What is Borderline Personality Disorder?
Borderline Personality Disorder is a personality disorder marked by a pervasive pattern of unstable personal relationships, self-image, and affects along with excessive impulsiveness beginning in early adulthood. This instability can cause significant problems in personal relationships, long-term planning, and careers.
BPD can remain undetected and untreated for years because it often exists with another mental illness (comorbidity) like depression, drug abuse or anxiety. It is also commonly misdiagnosed as something else altogether, since it shares traits with other personality disorders.
Borderline personality disorder affects 1-2% of the population (like bipolar disorder) but public awareness is minimal.
BPD is a complex disorder that has historically been difficult to treat for a number of reasons, including poor treatment plans and inadequate insurance coverage.
Thanks to developments in the last twenty-five years, a diagnosis of borderline personality disorder is no longer the grim fate it once was.
Borderline Personality Disorder is one of eleven Personality Disorders.
What Are Personality Disorders?
Personality Disorders occur when personality traits (longstanding ways of thinking, reacting, and perceiving the environment) and the self are inflexible, maladaptive and cause significant functional impairment or distress.
Symptoms/Diagnosis of Borderline Personality Disorder (per DSM-IV):
To receive a diagnosis of Borderline Personality Disorder, a person must exhibit at least 5 of 9 of these traits.
1) Frantic efforts to avoid abandonment (real or imagined). The perception (whether or not it exists) of abandonment creates changes in the self-image and behavior of a person with Borderline Personality Disorder. A person with BPD sees abandonment as proof that they are "all bad." They may commit impulsive lengths to avoid abandonment; including self-mutilation or suicidal behaviors.
2) Pattern of unstable, intense relationships marked by extremes of idealization and devaluation. Significant others (sources of protection) are either all good (idealized) or all bad (devalued), which is a coping mechanism known as "splitting."
3) Unstable self-image; identity disturbance. The values, ideas, habits, and attitudes of a person with BPD are changed by whomever they are with. People with borderline personality disorder may have no self-image or discrete identity of their own.
4) Poor impulse control. For a diagnosis of BPD, impulsivity in at least two potentially self-damaging areas must be exhibited. These acts can range from excess shopping, binging and purging, reckless sex, drug or alcohol abuse.
5) Recurrent suicidal behavior, threats, or gestures, including self-injury. These types of self-injurious behaviors are a hallmark for a person with borderline personality disorder. Self-destructive acts usually begin in early adolescence and are precipitated by the threat of separation, rejection, or unwanted responsibilities. These self-injurious behaviors become addictive to a person with borderline personality disorder, so treatment is often focused upon stopping these behaviors.
6) Affective instability. Intense, volatile periods of depression, panic, despair (to name a few) usually lasting only a couple of hours each.
7) Chronic feelings of emptiness. Visceral feelings of emptiness from the chest, described as "hollowness," "nothingness," and "no feelings, no thoughts, no dreams," by people with borderline personality disorder. Emptiness is not to be confused with boredom, anguish or grief.
8 ) Inappropriate, intense anger. Some people with BPD say that they're angry most of the time, even if they don't express it.
9) Lapses in reality. People with BPD can experience dissociation - the feeling of unreality - but usually only for a couple of days during periods of high stress. People with BPD may also be unrealistically self-conscious about the way they're perceived by others.
Splitting and Borderline Personality Disorder:
Splitting is a maladaptive coping mechanism used by people with manipulative tendencies, such as those with narcissistic personality disorder and borderline personality disorder, in response to anxiety, stress or the perception of anxiety or stress.
Splitting is the inability to integrate the good and bad parts of oneself or an object. Splitting means that it's all good or all bad. Such objects can be anything - animate or inanimate - outside themselves (a lover, a sibling, a table) to which they are attached.
Concerns With Borderline Personality Disorder:
Suicide and Borderline Personality Disorder:
The most dangerous behavior for a person with borderline personality disorder is the potential for self-harm or suicide.
It's estimated that 10% of people with BPD kill themselves.
Suicidal ideation (thinking and fantasizing about suicide) is pervasive among people with BPD.
Substance abuse and major depression can contribute to the risk of suicide in the borderline personality disorder population.
