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Borderline Personality Disorder

Overview

Borderline personality disorder (BPD) is characterized by an instability in moods, emotions, relationships, impulsive actions, and self image. The patient shifts from one emotional crisis to another. They experience sever anxiety, feelings of emptiness, display threats of committing suicide or self harm. This mental illness hinders family and work life and the individual's sense of self-identity. Often this disorder is diagnosed late, when the symptoms become severe.

This instability of the disorder begins in the early adulthood, and is affected by the person’s self-image and social interactions. The fluctuations of behavior and emotions are seen in every situation.

Borderline personality disorder is more prevalent in females (about 75%) than males. It is believed that borderline personality disorder affects approximately 2 percent of the general population. Like most personality disorders, borderline personality disorder also decreases in intensity with age, with few of the most extreme symptoms being experienced by the time the patient is in 40s or 50s.

The emotional instability and impulsivity seen in this disorder are very common in the adolescent age, but most adolescents grow out of this. If this emotional instability and impulsivity persists and increases into adulthood, they may be diagnosed with this disorder.


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Causes

The cause for this disorder is not yet known. The biopsychosocial model proposes that the BPD is caused due to genetic and biological factors. Social factors like the person’s social interactions with family and friends in the early years and psychological factors like the person’s personality as shaped by the environment and his coping skills can also determine the occurrence of this condition. No single factor can be accounted for the disorder, but BPD may pass on to the children of the person suffering from the disorder.


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Signs & Symptoms

The symptoms of BPD are most prevalent when there is isolation and lack of social support. The patient may experience anger, depression, and anxiety that may be there for some hours, or at most a day. There may be episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Low self image, with distorted cognition leads them to change their long-term goals, careers, friendships and values. They may view themselves as bad or worthless. They feel mistreated, not understood, or emptiness.

They have unstable patterns of relationships. Though they may form intense relationships, but they may suddenly start admiring someone a lot, and then shift to hatred or anger for the same person. Mild separation or change of plans with family members provokes fear of abandonment in them, causing them to feel rejected. There may be suicide threats and attempts at this stage.

Persons with BPD do impulsive things like excessive spending, eating, and the like. It may develop along with other psychiatric disorders like bipolar disorder, anxiety disorders, depression and substance abuse. The following symptoms may also be seen in the person suffering from BPD:

•          Making all efforts to avoid any form of abandonment

•          Unstable and intense interpersonal relationships that alternate between extremes of liking and hating someone.  

•          Identity crisis, like unstable self-image or sense of self

•          Impulsivity in areas that can damage self like substance abuse, reckless driving and binge eating.

•          Recurrent suicidal behavior, gestures, or threats, or self-harming behavior.

•          Emotional instability with mood swings that do not last for long.

•          Chronic feelings of emptiness.

•          Inappropriate, intense anger or difficulty in controlling anger, indulge in fights.

•          Paranoid thoughts or severe dissociative symptoms.

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Prevention

Though there is no known prevention of BPD, but early detection of the condition during early adulthood can help the problem to become severe. If there are signs of the disorder, the mood swings, emotional responses, feelings and behaviors should be monitored to detect the condition.


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Treatments
Psychotherapy Psychotherapy

Psychotherapy is the first choice for the treatment of any personality disorder. The most important step in therapy for BPD is to stop the person from committing suicide, as he or she has the tendency to do that. Suicidal tendencies should be carefully analysed and monitored throughout the course of treatment. If suicidal feelings become worse, medication and hospitalization can be considered.

Recently a new form of therapy is being used, exclusively for BPD, called the Dialectical Behavior Therapy (DBT). Given by Marsha Linehan, this has been the most successful and effective psychotherapeutic approach till date. It tries to teach clients to take better control of their lives and emotions. Through self knowledge, regulating emotions, and cognitive restructuring, this approach is often conducted in a group setting. Treatment for BPD can be somewhat lengthy in duration, mostly lasting at least for a year.

Other approaches based in social learning theory and conflict resolution have also been used. But, they have not been that effective, as they are not able to reach the core of the problem, i.e., expression of emotions.

People with BPD are often very troublesome; therefore the therapist has to take great care with the client. A structured therapeutic setting with well defined therapeutic relationship is important to be effective.

Hospitalization Psychotherapy

Many times people suffering from this condition need to be hospitalized due to depression or suicidal attempts. But, this method is not a preferred means of treatment of the disorder, as it can be a lengthy and costly procedure. Social support groups and other self help measures along with psychotherapy may be more beneficial. Though it may help stabilize the patient but that is temporarily. Some inpatient facilities like a day treatment program would be more helpful, since the individual experiences a feeling of security in the environment, as they return home in the evening. 

Inpatient treatment involves medication along with psychotherapy sessions in groups or individually. This treatment is appropriate if the person experiences great difficulty in living and daily functioning.

Medications Psychotherapy

Antipsychotic drugs can be helpful, but are not so important for the treatment. Low doses of high potency neuroleptics (e.g., haloperidol) may be beneficial for disorganized thinking and some psychotic symptoms. Neuroleptics are particularly recommended for the psychotic symptoms, and for patients who show anger which needs to be brought under control. Dosages should generally be low and the medication should be given only with adequate psychosocial intervention.

Antidepressant and anti-anxiety agents may be appropriate during particular times in the patient’s treatment. For example, in the case of suicidal thoughts, these drugs can help calm the person down and reduce such ideations. Medication of this type should be avoided for long-term use.

self help Psychotherapy

Individuals with BPD should be encouraged to gain additional social support. Patients can be taught to try new coping skills and regulate their emotions with people they meet within support groups. Though not very common, these groups can be very beneficial.

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