The signs that can make you suspect a borderline personality disorder
Borderline personality disorder
Borderline personality disorder (BPD) is a mental health condition in which a person exhibits violent or unstable emotional patterns over the long term. These inner experiences are often the cause of impulsive actions and chaotic relationships with other people.
A borderline personality disorder is characterized by a persistent pattern of instability and hypersensitivity in interpersonal relationships, instability in the personal image, extreme fluctuations in mood, and impulsiveness. The diagnosis is made by clinical criteria. The treatment is carried out with psychotherapy and medications.
Patients with borderline personality disorder have an intolerance of loneliness; they make frantic efforts to avoid abandonment and generate crises, such as making suicidal gestures in a way that invites rescue and care for others.
The reported prevalence of borderline personality disorder in the United States is variable. The estimated average prevalence is 1.6%, but it can go up to 5.9%. In patients hospitalized for mental health disorders, the prevalence is approximately 20%. About 75% of patients diagnosed with this disorder are women, but in the general American population, the ratio of men to women is 1:1.
The cause of borderline personality disorder is unknown. Genetic, family and social factors are believed to play a role in the causes.
Among the BPD risk factors we find:
- Abandonment during childhood or adolescence
- Unstable family life
- Little communication in the family
- Physical or emotional abuse.
This personality disorder tends to appear more frequently in women and among hospitalized psychiatric patients.
Tensions during early childhood can contribute to the development of borderline personality disorder. A history of physical and sexual abuse, neglect, separation from caregivers, and/or loss of a parent during childhood is common among patients with a borderline personality disorder.
Certain people may have a genetic tendency to develop pathological responses to environmental stresses, and borderline personality disorder appears to have an inherited component. First-degree relatives of patients with borderline personality disorder are 5 times more likely to have the disease than the general population.
Alterations in the regulatory functions of the brain and neuropeptide systems may also contribute, but are not present in all patients with a borderline personality disorder.
People with BPD are often undefined concerning their identity. As a result, your interests and values can change rapidly. They also often see things in terms of extremes, that is, everything is very good or everything is very bad. Your opinion of other people can change quickly. The person they admire today may be looked down upon tomorrow. These suddenly changing feelings often create intense and unstable relationships.
Other symptoms of BPD are:
- Intense fear of abandonment
- Intolerance of being alone
- Frequent feelings of emptiness and boredom
- Frequent outbursts of inappropriate anger
- Impulsiveness, as with substance abuse.
- Repeated seizures and self-harm, such as cuts to the wrists or overdose.
When borderline personality disorder patients feel that they are being neglected, their emotion is one of intense fear or anger. For example, they may panic or rage when someone important to them is a little late or cancels a commitment. They think that this abandonment means that they are bad. They fear abandonment in part because they don’t want to be alone.
These patients tend to change their views of others abruptly and drastically. They can idealize a potential caregiver or lover from the beginning of the relationship, require spending a lot of time together, and sharing everything. Suddenly, they may feel that the person does not care enough, and they become disappointed; then they can belittle or get angry with the person. This shift from idealization to devaluation reflects black and white thinking (division, the polarization of good and evil).
Patients with a borderline personality disorder can identify with and care for a person, but only if they feel that someone else will be there for them when necessary.
Patients with this disorder have difficulty controlling their anger and often show inappropriate and intense anger. They may express their anger with sarcasm, bitterness, or angry rants, often directed at their caregiver or lover due to neglect or neglect. After the crisis, they often feel ashamed and guilty, reinforcing their sense of being bad.
Patients with borderline personality disorder can also abruptly and dramatically change their image, which is reflected by sudden changes in goals, values, opinions, careers, or friends. They can be helpful one minute and be angry that they were mistreated the next moment. Even though they generally see themselves as bad, they sometimes feel that they don’t exist at all, for example, when they don’t have someone to care about them. They often feel empty inside.
Changes in mood (e.g., severe dysphoria, irritability, anxiety) usually last only a few hours and rarely persist for more than a few days; They may reflect extreme sensitivity to interpersonal stress in patients with a borderline personality disorder.
Patients with a borderline personality disorder often sabotage themselves when they are about to reach a goal. For example, they may drop out of school just before graduation, or they can ruin a promising relationship.
Exams and tests
BPD is diagnosed based on a psychological evaluation that looks at the history and severity of symptoms.
Individual talk therapy can successfully treat BPD. Likewise, group therapy can also be useful at times.
Medications play a minor role in treating BPD. However, in some cases, they can improve mood changes and treat depression or other disorders that may occur with this condition.
