Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time. It is harder for them to regulate their emotions after an emotionally triggering event.
This difficulty can lead to impulsivity, poor self-image, and unstable relationships. Struggling with calming themselves down can also result in dangerous behaviors such as self-harm (e.g. cutting).
It’s estimated that 1.4% of the adult U.S. population experiences BPD. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression.
People with BPD experience wide mood swings and can feel unstable and insecure. Some key signs and symptoms may include:
• Abandonment issues
• Unstable personal relationships that alternate between adoration (“I’m so in love!”) and strong dislike (“I hate her”). This is also sometimes known as “splitting.”
• Unstable self image which affects moods, values, opinions, goals and relationships.
• Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, reckless driving, or misuse or overuse of substances.
• Self-harming behavior including suicidal threats or attempts.
• Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
• Chronic feelings of boredom or emptiness.
• Inappropriate, intense or uncontrollable anger—often followed by shame and guilt.
• Dissociative feelings (feeling like you’re a robot or on autopilot)—disconnecting from your thoughts or sense of identity or “out of body” type of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes
Causes, Diagnosis, and Treatment
The causes of BPD are not fully understood, but scientists agree that it is the result of a combination of factors, including:
Genetics – Research suggests that people who have a close family member with BPD may be at a higher risk of developing the disorder.
Environmental factors – People who experience traumatic life events—such as physical or sexual abuse during childhood or neglect and separation from parents—are at increased risk of developing BPD.
Brain function – The emotional regulation system may be different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate optimally with one another.
There is no definitive medical test to diagnose BPD, and a diagnosis is not based on one specific sign or symptom. BPD is best diagnosed by a mental health professional following evaluation that may include talking with previous clinician and friends and family.
An effective treatment plan should be your choice while also addressing any other co-existing conditions you may have. Examples of treatment options include psychotherapy; medications; and group, peer and family support.
Psychotherapy — such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy—is the first line of choice for BPD. Learning ways to cope with emotional dysregulation in a therapeutic setting is often the key to long-term improvement for those experiencing BPD.
No medications have been proven to treat BPD, however they can help alleviate underlying symptoms.
Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.
BPD can be difficult to diagnose and treat, and successful treatment includes addressing any other conditions a person might have. Many with BPD also experience additional conditions like:
• Anxiety Disorders
• Post Traumatic Stress Disorder (PTSD)
• Bipolar Disorder
• Eating Disorders
• Substance Use