About borderline personality disorder (bpd)

What is borderline personality disorder (bpd)?

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.



What are the symptoms for borderline personality disorder (bpd)?

Paranoia symptom was found in the borderline personality disorder (bpd) condition

Signs and symptoms may include:

  • An intense Fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn't care enough or is cruel
  • Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don't exist at all
  • Periods of stress-related Paranoia and loss of contact with reality, lasting from a few minutes to a few hours
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to Fear of separation or rejection
  • Wide Mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Ongoing feelings of emptiness
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights



What are the causes for borderline personality disorder (bpd)?

As with other mental health disorders, the causes of borderline personality disorder aren't fully understood. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to:

  • Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members.
  • Brain abnormalities. Some research has shown 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.



What are the treatments for borderline personality disorder (bpd)?

Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. It's also necessary to get treated for any other mental health disorders that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and live a more stable, rewarding life.

Psychotherapy

Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you:

  • Focus on your current ability to function
  • Learn to manage emotions that feel uncomfortable
  • Reduce your impulsiveness by helping you observe feelings rather than acting on them
  • Work on improving relationships by being aware of your feelings and those of others
  • Learn about borderline personality disorder

Types of psychotherapy that have been found to be effective include:

  • Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships.
  • Schema-focused therapy. Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on helping you get your needs met in a healthy manner to promote positive life patterns.
  • Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting.
  • Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-week treatment that involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy.
  • Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.
  • Good psychiatric management. This treatment approach relies on case management, anchoring treatment in an expectation of work or school participation. It focuses on making sense of emotionally difficult moments by considering the interpersonal context for feelings. It may integrate medications, groups, family education and individual therapy.

Medications

Although no drugs have been approved by the Food and Drug Administration specifically for the treatment of borderline personality disorder, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics or mood-stabilizing drugs.

Talk to your doctor about the benefits and side effects of medications.

Hospitalization

At times, you may need more-intense treatment in a psychiatric hospital or clinic. Hospitalization may also keep you safe from self-injury or address suicidal thoughts or behaviors.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors takes time. Most people improve considerably, but you may always struggle with some symptoms of borderline personality disorder. You may experience times when your symptoms are better or worse. But treatment can improve your ability to function and help you feel better about yourself.

You have the best chance for success when you consult a mental health provider who has experience treating borderline personality disorder.



What are the risk factors for borderline personality disorder (bpd)?

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 relative — your mother, father, brother or sister — has the same or a similar disorder.
  • Stressful childhood. Many people with the disorder report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.



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