What is Borderline Personality Disorder
Borderline personality disorder (BPD) inevitably affects how a person thinks and how he feels and interacts with others. The diagnosis is recorded in ICD-10 and is considered a subtype of emotionally unstable personality disorder. The disorder manifests itself in problems with self-esteem, managing emotions and behavior, high anxiety and desocialization, and unstable relationships with others. In borderline personality disorder, the person has a fear of being alone or abandoned. In addition, inappropriate anger, impulsivity, and frequent mood swings can alienate potential partners.
Deviations, as a rule, are recorded in young people and can worsen with age. However, many patients diagnosed with BPD can live a fulfilling life by working through the underlying problems.
Borderline Personality Disorder Test
Some symptoms may directly indicate BPD, but only the attending physician will give accurate information. If you suspect you have a disorder, answer a few questions:
- Do you have a fear of loneliness that makes you misbehave? For example, constantly call your partner, try to be always with him.
- Have you had to drastically change your opinion about your partner, to switch from love to hate for no particular reason?
- Have you ever felt that you do not have a clear idea of yourself and are not confident in self-esteem?
- Have you committed dangerous impulsive behavior? For example, do they take drugs, waste large sums of money, or have unprotected sex?
- Have you hurt yourself, threatened with suicide in the presence of loved ones?
- Do you experience severe mood swings, from anxiety and irritability to days of depression and apathy?
- Is it difficult for you to control your anger?
- When you find yourself in a stressful situation, do you feel as if you are disconnected from reality and your own body, do not control your thoughts and behavior?
If you answered yes to more questions, it makes sense to talk to a therapist. Symptoms do not always indicate borderline personality disorder and may be due to other health problems. Only a specialist will be able to make the correct diagnosis and give competent advice.
Symptoms of Borderline Personality Disorder
BPD affects how a person relates to himself and others, how he behaves in society. Although signs and symptoms vary; there may be several or just a couple from the list:
- Intense fear of being abandoned. The person is willing to take extreme measures to avoid real or imagined leaving or rejection of the partner.
- Tendency to unstable relationships. For example, a person idealizes a partner but suddenly decides that the latter is cruel and unfair.
- Rapid changes in self-identification and self-esteem. Goals and values are switched out of proportion to the circumstances – abruptly and for no particular reason. As a result, a person is inclined to consider himself bad; he needs external impulses to feel alive and needed.
- Stress-related paranoia. Loss of contact with reality lasting from several minutes to several hours.
- Impulsive behavior, risk-taking. Gambling, reckless driving, unsafe sex, alcohol abuse, overeating, drugs.
- They are sabotaging success—sudden unreasonable abandonment of positive relationships, good work.
- Self-harm, suicidal tendencies. Often arise in response to the fear of separation or partner refusal.
- Mood swings lasting from several hours to several days. Vivid, hypertrophied emotions: happiness, anxiety, shame, and irritability.
- I am constantly accompanying feelings of emptiness, lack of interest in what is happening.
- Aggression – intense anger, cruel sarcastic remarks about the interlocutors, fights.
Causes and risk factors of Borderline Personality Disorder
As with other mental health problems, the causes of borderline personality disorder are not fully understood. In addition to childhood abuse or neglect, BPD may be associated with the following factors.
Genetics. Studies involving twins and relatives suggest that BPD may be inherited and part of a complex mental disorder.
Brain abnormalities. Several studies have confirmed changes in certain parts of the brain involved in regulating emotions, especially impulsivity and aggression. In addition, patients with BPD may have a dysfunction in regulating chemicals, such as the production of serotonin, which affects mood.
When is Borderline Personality Disorder Diagnosed? Diagnostic criteria for borderline personality disorder
The impulsive type of emotionally unstable personality disorder is characterized by a pronounced tendency to conflict and quarrels; in addition, to make a diagnosis, it is necessary to identify at least two of the following criteria:
- tendency to act impulsively
- a pronounced tendency towards aggression or violence
- difficulty in pursuing activities that do not bring immediate gratification
- unstable and moody mood.
For borderline emotionally unstable personality disorder, that is, borderline personality, three of the following criteria must be met:
- uncertainty of the self-image
- lack of precise goals and preferences (including sexual ones)
- a tendency to engage in intense, unstable relationships that lead to emotional crises
- trying to avoid potential loneliness
- threats or suicidal behavior and auto-aggressive behavior
- a constant feeling of inner emptiness.
The authors of the DSM-IV classification did not take into account the subtype differences described in ICD-10. The personality borderline is defined here as an example of behavior with predominant instability in interpersonal relationships, in self-esteem, in the emotional sphere, and with a pronounced explosive character. Such a diagnosis is justified if at least five of the following symptoms are present:
- making desperate efforts to avoid being alone in reality or fantasy
- unstable but intense interpersonal relationships (extreme idealization or depreciation)
- identity disorder – persistent and impaired or dangerous self-esteem or self-esteem
- impulsivity in at least two areas that pose a potential threat to oneself (sex life, spending money, substance use, careless driving, binge eating)
- repeated suicidal behavior, suicidal attempts or threats, self-harm
- emotional instability caused by mood hyperactivity
- constant feeling of emptiness
- inadequate about the situation, intense anger, or lack of control over outbursts
- passing, stress-related thoughts of a paranoid nature, or pronounced dissociative symptoms.
In diagnosis, a structured clinical history is valuable, designed to assess personality disorders from the axis II of DSM-IV – that is, SCID-II (Structured Clinical Interview for DSM-IV Axis II Personality Disorders), which, among other things, contains the following questions: Do you often felt horrified thinking that someone important to you could leave you? Have you had many extreme ups and downs in relationships with people who are important to you?
Is Borderline Personality Disorder Treatment?
BPD is difficult to treat. But with modern evidence-based therapies, people with the disorder can help manage symptoms and improve their quality of life. It is good if a licensed doctor specializing in this disease is involved in the treatment. Sometimes, the patient will need to interact with a psychiatrist and a social worker who will help to adapt in the absence of loved ones.
Typically, the doctor will interview and discuss the person’s symptoms. A thorough medical examination and testing follow this to rule out other diseases. However, comorbidities can make diagnosing and treating BPD challenging, especially if their symptoms are the same. For example, a person may show depression, bipolar disorder, anxiety, substance use problems, or eating disorders. If a patient with BPD is not treated appropriately, the chances are high in developing chronic illness. Moreover, mental and physical patients with BPD tend to make choices in favor of an unhealthy lifestyle and self-harm.
Psychotherapy is the primary care for the person with BPD. It can take place both individually and in a group. The second option helps the patient to interact with other people and express themselves in society. Most often, the doctor uses one of two therapy options or combines them:
- Dialectical Behavioral Therapy (DBT). It uses the concepts of awareness and acceptance of the current situation and emotional state. DPT also teaches skills to control and reduce self-destructive behavior.
- Cognitive Behavioral Therapy (CBT). This helps you identify and change the underlying beliefs that underlie inaccurate acceptance of yourself and others and communication problems.
Because their benefits are unclear, medications are not commonly used as the primary treatment for borderline personality disorder. However, a psychiatrist may recommend medications to treat specific symptoms, such as controlling mood swings and depression in some cases. In addition, a psychotherapist should specialize in borderline personality disorder, that is, receive additional education in this area.