Generally, a personality disorder is more than just having an unusual personality. It encompasses a set of personality traits and behaviors that may directly affect one’s day-to-day life.
Borderline personality disorder (BPD) refers to a mental illness that is usually misunderstood by many people.
BPD can cause a total loss of emotional control, increased impulsivity and negative feelings about oneself and relationships with other people [1].
Facts about borderline personality disorder
BPD comes with other mental health conditions
A person with BPD often comes with other mental health conditions. In fact, 84.5 percent of people with BPD had a co-occurring mental health disorder, according to The National Comorbidity Survey Replication [2].
The nature of BPD comorbidities is different for every person, making it more difficult to recognize, as per the National Institute of Mental Health (NIMH) [3].
For instance, intense episodes of depression can be a sign of BPD; however, they can also indicate other mental conditions, such as major depressive disorder or bipolar disorder.
On the other side, the relationship between BPD and other mental health conditions is not completely determined.
Similarly, feelings of abandonment and alienation from oneself and other people, plus a lack of close and stable relationships, can contribute to precipitate depression.
A person with borderline personality disorder may also suffer from the following mental health conditions:
- Anxiety disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Bipolar disorder
- Eating disorders
- Mood disorders
- Substance use disorder
- Somatoform disorders
BPD and bipolar disorder are different
These two mental illnesses do have similar characteristics, like bipolar disorder can also cause extreme shifts in one’s mood and behavior.
However, the emotional shifts are commonly only between depressive and manic episodes–referring to abnormally increased and energetic mood–or hypomanic episodes, which involve unusually elevated energy and activity levels but to a much lesser extent.
Additionally, the fear of abandonment and unstable social relationships that are usually inherent to BPD isn’t in the diagnostic criteria for bipolar disorder.
BPD has a high risk of self-harm
A person with BPD is at high risk for self-harm and suicide because of intense emotions and impulsivity.
Aside from self-harm, suicidal ideation and behavior are significantly prevalent among people with BPD, according to the NIMH [4].
In fact, there is about 8 to 10 percent of people with BPD die by suicide, which is considered significantly high, as cited by the American Psychiatric Association.
Furthermore, a person with BPD may depend on self-harm as it feels like instantaneous relief for heightened emotions.
Additionally, BPD may cause someone to impulsively attempt suicide as a means to cope with the deep emotional chaos.
BPD has no one root cause
Unfortunately, there is no one root cause of BPD; however, health experts claim that there are certain key risk factors involved.
Research indicates that a mix of hereditary, neurological and environmental factors can increase one’s likelihood of developing BPD.
Also, if one of your family suffers from BPD, you are more likely to also eventually have it but take note that there is no known gene linked to this mental health condition.
In addition, it shows that the brain of a person with BPD has structural and functional changes in parts associated with emotional regulation. However, it is not yet clear if the changes are a cause or result of BPD.
In terms of environmental factors, numerous people with BPD report instances of childhood trauma, such as abuse, abandonment and unstable relationships with parents.
Common symptoms of borderline personality disorder
Borderline personality disorder can affect one’s feeling about himself, relating to others and behaviors.
Major signs and symptoms of borderline personality disorder may include:
- Apparent patterns of unstable intense relationships, including idealization of a person one moment and then suddenly believing that the person does not care enough or is cruel
- Having an intense fear of abandonment and taking extreme measures to prevent real or imagined separation or rejection
- Fast changes of self-identity and self-image, including changing goals and values and considering yourself as bad or as if you don’t exist at all
- Experiencing periods of stress-related paranoia
- Constant suicidal threats, self-harm behavior or self-injury, which are often a response to a fear of separation or rejection
- Loss of contact with reality that may last from a few minutes to several hours
- Doing impulsive and risky behavior, like gambling, reckless driving, unsafe sex, spending sprees, binge eating and drug abuse
- Persistent feelings of emptiness
- Self-sabotaging, like suddenly quitting a great job or ending a positive relationship
- Uncontrolled mood swings that can last from a few hours to several days which may include intense happiness, irritability, shame or anxiety
- Intense anger may include frequently losing one’s temper, being sarcastic or bitter, or having physical fights [5].
Basic diagnosis for borderline personality disorder
Healthcare professionals don’t typically diagnose a person with borderline personality disorder until someone reaches 18 years old.
This is because one’s personality continues to develop throughout childhood and adolescence.
In some cases, a person younger than 18 can be diagnosed with BPD when symptoms are significant and last at least one year.
Borderline personality disorder can be a real challenge to diagnose because the majority of people with a personality disorder lack awareness about their disruptive behavior and thought patterns.
So, the question is when to seek professional help. A person suspected to have BPD may consult with a health professional when the signs and symptoms are disruptive to their personal life, such as divorce, fired at work or loss of relationships.
Mental health professionals, including psychiatrists, psychologists or clinical social workers, are all licensed to diagnose borderline personality disorder based on the medically accepted diagnostic criteria for BPD.
They may conduct a diagnosis by performing a thorough one-on-one interview and having conversations about BPD symptoms. They will ask questions focusing on the following:
- Personal medical history and family medical history, particularly histories of mental health conditions
- Previous work history
- Impulsivity and control management
Available borderline personality disorder treatment
Aside from BPD being difficult to diagnose, it is also harder to treat it. Luckily, there are newer, evidence-based treatments that help many people with BPD.
It is reported that people with BPD have experienced fewer and less severe symptoms, enhanced functioning and improved quality of life with the treatments. However, effective treatments usually take time, patience and commitment.
BPD treatments can be classified in two ways, such as psychotherapy or called talk therapy, medications or both.
Psychotherapy treatment
Psychotherapy, also known as talk therapy, is the main treatment of choice for BPD. The primary goal of this treatment is to aid in uncovering the motivations and fears linked to one’s thoughts and behavior and learning to relate to other people more easily and positively.
Different types of psychotherapy that can help treat BPD:
- Cognitive behavioral therapy (CBT): refers to a structured, goal-oriented type of talk therapy. A professional therapist or psychologist can help you take a closer look at thoughts and emotions.
- Dialectical behavior therapy (DBT): refers to a type of therapy that was developed particularly for people with BPD. DBT mainly focuses on helping patients accept the reality of their life and their behaviors.
This type of therapy also includes helping the patient learn to make the right changes in their life, especially the unhelpful behaviors. DBT teaches skills to help patients control intense emotions, lower self-destructive behaviors and thoughts and enhance social relationships.
- Group therapy: refers to a type of psychotherapy where a group of people meets to share and discuss their issues together under the supervision of a professional therapist or psychologist.
Medications
The benefits of prescribed medications for borderline personality disorder are still unclear; hence, health experts commonly don’t recommend taking certain medications as the main treatment for BPD.
In some cases, a psychiatrist may advise medications to treat particular BPD symptoms or co-occurring mental health conditions, which were mentioned earlier.
Some medications can help treat anxiety and depression, manage mood swings or help control impulsive behavior.
[1] https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
[2] https://www.sciencedirect.com/science/article/pii/S0006322306011929
[3] https://www.nimh.nih.gov/health/statistics/personality-disorders.shtml#part_155479
[4] https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
[5] https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237
