Borderline Personality Disorder (BPD)
It is normal to experience mood swings and moments of impulsive behavior during daily living. However, when these emotions become typical behavior, the issue may be borderline personality disorder (BPD).
While some people may use the term disparagingly to judge negative behavior, BPD is a clinical diagnosis.
- According to the National Alliance for borderline personality disorder, around 5.9% of the US population may be affected by borderline personality disorder. 5.9%
What is Borderline Personality Disorder?
Borderline personality disorder, or BPD, leaves sufferers with a constant sense of instability.
It alters moods, behavior, and thinking, and impacts relationships, careers, and social interactions.
These feelings, which may include intense anxiety, depression, and anger, can last for hours and even days, affecting daily functioning.
Inappropriate impulsive behavior and mood swings can make it difficult for people with BPD to maintain healthy relationships. Many may reject attempts by others to engage them, even when they wish to connect healthily.
Signs of borderline personality disorder generally begin to manifest in early adulthood and are believed to be at their most extreme during this life phase, finally tapering off over time.
People with BPD describe the feeling as being on an emotional rollercoaster, often struggling with their self-image and goals since these seem to change so frequently. Heightened sensitivity and susceptibility to triggers are also common, with many being unable to calm themselves after being upset.
During outbursts, BPD sufferers may lash out and say or do things they regret, leaving them guilt-ridden and ashamed afterward, which only exacerbates the problem.
Symptoms of Borderline Personality Disorder
Borderline personality disorder symptoms are primarily focused on the sense of self, and interactions with others, both of which are subject to rapid change as moods swing or values shift.
There are nine main BPD symptoms:
Abandonment issues
This fear of being alone can result in relationship issues as the BPD patient resorts to various measures—some extreme—to control others’ behavior. Unwarranted suspicions, tracking partners’ activities, clinginess, or physically blocking departure can all be part of the problem, which generally ends up making matters worse. Often people with BPD will indulge in intimate behavior very early in a romantic relationship or will unexpectedly cut ties with people to avoid the pain of rejection.
Unstable self-image
People with BPD may swing from self-acceptance to self-loathing, with no clear sense of identity, as they try to identify their values. This results in frequent job changes, relationship upheavals, religious changes, shifting goals or values, and even changes in sexual identity.
Impulsive behaviors
Harmful and sensation-seeking behavior can become an issue. BPD may drive a person to indulge in risky activities that may include drug or alcohol abuse, reckless driving, irresponsible sexual behavior, shoplifting, binge eating, and impulse spending. There can also be self-sabotaging attempts, such as abandoning promising careers or disconnecting from beneficial relationships.
Self-harming behaviors
People with BPD may self-harm through cutting or burning or more extreme behavior, such as suicidal thoughts.. However threats and attempts at suicide. In many instances, these reactions are in response to anxiety over rejection or abandonment.
Emotional instability
Extreme mood swings are often associated with BPD. Quickly switching from extreme happiness to intense sadness is common, although the episodes are often fleeting, lasting minutes, or sometimes a few hours. Emotional triggers can result in fast, extreme reactions to things that would not commonly affect others. Emotions may also include feelings of shame, irritability, or anxiety.
Unstable relationships
It is not uncommon for BPD sufferers to seek a sense of completeness within their relationships, which can be brief and tumultuous, starting with idealization and a seemingly instant love of the other, but rapidly devolving into anger and hate.
Feelings of emptiness
In many cases, relationship problems are connected to feelings of emptiness, which BPD sufferers try to fill through fleeting relationships with others, as well as food, drugs, or sex. Many describe themselves as feeling like they are nothing or nobody.
Paranoia and suspicion
Paranoia or suspicion of the motives of others is another BPD symptom. Stress exacerbates the situation and brings with it feelings of disassociation or losing touch with reality. Some even feel foggy or confused.
Outbursts of anger
Violent flares of anger are common BPD symptoms, with tempers spiraling quickly to rage. These often devolve into physical fights or may simmer as consistent bitterness or sarcasm. While often this manifests externally, many people with BPD spend a lot of time being angry with themselves.
Types of Borderline Personality disorder (BPD)
Four primary categories have been created to classify BPD.
These include:
Impulsivity:
Typically seen as the risk-takers and attention seekers, these individuals can be attractive and charismatic. However, their behavior is dramatic and unpredictable, and they can be prone to self-harm and suicidal tendencies.
Discouraged:
Often seen as clingy and lacking confidence, these individuals are prone to depression and a sense of powerlessness. Self-harm and suicidal thoughts are also symptoms.
Petulant:
People with this form of BPD can be highly critical and easily disappointed. They take offense easily and react with rage. Their sense of self is easily undermined and can be a trigger for negative behavior. They form intense bonds in their relationships, but can quickly reject those they are connected to. Paranoia and depression are additional symptoms.
Self-destructive:
People with self-destructive BPD are inclined to be highly self-critical to the point of loathing. This leads to self-destructive behavior as their anger is turned toward themselves, and suicide is a significant risk. Often introverts, they may share similar symptoms to depressive disorders.
