Borderline Personality Disorder (BPD) is a disorder characterized by difficulty regulating emotions. It’s estimated that 1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9%. 75% of people that are diagnosed with BPD are women, but this is not to say that men are not susceptible to having BPD. Research suggests that men may be equally affected by BPD but are commonly misdiagnosed with PTSD or depression. BPD is also a Borderline personality disorder, like all personality disorders is not diagnosed in children or adolescents, but mostly in adults. Personalities of children and adolescents are still developing so what may appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.
Borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, affects, and marked impulsivity that begins by early adulthood and is present in a variety of context. Individuals with borderline personality disorder have an intense fear of abandonment or instability, and may have difficulty tolerating being alone. While these individuals have this fear and seek out interpersonal relationships, their behavior more often than none pushes friends and family away. Behaviors like inappropriate anger, impulsiveness and frequent mood swings causes difficulty, even though they want to have loving and lasting relationships. BPD impacts the way an individual thinks and feels about themselves and others, causing problems functioning in everyday life. BPD frequently co-occurs with other personality disorders. The most common pattern for the course of BPD is one of chronic instability in early childhood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources.
There are no sub types of borderline personality disorder but it is classified under Cluster B under personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior.
The cause of borderline personality disorder is not fully understood but there is an agreement that it is caused by a combination of factors. BPD may be linked to brain abnormalities, in the part of the brain that control emotions and decision-making/judgment may not communicate optimally with one another. It may also be the case that certain brain chemicals that help regulate mood, like serotonin, may not functioning correctly. Genetics may play a role in the development of borderline personality disorder. While there is no specific gene related to BPD, some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members. BPD is about five times more common among people who have a first-degree relative with the disorder. Finally, environmental factors may also be linked to BPD. Research has shows that a history of child abuse or neglect or experience other traumatic life events, are at increased risk of developing BPD.
To be diagnosed with borderline personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, and indicated by five (or more of the following):
There is not a perfect way to approach a loved one that you assume or know has borderline personality disorder. People with borderline personality disorder struggle to understand how their loved ones experience their intense reactions, mood swings, and risky behavior. While preventing a loved one from developing BPD is not possible, providing support and being aware of what their learning in treatment can be helpful. It’s important to determine the level of care a loved one may need before engaging in (and throughout the duration of) treatment. For more information on how to approach a loved one visit:
Borderline personality disorder can be a challenge to treat not only because it is complicated and stigmatized, but also because its symptoms reflect ingrained patterns of thinking and behavior. Treatment for BPD is long- term and require a comprehensive treatment plan. When considering treatment it is important to consider co-occurring conditions that may exist, which is common with individuals with BPD.
Dialectical behavior therapy (DBT)- Dialectical behavior therapy is the most common form of treatment for individuals with borderline personality disorder. DBT focuses on teaching coping skills to combat counterproductive urges, regulate emotions and improve relationships. Dialectical behavior therapy usually lasts for a year and consists of both group and individual sessions. Studies conducted by researchers at the University of Washington have concluded that dialectical behavior therapy is effective at reducing self-mutilation and suicide attempts, as well as the number of days spent in psychiatric hospitals (Harvard Health Publishing, 2010).
Schema-focused therapy- The goal of therapy is to help the individual replace old schemas (or ways of thinking) with new ones and adopt a new mode of behavior, that of the "healthy adult.” Therapy must continue for at least two years to be effective.
Transference-focused psychotherapy- In this technique of therapy, clinician and individual to together understand the dynamics of past relationships and associated emotions and how these may affect their current functioning. The goal of therapy is to help individuals better integrate their views of themselves and other people. Individuals of this therapy usually attend therapy at least twice a week.
Mentalization- based treatment- This technique of therapy helps individuals develop a mental picture of the emotions, feelings, or beliefs of themselves and others, which they are lacking. A long-term study reported that mentalization- based treatment reduced antipsychotic use and the number of suicide attempts, and increased chances of recovery five years after completing treatment (Harvard Health Publishing, 2010).
Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety. For most treatment used for borderline personality disorder, the goal is usually to learn coping skills while in the community; therefore it is not organized around inpatient care. Although, there are some facilities that have a DBT track in inpatient-partial hospital program.
To date there are no drugs approved by the FDA that have been specifically created to treat borderline personality disorder. Medications can be useful when treating certain symptoms that are typically associated with borderline personality disorder, such as depression and anxiety. They can also be used to help increase a person’s ability to engage in psychotherapy.
There are other disorders that may resemble borderline personality disorder, so it is important to differentiate the difference between common disorders that may get confused with BPD.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
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