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Borderline Personality Disorder - A Clinical Perspective
As with other mental disorders, the causes of borderline personality disorder are complex. The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But that view doesn't reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.
Meanwhile, the cause of BPD remains under investigation, and there's no known way to prevent it. Possible causes include:
- Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
- Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
- Brain abnormalities. Some research shows changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.
Most likely, a combination of these issues results in borderline personality disorder.
Personality forms during childhood. It's shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase the risk of developing borderline personality disorder. These include:
- Hereditary predisposition. You may be at a higher risk if a close family member a mother, father or sibling has the disorder.
- Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
- Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.
People with borderline personality disorder often feel misunderstood, alone, empty and hopeless. They're typically full of self-hate and self-disgust. They may be fully aware that their behavior is destructive and be distressed about it. Impulsivity may cause problems with gambling, driving or even the law. You may find that many areas of your life are affected, including relationships, work or school.
If you notice these things about yourself, talk to your doctor or a mental health provider. The right treatment can help you feel better about yourself and help you live a more stable, rewarding life.
If you notice these things in a family member or friend, talk to them about seeing a doctor or mental health provider. But keep in mind that you can't force someone to seek help. If the relationship has you unduly distressed, you may find it helpful to see a therapist yourself.
Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
The DSM criteria note that people with BPD have a pattern of unstable relationships, self-image and mood, as well as impulsive behavior. These typically begin in early adulthood.
For BPD to be diagnosed, at least five of the following signs and symptoms must be present:
* Intense fears of abandonment
* A pattern of unstable relationships
* Unstable self-image
* Impulsive and self-destructive behaviors
* Suicidal behavior or self-injury
* Wide mood swings
* Chronic feelings of emptiness
* Inappropriate anger
* Periods of paranoia and loss of contact with reality
A diagnosis of BPD is usually made in adults, not children or adolescents. That's because what appear to be signs and symptoms of BPD may go away with maturity.
Borderline personality disorder can damage many areas of a person's life. Relationships, jobs, school, social activities, self-image all can be negatively affected. Repeated job losses and broken marriages are common. Self-injury, such as cutting or burning, can result in scarring and frequent hospitalizations. Suicide rates among people with BPD are very high, reaching 10 percent.
In addition, people with borderline personality disorder may have other mental health problems, too, including:
* Substance abuse
* Anxiety disorders
* Eating disorders
* Bipolar disorder
* Other personality disorders
Because of their risky, impulsive behavior, people with BPD are also more vulnerable to unplanned pregnancies, sexually transmitted diseases, motor vehicle accidents and physical fights. They may also be involved in abusive relationships, either as the abuser or the abused.
Treatment for borderline personality disorder has improved in recent years with the adoption of techniques specifically aimed at people with this disorder. Treatment includes:
- Psychotherapy. This is the core treatment for BPD. Dialectical behavior therapy (DBT) was designed specifically to treat the disorder. Generally conducted through individual, group and phone counseling, DBT uses a skills-based approach to teach people how to regulate their emotions, tolerate distress and improve relationships.
- Medications. Medications can't cure BPD, but they can help associated problems, such as depression, impulsivity and anxiety. Medications may include antidepressant, antipsychotic and antianxiety medications.
- Hospitalization. At times, people with BPD may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep them safe from self-injury.
Because treatment can be intense and long term, people face the best chance for success when they find mental health providers with experience treating BPD.
Living with borderline personality disorder can be difficult. You may fully realize that your behaviors and thoughts are self-destructive or damaging yet feel unable to control them. Treatment can help you learn skills to manage and cope with your condition.
Other things you can do to help manage your condition and feel better about yourself include:
* Sticking to your treatment plan
* Attending therapy sessions as scheduled
* Practicing healthy ways to ease painful emotions, rather than inflicting self-injury
* Not blaming yourself for having the disorder but recognizing your responsibility to get it treated
* Learning what things may trigger angry outbursts or impulsive behavior
* Not being embarrassed by having this condition
* Getting treatment for related problems, such as substance abuse
* Educating yourself about the disorder so you understand its causes and treatments better
* Reaching out to others with the disorder to share insights and experiences
Remember, there's no one right path to recovery from BPD. The condition seems to be worse in young adulthood and may gradually get better with age. Many people with the disorder find greater stability in their lives during their 30s and 40s. Their inner misery may lessen and they go on to sustain loving relationships and enjoy meaningful careers.
High Functioning Borderline Personality Disorder
Written by Valerie Porr, Founder, Treatment and Research Advancements Association for Personality Disorder.
Despite their extreme sensitivity and the severe emotional pain they live with, people with Borderline Personality Disorder seem to others to manifest irritating behavior rather than signs or symptoms associated with other mental illnesses.
Generally high functioning, it is not unusual for a person with BPD to graduate from college or become a doctor or lawyer. Princess Diana and Marilyn Monroe were reputed to have suffered with Borderline Personality Disorder. They had the ability to "be apparently competent" that often leads loved ones and professionals to trivialize their profound suffering and to deny the appropriate recognition or care required by this painful and persistent illness.
Archived Departments: Books
Archived Articles: How a BPD Love Relationship Evolves
The Symptoms and Diagnosis of BPD
Borderline Personality Disorder - A Clinical Perspective
Take the First Step Toward Improving Your Relationship
Supporting a Loved-one with BPD
Helping a Loved One with BPD Seek Treatment
Treatment of BPD
The Effects of a Mother with BPD on Her Children
Surviving a Break-up with Someone Suffering with BPD
Leaving A Partner with BPD
Free On-Line Cognitive Behavioral Therapy Program (CBT)
Depression: Stop Being Tortured by Your Own Thoughts
Codependency: When Our Emotional Issues Affect Our True Availability
Sexual Addiction: When the Sex is Too Important
The Characteristics of Healthy Relationships