Causes of Borderline Personality Disorder
Much like bipolar disorder (which it is sometimes misdiagnosed as), the causes of borderline personality disorder are not fully understood. There appears to be a correlation with a history of child abuse, neglect, or other trauma. When coupled with risk factors such as genetic predisposition and brain abnormalities, this appears to provide a recipe for BPD.
Experts have theorized that people with BPD tend to function on high alert, which results in extreme reactions to situations. This can cause them to behave irrationally since the brain is easily triggered into survival mode.
Risk Factors for Borderline personality disorder
Risk factors for borderline personality disorder include:
Genetic predisposition
It appears that BPD can be an inherited disorder, with symptoms being evident among other family members, or related to other mental health issues in the family.
Brain function
Abnormalities in brain structures related to the regulation of emotion, impulse control, and aggression appears to be a risk factor. Research indicates that irregularities in brain chemicals such as serotonin, which helps regulate mood, may play a role.
Environmental, cultural, and social factors
Exposure to conflict that can encompass child abuse, unstable family relationships, and other trauma such as caregivers with substance abuse or mental health issues have also been linked to developing BPD.
Diagnosing Borderline Personality Disorder
During a BPD diagnosis, a healthcare professional will conduct physical examinations and tests to negate any existing condition that may be causing the behavior.
Thereafter they will discuss symptoms with the patient, as well as speaking to family and close friends about the behavior of the individual to gain further insight.
Family histories of mental health issues will also be taken into consideration.
After conducting interviews based on BPD criteria in the Diagnostic and Statistical Manual of Mental Disorders, an assessment will then be made. Doctors will generally classify an individual with at least five of the classic symptoms of BPD as having the disorder.
It is advisable to consult a specialist psychiatrist, psychologist, or clinical social worker with experience in the area of BPD since the disorder can be complex. People with BPD often have co-existing conditions, such as depression, anxiety, eating disorders, or substance abuse issues which complicate diagnosis.
There is often confusion between borderline personality disorder vs bipolar disorder because they have similar symptoms. While BPD is focused on instability in self-image, moods, and behavior, bipolar disorder involves extreme shifts between mania and depression.
However, both conditions require different treatment protocols.
Treatment for Borderline Personality Disorder
While at one point it was believed that there was no effective BPD treatment available, research has shown that it is possible to reduce episodes, as well as minimize the severity of symptoms.
In this condition, therapy has proved to be more effective than medication. People with BPD respond well to a long-term protocol of learning new methods of self-soothing and emotional regulation, essentially “rewiring” neural pathways to react more appropriately.
In treating BPD, a healthcare professional may recommend:
Dialectical Behavior Therapy (DBT): DBT is a form of cognitive behavioral therapy (CBT) or talk therapy. It is designed to teach emotional regulation, stress management, and relationship development using a combination of group therapy, individual therapy, and phone coaching to give guidance on handling difficult situations.
Schema-focused Therapy: Schema-focused therapy is based on identifying an individual’s “schemas” or fundamental patterns of interacting with the world. These are acknowledged as being maladaptive—as a result of childhood neglect, for example—the protocol incorporates elements of CBT and other types of psychotherapy to create healthier coping mechanisms.
Primarily, therapists educate people with BPD in ways of managing their symptoms. These self-help skills include:
Self-calming techniques:
These include skills such as mindfulness techniques (meditation), sensory stimulation (focusing on input from one of the five senses), and managing emotional vulnerability (by incorporating healthy lifestyle habits).
Impulse control and distress management:
This includes learning to control behavior by getting in touch with emotions, learning to remain calm and focused, managing unpleasant or threatening feelings, and finding effective distraction techniques when other methods fail (work, activity, or even TV can help).
Improving interpersonal skills:
Taking responsibility and managing assumptions, understanding other perspectives, and developing communication skills can assist in building healthier relationships. Learning not to project negative thoughts onto others is another important skill.
There is currently no FDA approved protocol for BPD medication, however, healthcare specialists may prescribe medication to treat co-existing conditions such as:
Depression or bipolar disorder
Panic attacks or anxiety
Hallucinations or paranoia
Suicidal thoughts, or urges to self-harm or harm others
Get Help for Borderline Personality Disorder
Borderline personality disorder should not be taken lightly. Aside from a high risk of suicidal tendencies, those with the condition are more likely to develop chronic health issues, as well as being less likely to make healthy lifestyle choices.
While treating BPD is a long-term process, those with the condition can expect to regain control of their lives and relationships. However, it takes a commitment to the program, as well as support from a professional.
It is best to seek professional treatment for BPD. At Psyclarity Health, our highly qualified and compassionate therapists are specialists in treating a range of mental illnesses, including borderline personality disorder.
It is possible to live a fulfilled, productive life with borderline personality disorder. Get in touch with us at Psyclarity Health today to get a professional diagnosis and specialized treatment.
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