Borderline Personality Disorder

Personality Disorder Defined

Borderline personality disorder (BPD) 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 contexts. 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 cause 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.

Borderline Personality Disorder Causes

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 controls 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 function 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 shown that a history of child abuse or neglect or who experienced other traumatic life events are at increased risk of developing BPD.

Borderline Personality Disorder Symptoms

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):

1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremeness of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e,g., sex, substance abuse, spending, binge eating, reckless driving).
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., irritability, intense episodic dysphoria, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e,g., frequent displays of temper, recurrent physical fights, constant anger).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

How to Approach a Loved One

There is no perfect way to approach a loved one that you assume or know has a borderline personality disorder. People without borderline personality disorder struggle to understand how their loved ones experience intense reactions, mood swings, and risky behavior. 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.

Types of Borderline Personality Disorder Treatment

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 requires a comprehensive treatment plan. When considering treatment it is important to consider co-occurring conditions that may exist, which are common in individuals with BPD.

Psychotherapy

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. 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.”

Medications

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.

Resources

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

Borderline personality disorder. (2018).

NAMI. (n.d.).

Smith, K. (n.d.). When Your Loved One Has Borderline Personality Disorder.