Mental Health
Borderline personality disorder
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long-term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions. There is often an extreme fear of abandonment, frequent dangerous behavior, a feeling of emptiness, and self-harm. Symptoms may be brought on by seemingly normal events. The behavior typically begins by early adulthood, and occurs across a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. BPD increases the risk of self-harm and 10% of people affected die by suicide.
BPD's causes are unclear, but seem to involve genetic, brain, environment, and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events also appear to play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.Diagnosis is based on the symptoms while a medical exam may be done to rule out other problems. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.
BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.Diagnosis is based on the symptoms while a medical exam may be done to rule out other problems. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.
Borderline personality disorder is typically treated with therapy, such as cognitive behavioral therapy (CBT). Another type, dialectical behavior therapy (DBT) may reduce the risk of suicide. Therapy may occur one-on-one, or in a group. While medications do not cure BPD, they may be used to help with the associated symptoms. Some people require care in hospital.
About 1.6% of people have BPD in a given year. Females are diagnosed about three times as often as males. It appears to become less common among older people. Up to half of people improve over a ten-year period. People affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word "borderline". The disorder is often stigmatized in both the media and psychiatric field.
Signs and symptoms
Borderline personality disorder may be characterized by the following signs and symptoms:
- Markedly disturbed sense of identity
- Frantic efforts to avoid real or imagined abandonment and extreme reactions to such
- Splitting ("black-and-white" thinking)
- Impulsivity and impulsive or dangerous behaviours
- Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation
- Unstable and chaotic interpersonal relationships
- Self-damaging behavior
- Distorted self-image
- Dissociation
- Frequently accompanied by depression, anxiety, anger, substance abuse, or rage
The most distinguishing symptoms of BPD are marked sensitivity to rejection or criticism, and intense fear of possible abandonment. Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity.
Other symptoms may include feeling unsure of one's personal identity, morals, and values; having paranoid thoughts when feeling stressed; dissociation and depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.
Emotions
People with BPD may feel emotions more easily, more deeply, and longer than others do. In addition, emotions may repeatedly resurge and persist a long time. Consequently, it may take more time for people with BPD than others to return to a stable emotional baseline following an intense emotional experience. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them. In Marsha Linehan's view, the sensitivity, intensity, and duration with which people with BPD feel emotions have both positive and negative effects. People with BPD are often exceptionally enthusiastic, idealistic, joyful, and loving. However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.
People with BPD are also especially sensitive to feelings of rejection, criticism, isolation, and perceived failure. Before learning other coping mechanisms, their efforts to manage or escape from their very negative emotions may lead to emotional isolation, self-injury or suicidal behavior. They are often aware of the intensity of their negative emotional reactions and, since they cannot regulate them, they shut them down entirely. This can be harmful to people with BPD, since negative emotions alert people to the presence of a problematic situation and move them to address it which the person with BPD would normally be aware of only to cause further distress. People with BPD may feel emotional relief following cutting.
While people with BPD feel euphoria (ephemeral or occasional intense joy), they are especially prone to dysphoria (inability to experience entirety), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognized four categories of dysphoria that are typical of this condition: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity, and feelings of victimization. Within these categories, a BPD diagnosis is strongly associated with a combination of three specific states: feeling betrayed, "feeling like hurting myself", and feeling out of control. Since there is great variety in the types of dysphoria experienced by people with BPD, the amplitude of the distress is a helpful indicator of borderline personality disorder. In addition to intense emotions, people with BPD experience emotional "lability"; or in other words, changeability. Although the term emotional lability suggests rapid changes between depression and elation, the mood swings in people with this condition actually fluctuate more frequently between anger and anxiety and between depression and anxiety.