Borderline personality disorder is a personality disorder characterized by consistently problematic ways of thinking, feeling, and interacting, impulsivity, negative self-image and fear of abandonment, leading to difficulties with interpersonal relationships.
- BPD affects men as often as women in general, women more than men in treatment populations.
- Antisocial personality disorder in adults, substance-abuse problems in men, eating disorders in women, and anxious and odd personality disorders in adolescents tend to co-occur with BPD.
- There has been some controversy about whether or not BPD is its own disorder or a variation of bipolar disorder, but in many countries, there is more agreement on the existence of BPD.
- Like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model).
- BPD sufferers are more likely to have a learning problem or certain temperaments as children, or come from families of origin where divorce, neglect, sexual abuse, substance abuse, or death occurred.
- In order to be diagnosed with BPD, the sufferer must experience at least five of the following symptoms: unstable self-image, relationships or emotions, severe impulsivity, repeated suicidal behaviors or threats, chronic feelings of emptiness, inappropriate anger, trouble managing anger, or transient paranoia or dissociation.
- As with other mental disorders, there is no specific definitive test, like a blood test, to diagnose BPD. Therefore, practitioners conduct a mental-health interview that looks for the presence of the symptoms previously described and usually explore the person's history for any medical problem or other emotional problem that may show symptoms of the disorder.
- Psychotherapy approaches that have been helpful in treating BPD include dialectical behavior therapy, cognitive behavioral therapy, interpersonal therapy, and psychoanalytic psychotherapy.
- The use of psychiatric medications like antidepressants, mood stabilizers, and antipsychotics may be useful in addressing some of the symptoms of BPD but do not manage the illness in its entirety.
- Partial hospitalization can help treat BPD by providing frequent supervision and assessment in a safe environment, while allowing the sufferer to go home each evening.
- The presence of BPD tends to worsen the symptoms of other mental illnesses and increase the risk for self-mutilation, as well as for attempting or completing suicide.
- People with BPD are at somewhat higher risk for engaging in violent behavior. That risk is further increased when the individual with BPD also is suffering from antisocial personality disorder, has a previous history of violent behavior, frequently uses sedative medications, or experiences several changes in their psychiatric medications.
- While they symptoms of BPD tends to diminish over years for many people, how well or poorly people with BPD progress over time seems to be influenced by the severity of the symptoms, the individual's current personal relationships, whether or not the sufferer has a history of being abused as a child, as well as whether or not the individual receives appropriate treatment.
- Steady employment or school status once symptoms of BPD subside (remit) tends to protect BPD sufferers from experiencing a future relapse.
What is borderline personality disorder (BPD)?
Borderline personality disorder (BPD) is a mental disorder that belongs to the group of mental illnesses called personality disorders. Like other personality disorders, it is characterized by a consistent pattern of thinking, feeling, and interacting with others and with the world that tends to cause significant problems for the sufferer. Specifically, BPD tends to be associated with a pattern of unstable ways of seeing oneself, feeling, behaving, and relating to others that markedly interferes with the individual's ability to function. Also, as with other personality disorders, the person is usually an adolescent or adult before they can be assessed as meeting full symptom criteria for BPD.
Historically, BPD has been thought to be a set of symptoms that include both mood problems (neuroses) and distortions of reality (psychosis) and therefore was thought to be on the borderline between mood problems and schizophrenia. However, it is now understood that while the symptoms of BPD may straddle those symptom complexes, this illness is more closely related to other personality disorders in terms of how it may develop and occur within families. Contrary to what the medical community thought in the past, BPD is now understood to occur equally in men and women in general, while primarily in women in groups of people who are receiving mental-health treatment (treatment populations). The frequency with which this disorder occurs is also thought to be considerably higher than previously thought, affecting nearly 6% of adults over the course of a lifetime.
What other disorders often occur with BPD?
Men with BPD are more likely to also have a substance-use disorder. BPD is more likely to be associated with eating disorders symptoms in women. In adolescents, BPD tends to co-occur with more anxious and odd personality disorders like schizotypal and passive aggressive personality disorder, respectively. Adults who have antisocial personality disorder, formerly also colloquially called sociopaths, may be more likely to also have BPD. Interestingly, even people who have some symptoms (traits) of BPD but do not meet full diagnostic criteria for the disorder can experience both traits of BPD and narcissistic personality disorder.
Although there has been some controversy as to whether or not BPD is truly its own disorder or a variation of bipolar disorder, research supports the theory that BPD, like virtually every medical or other mental-health disorder, can appear in nearly as many unique and complex ways as there are people who have it. In other words, some individuals with BPD will have that disorder alone, while others will have it in combination with bipolar or another mental disorder. Still others will appear to have BPD but really qualify for the diagnosis of bipolar disorder and visa versa.
BPD is not recognized worldwide. It is most closely diagnosed as emotionally unstable personality disorder in the International Classification of Disease, or ICD-10. Although countries like China and India recognize mental disorders that have some symptoms in common with BPD, its existence is not formally recognized.
What causes borderline personality disorder?
Although there is no specific cause for BPD, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). Biologically, individuals with BPD are more likely to have abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes, which are the areas of the brain that are understood to regulate emotions and integrate thoughts with emotions. Although some research asserts that people with BPD seem to have areas of the brain that are more and less active compared to individuals who do not have the disorder, other research contradicts that. Therefore, specific patterns of brain functioning, as they are currently studied and understood, seem unreliable predictors of BPD.
While it is not thought to be genetic, it can somewhat run in families. Psychologically, BPD seems to make a person more vulnerable to difficulty managing their emotions, particularly impulsive aggression. Socially, this disorder predisposes sufferers to be more likely to excessively expect to be criticized or rejected and negatively personalize disinterest or inattention from others. Their social tendencies make for great difficulty in their relationships. In addition to these issues, people with BPD are more likely to have suffered from childhood abuse or neglectful parenting.