Borderline Personality Disorder
What is borderline personality disorder?
Borderline personality disorder is a condition characterized by long-term mood instability that can disrupt relationships and lead to frequent changes in goals, values and self-identity. People who have borderline personality disorder have a tendency to see things as all bad or all good, and their views about specific people and conditions can fluctuate from one extreme to the other. Suicide attempts and self-injury without suicidal intent are both common.
Coexisting psychiatric conditions, such as depression, anxiety disorders, other personality disorders, or drug and alcohol abuse, may be present. Features of borderline personality disorder appear in other psychiatric conditions, such as mood disorders, post-traumatic stress disorder, and dissociative identify disorder.
Although the cause of borderline personality disorder is not known, it seems to be more common in those whose childhood or adolescence involved abandonment, neglect, separation, disruption, physical or sexual abuse, or poor communication within their families. Borderline personality disorder accounts for 20% of psychiatric hospitalizations, and it is more common in women. It is estimated that about 2% of adults are affected by this disorder (Source: NIMH).
People who have borderline personality disorder often fear abandonment. They may be sensitive to rejection and may meet even minor disappointments with anger. They may respond to perceived abandonment by threatening suicide or self-harm. Relationships may start with intense attachments and admiration, only to end abruptly with profound animosity and devaluation. Impulsive spending and sexual activity, bingeing, and drug use may occur.
The foundation of treatment for borderline personality disorder is psychotherapy, which is often at least partially effective. It may initially focus on self-destructive behaviors, and may start in the hospital if suicide is a concern. Longer-term therapy may include discussion of current and past issues, working on coping skills, and changing thoughts and behaviors. Medications can be helpful and may include mood stabilizers, antidepressants, or antipsychotics, depending on the person’s symptoms.
Self-harm and suicidal behavior, threats, and dangerous actions are common in people who have borderline personality disorder. Seek immediate medical care (call 911) for behavior or actions that could be dangerous, including threatening, irrational or suicidal behavior.
S eek prompt medical care if you are concerned about possible borderline personality disorder or if you are being treated for borderline personality disorder but symptoms recur or are persistent.
What are the symptoms of borderline personality disorder?
Long-term mood instability, which can disrupt relationships and lead to frequent changes in goals, values, relationships and self-identity, is a common symptom of borderline personality disorder.
Common symptoms of borderline personality disorder
Common symptoms of borderline personality disorder include:
- Fear of abandonment
- Feelings of being mistreated or misunderstood
- Feelings of emptiness or worthlessness
- Fluctuations in self-identity, goals and values
- Frequent mood changes
- Impulsivity in spending money, sexual activity, and eating
- Inability to bear being alone
- Inappropriate or excessive anger
- Sexual orientation instability
- Suicidal behavior, threats and actions
- Tumultuous relationships
Serious symptoms that might indicate a life-threatening condition
In some cases, borderline personality disorder can be life threatening. Seek immediate medical care ( call 911) if you, or someone you are with, have life-threatening symptoms including:
- Being a danger to oneself or others, including threatening, irrational or suicidal behavior
- Trauma, such as bone deformity, burns, lacerations, eye injuries, and other injuries
What causes borderline personality disorder?
The cause of borderline personality disorder is not known. Biologic and environmental factors have been identified. It is more common in people whose childhood or adolescence involved abandonment, neglect, separation, disruption, physical or sexual abuse, or poor communications within their families.
A number of factors increase the risk of developing borderline personality disorder. Not all people with risk factors will get borderline personality disorder. Risk factors for borderline personality disorder include:
- Abandonment or neglect as a child or adolescent
- Family separations or disruptions as a child or adolescent
- Female gender
- Physical abuse as a child or adolescent
- Poor bonding with parents
- Poor communication within the family
- Sexual abuse as a child or adolescent
How is borderline personality disorder treated?
Psychotherapy forms the foundation of treatment of borderline personality disorder. Medications may be used to treat mood instability, depression, or disordered thinking. Although borderline personality disorder can be difficult to treat, many people improve with therapy. A type of psychotherapy designed specifically for the treatment of borderline personality disorder, called dialectical behavior therapy, has shown promise in clinical trials.
Hospitalization may be needed as part of treatment if threats of suicide, substance abuse, or psychosis are present, or in times of significant stress.
Types of psychotherapy commonly used to treat borderline personality disorder
Different types of psychotherapy may be used to treat borderline personality disorder including:
Cognitive behavioral therapy to work on thought patterns and behavior
Dialectical behavior therapy to work on acceptance, problem solving, skill development, thought patterns, and behavior
Family therapy to help develop familial support and understanding
Psychodynamic therapy to work on discovering and understanding past issues and their relationship to current behaviors and actions
Medications that may be used in the treatment of borderline personality disorder
If there are coexisting psychiatric conditions or symptoms, such as depressed mood, unstable mood, or psychosis, medications may be used in addition to psychotherapy. Medications commonly used include:
- Antidepressants to treat depression or depressed mood
- Antipsychotics to treat psychoses or disordered thinking
- Mood stabilizers to treat bipolar disorder or unstable moods
What you can do to improve your borderline personality disorder
In addition to engaging in psychotherapy and taking medications if recommended, you may be able to improve the likelihood of success of your treatment by:
- Avoiding alcohol or illicit drugs
- Avoiding making decisions based on emotions
- Getting enough sleep
- Getting regular exercise
- Seeking help immediately if you feel like hurting yourself or others
Complications of untreated or poorly controlled borderline personality disorder can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of borderline personality disorder include:
- Abuse of drugs or alcohol
- Difficulties maintaining relationships
- Eating disorders
- Legal or financial problems
- Problems at work
- Social isolation
- Strained familial relationships