What is Borderline Personality Disorder?
Borderline personality disorder is a disorder where individuals have extreme difficulties regulating their emotions. Problems include intense anger, chaotic relationships, impulsivity, unstable sense of self, suicide attempts, self-harm, shame, fears of abandonment, and chronic feelings of emptiness.
But there is hope. With appropriate treatment many sufferers show improvement in one year. Over time, 80% of BPD sufferers reduce their symptoms.
It is estimated that more than 14 million American adults, distributed equally between men and women, have BPD. It is more common than schizophrenia or bipolar disorder: an estimated 11% of outpatients, 20% of psychiatric inpatients and 6% of primary care visits meet the criteria for the disorder. Obtaining an accurate diagnosis can be difficult.
Research, treatment options and family education are decades behind compared to other major psychiatric disorders. The costly personal, social and economic toll of BPD makes it a significant national public health burden and issue. However, the impact of BPD remains largely unrecognized.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change of plans.
Distortions in thinking and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone by acting out; i.e. impulsive behavior or suicide attempts.
1. Frantic efforts to avoid real or imagined abandonment.
2. Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood.
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger.
9. Transient, stress, related paranoid ideation or severe dissociative symptoms. (DSM IV)
To meet criteria for the disorder, one needs to have five of the nine criteria listed above. Having several symptoms however, can also create problems in living and a sense of suffering.
BPD rarely stands alone. People with borderline personality disorder often have other diagnosis. This is called co-morbidity or having co-occurring disorders. Common co-occurring disorders include substance abuse, eating disorders, anxiety disorders, bipolar disorder as well as other personality disorders. Over half the BPD population suffers from Major Depressive Disorder. When depression and BPD co-occur, until the borderline personality disorder symptoms improve , the depression often does not lift with medication.
There has been considerable progress in the last 25 years both in understanding and treating BPD. Now there are treatments shown to be effective. The most researched and well known are Dialectical Behavior Therapy (DBT) and Mentalization Therapy (MBT). Unfortunately, inpatient and outpatient treatment options for the disorder are not sufficient to the demand.
There is no specific medication approved to treat BPD. People with BPD are often prescribed medications to treat their symptoms. Research shows that medications can be moderately effective for anger, impulsivity and depression. Both patients and doctors need to be aware that more often than not the response is modest at best. Those with BPD can be to be quite sensitive to the side effects of the medications. It is important to discuss these side effects with a doctor before deciding on ones own that the medication is not good or too troublesome to continue to take. Clinicians trained to treat BPD use medication as an addition to, not a replacement for, talk therapy.