The impulsiveness that generates self-harm is common. These patients can gamble, have unprotected sex, compulsive eating, reckless driving, substance use, or overspending. Suicidal behaviors, gestures, threats, and self-mutilation (e.g. cuts, burns) are very common. Although many of these self-destructive acts are not intended to end life, the risk of suicide in these patients is 40 times greater than that of the general population; about 8 to 10% of these patients die from suicide. These self-destructive acts are generally caused by rejection, possible abandonment, or disappointment by a caregiver or lover. Patients can self-mutilate to compensate for their wickedness or to reaffirm their ability to feel during a dissociative episode.
Dissociative episodes, paranoid thoughts, and sometimes psychotic-type symptoms (eg, hallucinations, ideas of reference) can be triggered by extreme stress, usually, fear of abandonment, whether real or imagined. These symptoms are temporary and are generally not severe enough to be considered a separate disorder.
Symptoms decrease in most patients; the relapse rate is low. However, the functional state does not usually improve so dramatically.
The general treatment of borderline personality disorder is the same as for all personality disorders.
The identification and treatment of coexisting disorders are important for the effective treatment of borderline personality disorder.
The main treatment for a borderline personality disorder is psychotherapy.
Many psychotherapeutic interventions are effective in reducing suicidal behaviors, alleviating depression, and improving function in patients with this disorder.
Cognitive-behavioral therapy focuses on emotional dysregulation and a lack of social skills. Includes the following:
Dialectical behavioral therapy (which combines individual and group sessions with therapists who act as behavioral trainers and are available on the phone 24 hours a day)
Systems of training for emotional predictability and problem-solving (STEPPS)
STEPPS consists of weekly group sessions for 20 weeks. Patients are taught skills to manage their emotions, to challenge negative expectations, and to take better care of themselves. They learn to set goals, avoid illegal substances, and improve their eating, sleeping, and exercising habits. Patients are asked to identify a support team made up of friends, family, and healthcare professionals who are willing to support them when they are in crisis.
Other interventions focus on disorders in the way patients experience emotions for themselves and with others. These interventions include the following:
- Mentalization-based treatment
- Transfer-focused psychotherapy
- Schema-focused therapy
Mentalization refers to the ability of people to reflect and understand their state of mind and the state of mind of others. It is believed that mentalization should be learned through a secure bond with the caregiver. Mentalization-based treatment helps patients do the following:
- Regulates your emotions effectively (eg, calm down when upset)
- Understand how they contribute to their problems and difficulties with others
- Reflect and understand the minds of others
Therefore, it helps them to relate to others with empathy and compassion.
Transfer-focused psychotherapy focuses on the interaction between the patient and the therapist. The therapist asks questions and helps patients think about their reactions so they can examine their distorted, exaggerated, and unrealistic self-images during the session. The current moment (eg, how patients are related to their therapist) is highlighted more than the past. For example, when a shy, calm patient suddenly becomes hostile and inquisitive, the therapist may ask if the patient noticed a change in feelings, and then ask the patient to think about how the therapist and himself felt when produced the change. The purpose is
To enable patients to develop a more stable and realistic sense of themselves and others
Relate to others more healthily through a transfer with the therapist
Schema-focused therapy is a comprehensive therapy that combines cognitive behavioral therapy, attachment theory, psychodynamic concepts, and emotion-focused therapies. It focuses on lifelong maladaptive patterns about thinking, feelings, behavior, and adaptation (called schemas), affective change techniques, and the therapeutic relationship, with limited re-parenting. It involves establishing a secure bond between the patient and the therapist (within professional limits), allowing the therapist to help the patient experience what he lost during childhood and that led to the development of maladaptive behavior.
The purpose of schematic focused therapy is to help patients change their schemas. The therapy has 3 stages:
Evaluation: Identification of the schemes
Consciousness: recognition of schemas when they are operating in daily life
Behavioral change: replacing negative thoughts, feelings, and behaviors with healthier ones
Some of these interventions are specialized and require specialized training and supervision. However, some interventions do not; one of these interventions, which is designed for the general practitioner, is
General psychiatric management
Good psychiatric management includes individual therapy once a week, psychoeducation on borderline personality disorder and the goals and expectations of treatment, and sometimes drugs. It focuses on the patient’s reactions to interpersonal stressors in everyday life.
Supportive psychotherapy is also helpful. The goal is to establish an encouraging emotional support relationship with the patient and thus help them develop healthy defense mechanisms, especially in interpersonal relationships.
Medications work best when used sparingly and consistently for specific symptoms.
SSRIs are generally well tolerated; the risk of a fatal overdose is minimal. However, SSRIs are only marginally effective for depression and anxiety in patients with a borderline personality disorder.
The following medications are effective in improving symptoms of borderline personality disorder:
Atypical Antipsychotics (Second Generation) – For anxiety, anger, and cognitive symptoms, including transient stress-related cognitive distortions (eg, paranoid thoughts, black-and-white thinking, severe cognitive disorganization)
Benzodiazepines and stimulants can also help alleviate symptoms but are not recommended due to the risk of dependency, overdose, disinhibition, and drug abuse.