Borderline Personality Disorder
Symptoms and treatment of BPD
A person with borderline personality disorder shows marked instability in relationships, mood and self-image, and has little impulse control. The disorder begins by early adulthood.
A person with BPD may present with at least five of the following symptoms:
- Self-image is markedly disturbed, distorted or unstable
- Chronic feelings of emptiness
- Fear of abandonment
- Moods are intense with episodes of depression, irritability or anxiety, which last for hours or days
- Interpersonal relationships are affected as the person alternates between extremes of idealization and devaluation of others
- A person with BPD shows emotional instability with inappropriate anger or recurrent physical fights
- Disturbed perceptions arise from stress-related feelings of persecution or dissociative symptoms (feelings of discontinuity of experiences)
- Impulsiveness in two of the following areas help support the diagnosis: substance abuse, spending, sex, reckless driving and / or binge eating
- Repeated suicidal attempts or threats and self-mutilating behavior like self-cutting or burning
Health professionals can do an evaluation of symptoms through verbal and / or written tests. They will also require a physical exam and complete medical history.
The disorder is seen two to three times more often in women than men. It can be related to genetic or hormonal influences, which may partially explain why women are more often affected. Early childhood experiences are likely to play a role, as well. BPD affects about 2 percent of the general population.
People with BPD often have stormy relationships because of their mood changes, and also may distance themselves before they become "abandoned." Extreme stress can produce short, psychotic breaks. In fact, BPD is so named because people with borderline personalities range between neurotic and psychotic.
Persons with BPD often have problems in interpersonal relationships and their work lives. An emotional crisis may force some to seek treatment. They sometimes require hospitalization during acutely stressful episodes or for suicide attempts.
A psychotherapist has an arsenal of treatments that can be effective in varying degrees. Therapists often must treat presenting symptoms as they arise. Antidepressants may help control irritability and depression, mood stabilizers may help control impulsive behaviors and atypical antipsychotics may help reduce impulsive and reckless behavior.
Patients with BPD can be quite a challenge to their families and therapists. They require trust and setting strong boundaries so they can develop a separate identity. People with BPD often bait others into behavior that allows them to create a conflict situation, which they can watch while disavowing their part in the drama. They can also be seductive and manipulative, and may try to lure others into a codependent relationship.
Therapists must maintain the patient's trust and confidentiality even while reaching out to families. Affected family members should be present to discuss treatment goals, so the family knows how to help and what to expect. A therapist wants to provide stability, predictability and a contract of goals and expectations.
Some patients need immediate control of self-destructive impulses, some need to develop stable relationships and others need to develop a stable identity. Patients must develop support systems while seeking long-term recovery.
Crisis intervention can last a few days to weeks. With counseling and medication, many patients obtain some relief within the first year. However, for those with lifelong symptoms, who were perhaps abused as a child or also had problems with aggression, depression, substance abuse or other mental health problems, treatment can go on for 10 years or more.
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