Understanding Borderline Personality Disorder!

An article by Psychology Today.

Borderline personality disorder affects approximately two percent of adults.

It can manifest as mood instability, difficulty with interpersonal relationships, high rates of self injury and suicidal behaviour.

Borderline personality disorder is a serious mental illness characterised by pervasive instability in moods, interpersonal relationships, self image and behaviour.

This instability often disrupts family and work life, long-term planning and an individual’s sense of identity.

People with borderline personality disorder originally thought to be at the border of psychosis and neurosis, suffer from difficulties with emotion regulation.

While less well known than schizophrenia or bipolar disorder, borderline personality disorder affects two percent of adults.

People with borderline personality disorder exhibit high rates of self injurious behaviour such as cutting and in severe cases significant rates of suicide attempts and completed suicide.

Impairment from borderline personality disorder and suicide risk are greatest in the young adult years and tend to decrease with age.

Borderline personality disorder is more common in females than in males with 75% of cases diagnosed among women.

People with borderline personality disorder often need extensive mental health services and account for 20% of psychiatric hospitalisations.

Yet with help many improve over time and are eventually able to lead productive lives.

A person with borderline personality disorder may experience intense bouts of anger, depression or anxiety that may last only hours or at most a few days.

These may be associated with episodes of impulsive aggression, self injury and drug or alcohol abuse.

Distortions in thoughts and sense of self can lead to frequent changes in long term goals, career plans, jobs, friendships, identity and values.

Sometimes people with borderline personality disorder view themselves as fundamentally bad or unworthy.

They may feel bored and empty or unfairly misunderstood or mistreated and they have little idea who they are.

Such symptoms are most acute when people with borderline personality disorder feel isolated or lack in social support and they may result in frantic efforts to avoid being alone.

People with borderline personality disorder often have highly unstable patterns of social relationships.

While they can develop intense but stormy attachments, their attitudes toward family, friends and loved ones may suddenly shift from idealisation to devaluation.

Thus they may form an immediate attachment and idealise another person but when a slight separation or conflict occurs, switch unexpectedly to the other extreme and angrily accuse the other person of not caring about them at all.

Most people can tolerate the ambivalence of experiencing two contradictory states at one time.

People with borderline personality disorder however must shift back and forth between good and bad states.

If they are in a bad state for example they have no awareness of the good state.

Individuals with borderline personality disorder are highly sensitive to rejection, reacting with anger and distress to mild separations.

Even a vacation, a business trip or a sudden change in plans can spur negative thoughts.

These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with borderline personality disorder feeling lost and perhaps worthless.

Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with borderline personality disorder exhibit other impulsive behaviours such as excessive spending, binge eating and risky sex.

Borderline personality disorder often occurs with other psychiatric problems particularly bipolar disorder, depression, anxiety disorders and substance abuse.

Although the cause of borderline personality disorder is unknown, both environmental and genetic factors are thought to play a role in predisposing people to borderline personality disorder symptoms and traits.

Borderline personality disorder is approximately five times more common among people with close biological relatives with borderline personality disorder.

Studies show that many individuals with borderline personality disorder report a history of abuse, neglect or separation as young children.

40 to 71% of borderline personality disorder patients report having been sexually abused usually by a non caregiver.

Researchers believe that borderline personality disorder results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children and a series of events that trigger the onset of the disorder as young adults.

Adults with borderline personality disorder are also considerably more likely to be the victims of violence including rape and other crimes.

These incidents may result from harmful environments as well as the victims’ impulsivity and poor judgment in choosing partners and lifestyles.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger and negative emotion seen in borderline personality disorder.

Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.

The brain’s amygdala, a small almond shaped structure is an important component of the circuit that regulates negative emotion.

In response to signals from other brain centres indicating a perceived threat, it marshals fear and arousal which maybe more pronounced under the influence of stress or drugs like alcohol.

Areas in the front of the brain prefrontal area act to dampen the activity of this circuit.

Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions including sadness, anger, anxiety and irritability.

Drugs that enhance brain serotonin function may improve emotional symptoms in borderline personality disorder.

Likewise mood stabilising drugs that are known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter may help people who experience borderline personality disorder like mood swings.

Such brain based vulnerabilities can be managed with help from behavioural interventions and medications much as people manage susceptibility to diabetes or high blood pressure.

The recommended treatment for borderline personality disorder includes psychotherapy, medications, group, peer and family support.

Group and individual psychotherapy have been shown to be effective forms of treatment for many patients.

Psychotherapy is the first line treatment for borderline personality disorder and several forms of therapy such as,

Dialectical behavioural therapy DBT,
Cognitive behavioural therapy CBT and Psychodynamic psychotherapy have been studied and proven to be effective ways to alleviate symptoms.

Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient.

Antidepressant drugs and mood stabilisers may be helpful for depressed and labile mood.

Antipsychotic drugs may also be used when there are distortions in thinking.

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