Borderline Personality Disorder: what is it?

Borderline Personality Disorder: what is it?

People with Borderline Personality Disorder experience chronically unstable moods, behavior, and relationships. They have problems having consistent and calm emotions and thoughts, they show highly impulsive and reckless behavior and they usually have unstable or dangerous relationships with other people. People with this disorder also have high rates of other psychological issues, such as depression, anxiety, alcohol and drug abuse, eating disorders, along with self-harm, suicidal behaviors or attempts. In fact, most people with Borderline PD first come to therapy for help with one of these other conditions.

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What are the signs of Borderline PD?

Borderline PD is suggested if five or more of the following can be reliably and consistently seen:

  • Extreme emotional reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
  • A pattern of very intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger
  • Sudden and intense changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal threats or gestures, or self-harming behavior, such as cutting or burning skin
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness and/or boredom
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related suspicious thoughts or feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

While the symptoms of Borderline PD may initially have been triggered by a traumatic event (or events) in childhood or adolescence, most of the time even seemingly mundane events can trigger ongoing symptoms in adults with Borderline PD. For example, people with Borderline PD may feel extremely angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. They may feel abandoned and seek reassurance through clingy or self-harming behaviours.

Studies on twins with Borderline PD suggest that it may be partly genetic. Developmental and cultural factors also seem to raise the risk for developing Borderline PD. For example, individuals with Borderline PD are considerably more likely to have been a victim of violence, including childhood sexual and physical abuse, rape and other crimes. Also, being part of a community or culture in which unstable (abusive or highly critical) family relationships are common may increase a person’s risk for the disorder.

How is Borderline PD treated?

Some people with borderline personality disorder experience severe symptoms and require intensive, often inpatient, care. Such treatments are often targeted at reducing suicidal and self-harming behaviours. Others with milder forms of Borderline PD can benefit from less-intensive outpatient treatments and never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.

Effective less-intensive outpatient treatments for Borderline PD include:

  1. Dialectical behavior therapy (DBT). DBT is a new kind of therapy, based on the well-established principles of Cognitive-Behavioral Therapy (CBT). This type of therapy uses concept of mindfulness, or being aware of and fully attentive to the current situation. DBT teaches mindful and behavioral skills to manage intense emotions, reduces self-destructive behaviors, and improve relationship skills. This therapy also seeks a balance between changing and accepting difficult beliefs and behaviors.
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  • Cognitive Behavioral Therapy (CBT). CBT can help people with Borderline PD identify and change the core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and their world. By changing core beliefs, CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
  • Schema-focused therapy. This type of therapy combines elements of CBT with a focus on reframing schemas, or the ways people view themselves and others. This approach is based on the idea that Borderline PD stems from a rigid and dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress. The therapy develops skills in identifying and challenging faulty schemas.
  • Regardless of the type of therapy, two features of Borderline PD receive the most attention from therapists. The first is suicidal thoughts and behaviours. Suicide is one of the most feared outcomes of any mental illness. Fortunately, DBT is effective in reducing suicide attempts compared with supportive types of psychotherapy. The second feature of Borderline PD that receives attention if is self-harming behaviours. Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with Borderline PD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with Borderline PD may self-harm to help soothe their emotions, to punish themselves, or to express their pain. DBT and CBT are effective for reducing the need for self-harming behaviors as well.

    The suicidal and self-harm behaviours of Borderline PD respond well to treatment, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend, unfortunately, to be more persistent. Borderline PD may also impair people’s responses to treatments for other disorders like depression or anxiety. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare, and treatments for Borderline PD are constantly being developed and improved.

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