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What Is Borderline Personality Disorder?

Borderline personality disorder, or BPD, can be a difficult mental illness to understand. It is also a challenge to live with, but that’s just what 1 percent to 2 percent of the population does. BPD is as common as other more noteworthy mental illnesses like bipolar disorder and schizophrenia, and yet it gets little attention. There are effective treatments for BPD, but too many people go undiagnosed and don’t get the help they need. If the description of BPD here rings true to you and reminds you of someone you love or of yourself, it may be time to see a doctor about a diagnosis.

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 behaviors 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 behaviors.
  • Extreme reactions to the feeling of being abandoned, whether real or just perceived.
  • Suicidal thoughts and behaviors 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.

To be diagnosed with BPD you need to exhibit at least five of the symptoms and those symptoms need to be pervasive. That is, they last for a long time and are not just phases that you go through. Because there is such variety in the symptoms, BPD can look different from one person to another. It can also be difficult to diagnose in adolescents because many of the symptoms are similar to typical teenage behaviors.

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 they feel 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 behaviors. 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 behaviors 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

Is There Hope for Someone With BPD?

Yes, there is hope for anyone struggling with BPD, but a diagnosis is important for treatments to be appropriate and effective. If you or someone you care about is exhibiting signs of BPD, getting a correct diagnosis is your next crucial step. Unlike treatment for other mental illnesses, medications are not a major part of treatment for BPD. Drugs can help with certain symptoms like depression, but therapy is the main way in which BPD is treated, and it can be successful for most patients. There are a number of types of therapy that have been proven to help patients with BPD. A good therapist will work with a patient until the right kind of treatment is found. Most are based on the idea that you can learn to recognize your inappropriate or incorrect thoughts and behaviors and work toward changing them. In other words, you learn to be more self-aware and how to control emotions, feelings and negative thoughts. BPD is a frightening disorder and has long been misunderstood. With better awareness, more people will begin to realize that there is an answer and an explanation for their troubling moods and feelings. Most importantly, they will realize that help is available.

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