Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition in which a person has long-term patterns of unstable emotions, moods, and behavior. These experiences often result in impulsive actions and stormy relationships with other people.

Persons with borderline personality disorder tend to view things in terms of extremes, such as either all good or all bad. These suddenly shifting feelings often lead to intense and unstable relationships. Other symptoms of borderline personality disorder include intense fear of being abandoned, frequent feelings of emptiness and boredom, frequent expression of inappropriate anger, impulsivity, and repeated crises and acts of self-injury.

The cause of borderline personality disorder is unknown. Genetic, family, and social factors are thought to be associated with borderline personality disorder. Risk factors for borderline personality disorder include abandonment in childhood or adolescence, disrupted family life, poor communication in the family, and sexual, physical, or emotional abuse.

Borderline personality disorder can be treated with psychotherapy, including cognitive behavioral therapy among others. The U.S. Food and Drug Administration has not approved any medications to treat borderline personality disorder, but selective serotonin reuptake inhibitors such as paroxetine (Paxil) and monoamine oxidase inhibitors such as phenelzine (Nardil) can be used to help manage certain symptoms. Atypical antipsychotics such as olanzapine (Zyprexa) and risperidone (Risperdal). Mood stabilizers such as lithium (Lithobid) and divalproex sodium (Depakote) may be effective.

Borderline personality disorder usually begins during adolescence or early adulthood. Some studies suggest early symptoms may occur during childhood.

Persons with borderline personality disorder are often uncertain about their identity. As a result, their interests and values can change rapidly. They also tend to view things in terms of extremes, such as either all good or all bad. Their views of other people can change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships.

Other symptoms of borderline personality disorder include:

• Intense fear of being abandoned
• Cannot tolerate to be alone
• Frequent feelings of emptiness and boredom
• Frequent expression of inappropriate anger
• Being impulsive
• Repeated crises and acts of self-injury

The cause of borderline personality disorder is unknown. Genetic, family, and social factors are thought to be associated with borderline personality disorder

Risk factors for borderline personality disorder include:

• Abandonment in childhood or adolescence
• Disrupted family life
• Lack/poor communication in the family
• Sexual, physical, or emotional abuse

This personality disorder tends to be seen more often in women and among hospitalized psychiatric patients.

Unfortunately, borderline personality disorder often goes underdiagnosed or misdiagnosed.

In order to diagnose borderline personality disorder, a mental health professional will perform a thorough interview and evaluate your symptoms.

A person must behaviors that include at least five of the following symptoms:

• Extreme reactions such as panic, depression, rage, or frantic actions, to abandonment, whether real or perceived
• A pattern of intense relationships with family, friends, and loved ones
• Distorted and unstable self-image or sense of self
• Engaging in impulsive and often dangerous behaviors
• Continuing suicidal behaviors or threats or self-harming behavior
• Intense mood changes
• Chronic feelings of emptiness and/or boredom
• Inappropriate, intense anger or problems controlling anger
• Having stress associated with paranoid thoughts or severe dissociative symptoms

People with borderline personality disorder may also have co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Some people with borderline personality disorder may experience symptoms that are severe enough that require intensive care such as impatient care. Other people may be treated outpatient treatments and never need hospitalization or emergency care. Some people with borderline personality disorder may even improve without any treatment.

To help yourself:

• Talk to your doctor about treatment options and follow treatment
• Maintain a stable schedule of meals and sleep times
• Follow an exercise program to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones and set priorities
• Engage with trusted friend and/or family members
• Discuss your trigger symptoms
• Expect your symptoms to improve gradually. Symptoms will not improve immediately.
• Find comforting situations, places, and people
• Remain educated on borderline personality disorder

If you are unsure where to go for help, ask your family doctor. Other people who can help are:

• Mental health professionals, such as psychiatrists, psychologists, social workers, or mental health counselors
• Community mental health centers
• Hospital psychiatry departments and outpatient clinics
• Mental health programs
• State hospital outpatient clinics
• Family services or social agencies
• Peer support groups
• Private clinics and facilities
• Employee assistance programs

Borderline personality disorder can be treated with psychotherapy ("talk" therapy). Treatment may include medications.

Psychotherapy is usually the first treatment for people with borderline personality disorder.

Types of psychotherapy used in the treatment of borderline personality disorder include:

1. Cognitive behavioral therapy (CBT). CBT can help people with borderline personality disorder determine and change core beliefs and/or behaviors that are associated with inaccurate perceptions of themselves and others and problems as well as with interacting with others.
2. Dialectical behavior therapy (DBT). This type of therapy helps people with borderline personality disorder focus on being aware of and being attentive to the current situation. DBT teaches skills such as controlling intense emotions, decreasing self-destructive behaviors, and improves relationships.
3. Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on changing the way people view themselves.

Therapy can be one-on-one between the therapist and the patient or be done through a group setting.

• One type of group therapy, such as Systems Training for Emotional Predictability and Problem Solving (STEPPS), consists of 20, two-hour sessions.
• DBT-family skills training (DBT-FST) includes family members in treatment sessions.

More research is required to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

The U.S. Food and Drug Administration has not approved any medications to treat borderline personality disorder. A few studies show medications are effective in treating borderline personality disorder. Although medications do not cure borderline personality disorder, some medications may be helpful in managing certain symptoms.

Selective serotonin reuptake inhibitors such as paroxetine (Paxil) and monoamine oxidase inhibitors such as phenelzine (Nardil) can be used to help manage certain symptoms.

Your doctor may also prescribe atypical antipsychotics such as olanzapine (Zyprexa) and risperidone (Risperdal). In addition, your doctor may prescribe mood stabilizers such as lithium (Lithobid) and divalproex sodium (Depakote).

One study looked at 30 women with borderline personality disorder being treated with Omega-3 fatty acids. The results from the study indicated omega-3 fatty acids may help decrease symptoms of aggression and depression.

Borderline personality disorder is often seen as difficult to treat. Depending on how severe the condition is and whether the person is willing to accept treatment will determine how effective treatment will be. The person will usually see improvement with long-term talk therapy.

However, recent research shows treatment can be effective and many people with borderline personality disorder improve over time.