What Is BPD and What Does It Look Like?
Borderline personality disorder is not easy to define. It is a mental health disorder. It is serious and it is characterized by instabilities: unstable moods, unstable relationships, unstable behavior and an unstable sense of self. Someone with BPD is likely to have wildly fluctuating moods and to experience intense emotions. She has relationships with other people that are tumultuous and rocky. Her self-image is distorted and she feels flawed and worthless, even if others don’t view her that way. Classic symptoms of BPD include the following:- A pattern of turbulent relationships that rapidly veer from love and neediness to hate and anger.
- Dangerously impulsive behavior.
- Extreme reactions to the feeling of being abandoned, whether real or just perceived.
- Suicidal thoughts and behavior or self-harm, like cutting.
- A distorted self-image or a sense of being flawed, broken or worthless.
- Feeling bored and empty.
- Highly variable moods with intense feelings.
- Inappropriate rage and anger.
- Paranoia or dissociation. This could mean having out-of-body experiences or feeling out of touch with reality.
Causes of Borderline Personality Disorder
There’s no one cause of borderline personality disorder, but research suggests factors such as genetics, the environment and brain abnormalities contribute to its onset. Many people with borderline personality disorder report being abused. Some studies have found around 40 to 71% of BPD patients have been sexually abused. Other environmental factors such as stress or neglect can trigger the disorder in young adults. Brain imbalances of the chemicals serotonin, norepinephrine and acetylcholine are also believed to contribute to BPD. These chemicals help regulate emotions like sadness, irritability, anger and anxiety—emotions individuals with borderline personality disorder have difficulty controlling.Borderline Personality Disorder Treatment Challenges
Borderline personality disorder treatment can prove challenging due to the nature of the condition. Transference is a situation in therapy where the client unconsciously redirects expectations and emotions he or she feels toward an individual in their life, usually from childhood, onto the therapist. The therapist serves as an emotional vessel of sorts, allowing the client to work through past unresolved interpersonal issues in the present. Because people with borderline personality disorder can have especially intense emotions and black-and-white thinking when it comes to relationships, the therapist must be resilient while serving as the target of powerful emotions and accusations. They must work to keep their own countertransference in check. Patients can flip-flop between idealizing them one minute to detesting them the next. The therapist must weather these extremes and help the client work through deep-rooted feelings and difficulties from their past. Because of these tendencies, BPD residential treatment can also be difficult for people with borderline personality disorder. A large part of why inpatient mental health treatment is so transformative involves the interactions with a community of peers that help people learn about healthy interactions, trust and self-acceptance. Some psychologists believe the full potential of support and accountability a group of treatment peers usually offers cannot be realized in the case of borderline personality disorder because of their polarizing behavior. Though there is limited research on inpatient borderline personality disorder treatment, many clinicians believe inpatient treatment can cause BPD symptoms to worsen or have no effect at all based on what is known about the pathology of the diagnosis and individual accounts.Study Shows BPD Residential Treatment Is Effective
A study published in the Journal of Affective Disorders suggests that people with borderline personality disorder may indeed benefit from BPD residential treatment. Researchers examined outcomes for 245 people with borderline personality disorder receiving up to eight weeks of inpatient treatment in a psychiatric hospital. They compared these outcomes to those of 220 patients without BPD who received inpatient treatment at the same hospital, from the same staff, with the same therapies and approaches for similar amounts of time. The study authors wrote, “Current results indicate that extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in BPD patients.” They attribute the success to a few factors:- Secure, locked setting which helped prevent self-injury and suicide attempts
- Peer support and suicide alert system, which also helped prevent suicidality
- Patients were unable to engage in destructive behavior that fuel their disorder like substance abuse
- Medical staff ensuring medication adherence
- Approach that focused on emotion dysregulation, which is a key symptom in people with BPD
