Borderline Personality Disorder: Causes, Symptoms and Treatment

Borderline personality disorder (BPD) is a serious mental disorder that is characterized by pervasive mood instability, unstable inter-personal relationships, unstable self-image, and other types of destructive behavior.

In this disorder the individual's sense of self identity is disturbed, and he or she finds it difficult to interpret reality, thereby disrupting family and work life. They idealize themselves, whereas on the other hand demean and disregard certain other people completely.

They set high expectations from people and get extremely disappointed when their desires and expectations are not met. This extreme valuation and devaluation is the hallmark feature of this disorder.

In the 1930s, a psychologist named Adolf Stern used this term 'borderline' to describe the condition between psychosis and neurosis. It describes the borderline states of consciousness that the individuals with this disorder feel when they experience a sense of disconnection from oneself.

Even though it is more common, BPD is less known as compared to schizophrenia and bipolar disorder. It is seen to affect 2% of the adult population, most of whom are women. Some BPD patients tend to injure themselves without any suicidal intent, whereas in severe BPD cases, successful suicides are also observed.

BPD is believed to be a biological, neurological, and genetic disorder, that is caused by the dysfunction of that area of the brain that controls emotions (limbic area of the brain). Adults suffering from BPD are those people who have had a traumatic childhood, wherein they were physically, mentally, or sexually abused (child abuse).

Parental loss or neglect can also trigger borderline personality disorder. Such people are often insecure and have the tendency to cling on to those they love. They often mishandle their emotions and get angry, stressed, and anxious very quickly.

The reason why child abuse is so predominant in BPD history is believed to be because one or both parents of the child suffer from a mental illness. Since people tend to cling and hang out with people whom they are comfortable with similarly, most mentally ill people are also seen congregating with other mentally ill people, resulting in a limited gene pool.

Mental illness when genetically considered is a trait and not a disorder. It is believed that the rate of transfer of this trait from one generation to another is 7%. Certain studies also suggest that BPD is related to mood swings or impulse controlling issues, while some other studies suggest that there is a malfunction of the neurotransmitters.

Mental health professionals in the United States use a handbook called the Diagnostic and Statistical Manual of Mental Disorders (DSM) that is published by the American Psychiatric Association to diagnose mental disorders.

This handbook comprises criteria for diagnosis, research, findings, and information regarding the treatment of various mental illnesses. According to the handbook, a person is said to suffer from BPD if he or she satisfies five of the symptoms mentioned below.

• Bouts of depression, anxiety, and anger that last for a few hours to a day.

• Idolize people they are attached to and on occurrence of any conflict, they begin to strongly dislike the same person. Patterns of unstable social relationships which circulate in the love-hate vicious cycle.
• Actions of self injury, drug or alcohol abuse, and aggression.

• View themselves as unworthy and often feel mistreated, bored, isolated, empty, and fail to understand who they really are.
• Take frantic efforts to avoid being left alone, be it perceived abandonment or real.

• Exhibit impulsive behavior such as excessive spending, risky sex, reckless driving, binge eating, and substance abuse.
• Recurrent acts of self-mutilation such as cutting and burning oneself, suicidal threats and attempts.

• Unstable self-image, often lack self-confidence and are confused about their identity.
• Highly sensitive to rejection and can get depressed even by small separations such as vacations, change of plans, or business trips.

It is believed that the onset of this disorder is at puberty. However, since mood swings, depression, irritability, impulsive behavior are common during adolescence, it is very difficult to diagnose this disorder at that time, and hence it is diagnosed mostly in early adulthood. Patients with this disorder are seen to get hospitalized and receive medical treatment more than other mental disorder patients.

The reason could be because of their fear of abandonment and the urge to develop ideal inter-personal relationships. Psychotherapy is something that is seen to be partially effective to many patients. A psychosocial treatment called Dialectical Behavior Therapy (DBT) has been specifically developed to treat people with BPD, and has proved to be an effective in BPD cases with suicidal tendencies.

This therapy aims at dealing with the self-confidence issues, and involves a combination of mood awareness exercises, social skill training, meditative techniques, and educative programs on the disorder. Medication is not considered as the first option.

However, certain pharmacological treatment is prescribed to patients, according to their specific symptoms. To stabilize the bouts of depression and extreme mood swings, antidepressants are also prescribed. In cases where severe distortion in thinking is observed, antipsychotic drugs are used.

Thus, borderline personality disorder is a condition of prolonged disturbance in the personality function of a person, wherein the patient goes through a series of ups and downs in mood behavior. They live in constant fear of loneliness and get frantic when someone they love gets separated even for a short period of time.

They get so depressed that they even try harming themselves and attempt suicide. Treatment is important because BPD patients cannot have stable relationships at home or at work, thereby disrupting their family, social, and work life.

Disclaimer: This story is for informative purposes only, and should not be used as a replacement for expert medical advice.