How Does Borderline Personality Disorder Differ From Somatoform Disorders?

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How Does Borderline Personality Disorder Differ From Somatoform Disorders?New findings from a team of Dutch and American researchers indicate that people with borderline personality disorder (BPD) have symptoms that partially overlap with conditions called somatoform disorders, although BPD symptoms also differ in important ways.

Borderline personality disorder is largely characterized by a poor ability to regulate emotions and related problems with maintaining stable relationships. In a study published in March 2015 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from one Dutch institution and one American institution compared the emotion and relationship stability difficulties associated with BPD to the emotion and relationship stability difficulties associated with a group of illnesses known as somatoform disorders or somatic symptom disorders. The researchers concluded that BPD and somatoform disorders have some similarities, as well as some notable differences.

Borderline Personality Disorder

Borderline personality disorder belongs to a larger group of mental health conditions called Cluster B personality disorders; all Cluster B conditions are distinguished by some sort of problem with erratic behavior, difficulty maintaining emotional control and difficulty avoiding acting in an impulsive or reckless manner. In the case of BPD, manifestations of these generalized symptom categories include intensely emotional responses to perceived or actual abandonment by others, “split” relationships with friends and loved ones that teeter between extremes of adoration and demonization, unreasonable outbursts of anger and repeated involvement in reckless behaviors with potentially severe negative consequences (e.g., driving at high speeds or consuming excessive amounts of drugs or alcohol).

Additional symptoms of borderline personality disorder include lack of a consistent or realistic sense of self, feelings of detachment from reality, involvement in self-harming behavior not intended to cause death and involvement in suicidal thinking, planning or action. Affected individuals must have five out of nine potential symptoms of the condition. Since the symptoms of BPD are quite wide-ranging, this effectively means that one person with the disorder may have problems that differ considerably from the problems found in another person with the disorder. Current best estimates indicate that about 1.6 percent of American adults have BPD, although actual rates for the condition may be as high as 6 percent of the adult population.

Somatoform Disorders

Somatoform disorders (now officially termed somatic symptom disorders by the American Psychiatric Association) are a group of mental health conditions that center on the development of medical symptoms that seem excessive for an individual’s actual physical condition. Illnesses previously listed in this category include hypochondriasis (i.e., hypochondria) and body dysmorphic disorder. However, in 2013, the APA discontinued use of the term somatoform disorder and reclassified the conditions in this category under names that include somatic symptom disorder, factitious disorder and conversion disorder. Due to the fairly lengthy amount of time it takes to design, conduct and accurately report scientific studies, researchers still commonly refer to somatoform disorders in their work, not somatic symptom disorders.

Differences and Similarities With BPD

In the study published in Borderline Personality Disorder and Emotional Dysregulation, researchers from the University of Connecticut Health Center and the Netherlands’ VU University Amsterdam used a project involving 472 adults to compare the emotion and relationship stability problems found in people with borderline personality disorder to the emotion and relationship stability problems found in people with somatoform disorders or somatic symptom disorders. Roughly 25 percent of the participants only had a diagnosis for BPD, while approximately 33 percent only had a diagnosis for a somatoform disorder. Another quarter of the study participants had a combined diagnosis for BPD and a somatoform disorder, while the remaining participants had mental health problems unrelated to BPD or somatoform disorders.

The researchers specifically wanted to know if the emotional control and relationship stability problems associated with BPD and somatoform disorders stem at least partially from poor bonding attachment during childhood and the formation of anxiety-based or avoidance-based relationships in adulthood. After completing an analysis of the participant subgroups, they concluded that attachment difficulties do play a role; however, the nature of that role varies between borderline personality disorder and somatoform disorders. While people with BPD express their attachment distress through “hyperactive” loss of emotional control that excessively activates the bonding urge, people with somatoform disorders express their distress through an “underactive” loss of emotional control that essentially deactivates the bonding urge. People affected by BPD and a somatoform disorder shift in a disorganized fashion from hyperactive bonding urges to underactive bonding urges.

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