Borderline personality disorder; a “borderline case”

Borderline personality disorder (BPD) is a serious mental illness characterized by instability in moods, interpersonal relationships, self-image and behavior. This instability often disrupts work and family life, long-term planning, the individual and the sense of self-identity. People with BPD were originally thought to be on the “borderline” of psychosis, but people with BPD suffer from a disorder of emotion regulation. Although less known than schizophrenia and bipolar disorder (manic-depressive illness), BPD is more common. About 2 percent of adults, mostly young women, suffer from this disease. There is a high rate of self-harm without suicidal tendencies, as well as a significantly high rate of suicide attempts and, in severe cases, suicide. Patients often require extensive mental health and psychiatric services. But, with good help, there is a good chance of improvement and patients can ultimately lead productive lives.

Symptoms

While a person with depression or bipolar disorder may have a longer state of mind, in a patient suffering from BPD the state of mind often lasts no longer than an hour or at most a day. This may be accompanied by episodes of impulsive aggression, self-harm and drug or alcohol abuse. Disturbances in cognitive and self-esteem can lead to frequent changes in long-term goals such as; career, work, friendships, identity and values and norms. Sometimes people with BPD see themselves as fundamentally bad or unworthy. They may feel unfairly misunderstood or mistreated, feel bored, empty and have little idea of the person they are. These symptoms are most acute when people with BPD feel isolated and lack social support and this can lead to exaggerated attempts to avoid being alone.
People with BPD often have very unstable patterns of social relationships. They may develop stormy and intense relationships, but in addition, their attitude towards family, friends and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and disgust). They may immediately bond with and idealize a person, but when a mild separation or conflict occurs, they unexpectedly go to the other extreme and accuse the other person of not caring for them at all. Even among family members, individuals with BPD are highly sensitive to rejection and respond with anger and panic to mild separations such as a vacation, business trip, or a sudden change in plans. The fear of abandonment appears to be related to having difficulty staying emotionally connected to important people while they are physically absent, leaving the person with BPD feeling lost and perhaps worthless. Suicide threats and suicide attempts may result, along with expressing anger over perceived neglect and disappointments.
People with BPD also exhibit other impulsive behavior such as; excessive spending, binge eating and risky sex. BPD is often accompanied by other psychiatric problems, especially bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Therapy

Treatments for BPD have improved in recent years. Group and individual psychotherapy are certainly largely effective for many patients. In the past 15 years, a new psychosocial treatment, the so-called Dialectical Behavior Therapy (DBT), has been developed. This is specifically aimed at treating BPD and appears to be promising. Medicinal treatments are often prescribed on an individual patient basis, based on specific symptoms. Antidepressants and mood stabilizers can be supportive for depression and/or unstable mood. Antipsychotics can be used if there are disturbances in thinking.

Recent research results

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in patients with BPD symptoms and characteristics. Studies show that many BPD patients have a history of abuse, neglect, or divorce at a young age. Forty to 71 percent of patients have been sexually abused. Researchers believe that BPD results from a combination of individual vulnerability to stress, neglect or abuse at a young age, and a series of events that lead to the onset of the condition in young adulthood. Adults with BPD are also significantly more likely to be victims of violence, rape, and other crimes.
Neuroscientific research shows brain mechanisms underlying impulsivity, mood instability, aggression, anger and negative emotions that occur in BPD. Serotonin, Acetylcholine and Norepinephrine are among the chemical messengers in the brain that play a role in the regulation of emotions such as sadness, anger, fear and irritability. Drugs that improve serotonin function in the brain may have a beneficial effect on the emotional symptoms of BPD. Mood-stabilizing drugs can also help people who have BPD mood swings because of their ability to increase the activity of GABA, the main inhibitory neurotransmitter in the brain. These types of neurological vulnerabilities can be controlled with behavioral therapy and medications, just as people with diabetes or high blood pressure can control them.
The National Institute of Mental Health (NIMH) in the USA has been the only truly influential source of rigorous research and reliable information about the underlying biological causes of Borderline Personality Disorder. Studies have shown how effective Tegretol (carbamazipine) and neuroleptics are in Borderline, and how dangerous the use of Xanax (alprazolam) can be.

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