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 and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.
BPD has been theorized to result from a variety of factors.
It is believed that genetics or a family history of BPD can increase the risk of developing BPD.
Both chemical and structural changes in the areas of the brain that affect emotion and judgment have been associated with BPD patients. However, scientists aren’t sure if the changes caused BPD or the changes came about due to the disorder.
Environmental, social, and/or cultural factors where the person experienced a traumatic life event, such as abuse or neglect, have been theorized to contribute to BPD.
There are no definitive diagnostic tests. BPD is best diagnosed after a thorough medical exam to rule out physiological diseases, past medical history interviews with the patient and possibly family and friends, and a thorough interview conducted by a mental health professional.
Currently, psychotherapy and medications are the mainstays of treatment. Some of the psychotherapies used include: dialectical behavior therapy, cognitive behavioral therapy, and psychodynamic psychotherapy.
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others.
Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties and, in doing so, change the way they feel.
Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension.
While there is no one medication specifically made to treat the core symptoms of BPD, several medications can be used off-label to treat various symptoms. For example, mood stabilizers and antidepressants help with mood swings, and, for some, low-dose antipsychotic medication may help control symptoms such as disorganized thinking.
Short-term hospitalization may be necessary during times of extreme stress and/or impulsive or suicidal behavior, to ensure safety.
As always, patients should be screened for suicidal thoughts and ideations so as to prevent them from harming themselves.
BPD can be difficult to diagnose and treat, and, sadly, the person may also experience other mental health disorders along with BPD, such as: anxiety disorders, bipolar disorders, eating disorders, depression, and substance abuse.