Family members of a person with BPD who are expressing suicidal thoughts, actions, or feelings, should immediately involve mental health professionals. It is not the family member's burden to assume safety for their loved one.
Always involve a professional if you or someone you love is feeling suicidal.
Self-Injury and Borderline Personality Disorder:
National Self-Injury Hotline: 1-800-DONT CUT (1-800-366-8288)
"Parasuicidal Acts" are acts of deliberate self-harm. Self-harm occurs in 75% of people diagnosed with BPD. Self-injury often occurs without suicidal intent.
Self-injury can involve cutting, burning, head-banging, hair-pulling, or hitting.
Self-injury may be classified as self-destructive behavior such as binging and purging, engaging in unsafe sex with multiple partners, and drug abuse.
The motivations for self-injury in BPD patients vary and often occur during dissociative episodes; when numbness prevails. The physical pain of self-harm, patients have reported, causes a release of endorphins, naturally occurring opiates sent by the brain in response to pain.
Self-harm may be used as a communication to others or an attempt to evoke a rescue.
Self-injury can be addictive and treatment for patients with borderline personality disorder is to break this cycle of addiction.
Treatment for Borderline Personality Disorder:
Hospitalization for crisis management so that the person with BPD can gain perspective of the crisis in a safe environment. Hospital staff can evaluate the person's medications and make any changes in a controlled setting.
Psychotherapy is the best treatment for borderline personality disorder, but requires a level of trust not easily earned between the patient and the therapist. Standard treatment is once or twice a week visits with an experienced therapists for one to six years.
Cognitive Behavioral Therapy is a type of therapy where the patient examines and challenges the core beliefs that adversely affect negative self-image and ways of interacting with the world. CBT is more emotionally neutral and structured than psychotherapy.
Family Therapy for Borderline Personality Disorder. Parents, siblings and spouses of people with BPD bear a huge burden, especially when the person with BPD blames them for their suffering. Living with someone with borderline personality disorder is challenging but a therapist may help to educate and improve communication for everyone involved.
Group Therapy. Two types of group therapy can help people with BPD, even though those with borderline personality disorder can be resistant to disclosure; a group setting allows them to learn from others who've had similar life experiences.
1) Group therapy lead by a professional with selected members, the most beneficial of which is considered to be Dialectical Behavior Therapy (DBT).
2) Self-help groups (such as AA) provide support and a network of peers and can be used with other treatments for BPD, but shouldn't be the sole treatment for people with borderline personality disorder.
For Children Affected By Borderline Personality Disorder:
Remove children if the person with BPD is being abusive. If the abuse is constant, consider your options.
Make sure your kids know that no one has the right to abuse them.
Don't make excuses for abusive behavior. There are no excuses when it comes to your children's mental health.
Help your kids by being there for them, supporting them, and following through on your promises.
Try to explain that the person with BPD isn't lashing out because the child did something wrong.
Enjoy your child. Spend time with them. Take their concerns seriously and make sure they know that you love them.
Living With A Partner with Borderline Personality Disorder:
Try to remember the actions of a person (self-mutilation, abuse, screaming, blame, criticism) with BPD aren't personal; it's part of the disorder.
Take care of yourself, too. Live your life. Enjoy it.
Hotlines for Borderline Personality Disorder:
National Suicide Prevention Hotline: 1-800-273-8255
National Adolescent Suicide Hotline: 1-800-621-4000
National Self-Injury Hotline: 1-800-DONT CUT (1-800-366-8288)
Additional Resources for Borderline Personality Disorder:
National Education for Borderline Personality Disorder: website devoted to raising awareness, providing education, and promoting research for borderline personality disorder and those affected by it.
NAMI (National Alliance on Mental Health): website devoted to raising awareness and improving the lives of those afflicted with serious mental illness.
BPD Central provides information and support for Borderline Personality Disorder, as well as a support group for loved ones of those with BPD.
A list of locations to find DBT broken down by state can be found on this page within the BPD Central Site. In addition, this page also provides tips on how to select a DBT therapist.
BPD World has information, advice, education opportunities, and support for those with personality disorders.