|
What is Borderline
Personality Disorder?
Borderline Personality Disorder (BPD) is a serious and often life-threatening disorder
that is characterized by severe emotional pain and difficulties managing emotions.
The problems associated with BPD include impulsivity (including suicidality
and self-harm), severe negative emotion such as anger and/or shame, chaotic
relationships, an extreme fear of abandonment, and accompanying difficulties
maintaining a stable and accepting sense of self. Thus, BPD is characterized
by pervasive instability of mood, interpersonal relationships, self-image,
and actions, often negatively affecting loved ones, family and work life, long-term
planning, and the individual's sense of self-identity.
Borderline
Personality Disorder By John M. Grohol, Psy.D.
The main feature of borderline personality disorder (BPD) is a pervasive
pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder
are also usually very impulsive. This disorder occurs in most by early
adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the
person’s self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just
at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner)
in a person’s emotions and feelings. Relationships and the person’s emotion may often be characterized as being
shallow. A person with this disorder will also often exhibit impulsive
behaviors and have a majority of the following symptoms: - Frantic
efforts to avoid real or imagined abandonment
- A
pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization
and devaluation
- Identity disturbance, such as a
significant and persistent unstable self-image or sense of self
- Impulsivity
in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats,
or self-mutilating behavior
- Emotional instability
due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours
and only rarely more than a few days)
- Chronic feelings of
emptiness
- Inappropriate, intense anger
or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid thoughts or severe dissociative symptoms
As with all personality disorders, the person must be at least 18
years old before they can be diagnosed with it. Borderline personality
disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that borderline personality
disorder affects approximately 2 percent of the general population. Like
most personality disorders, borderline personality disorder typically will decrease in intensity with age, with many people
experiencing few of the most extreme symptoms by the time they are in the 40s or 50s. Details about Borderline Personality Disorder Symptoms Frantic
efforts to avoid real or imagined abandonment. The perception
of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion,
thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them
in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic
separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few
minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment
implies that they are “bad.” These abandonment fears are related to an intolerance of being alone and a need
to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating
or suicidal behaviors. Unstable and intense relationships.
People with borderline personality disorder may idealize potential caregivers or
lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early
in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other
person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with
and nurture other people, but only with the expectation that the other person will “be there” in return to meet
their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately
be seen as beneficient supports or as cruelly punitive. Such shifts other reflect disillusionment with a caregiver whose
nurturing qualities had been idealized or whose rejection or abandonment is expected. Identity disturbance. There are sudden and dramatic
shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in
opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from
the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image
that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they
do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship,
nurturing and support. These individuals may show worse performance in unstructured work or school situations.
How is Borderline Personality Disorder Diagnosed? Personality disorders such as borderline personality disorder are typically diagnosed by a trained mental health
professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained
or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about
this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory,
blood or genetic tests that are used to diagnose borderline personality disorder. Many people with borderline personality disorder don’t seek out treatment. People with personality disorders,
in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s
life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other
life events. A diagnosis for borderline personality disorder is made
by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination
whether your symptoms meet the criteria necessary for a personality disorder diagnosis. Causes of Borderline Personality Disorder Researchers today don’t
know what causes borderline personality disorder. There are many theories, however, about the possible causes of borderline
personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of
are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development
with their family and friends and other children), and psychological factors (the individual’s personality and temperament,
shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible
— rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has
this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed
down” to their children. Treatment of Borderline Personality Disorder
Treatment of borderline personality disorder typically involves long-term psychotherapy
with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to
help with specific troubling and debilitating symptoms.
Characteristics
of Borderline Personality Disorder
By John M. Grohol, Psy.D.
Individuals with Borderline Personality Disorder make frantic efforts
to avoid real or imagined abandonment. The perception of impending separation or rejection, or the loss of external structure,
can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental
circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited
separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician’s announcing
the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment).
They may believe that this “abandonment” implies they are “bad.” These abandonment fears are related
to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may
include impulsive actions such as self-mutilating or suicidal behaviors. Individuals
with Borderline Personality Disorder have a pattern of unstable and intense relationships. They may idealize potential
caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate
details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling
that the other person does not care enough, does not give enough, is not “there” enough. These individuals can
empathize with and nurture other people, but only with the expectation that the other person will “be there”
in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of
others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment
with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected. There may be an identity disturbance characterized by markedly and persistently unstable self-image
or sense of self. There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational
aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends.
These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment.
Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times
have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels
a lack of a meaningful relationship, nurturing, and support. These individuals may show worse performance in unstructured
work or school situations. Individuals with Borderline Personality Disorder
display impulsivity in at least two areas that are potentially self-damaging. They may gamble, spend money irresponsibly,
binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals
with Borderline Personality Disorder may also sometimes display recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior. Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and
suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for
help. These self-destructive acts are usually precipitated by threats of separation or
rejection or by expectations
that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief
by reaffirming the ability to feel or by expiating the individual’s sense of being evil. Individuals with Borderline Personality Disorder may display affective instability that is due to a marked reactivity
of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). The basic dysphoric mood of those with Borderline Personality
Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction.
These episodes may reflect the individual’s extreme reactivity to interpersonal stresses. Individuals with Borderline Personality Disorder may be troubled by chronic feelings of emptiness. Easily bored,
they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate,
intense anger or have difficulty controlling their anger. They may display extreme sarcasm, enduring bitterness, or verbal
outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning.
Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil.
During periods of extreme stress, transient paranoid ideation or dissociative symptoms
(e.g., depersonalization) may occur, but these are generally of insufficient severity or duration to warrant an additional
diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient,
lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of
symptoms.
|
