Borderline Personality Disorder (BPD) - The Emotionally Unstable
Borderline Personality Disorder (BPD)
What Is Borderline Personality Disorder?
As with any personality disorder, Borderline Personality Disorder (BPD) can be extremely difficult to understand and to come to grips with. BPD can also have devastating effects on the family and friends of a person who suffers with the personality disorder.
Generally, those inflicted with Borderline Personality Disorder are extremely sensitive to the way that other people treat them and they may over-react whenever they perceive criticism or hurtfulness.
A Borderline personality's feelings about someone often shift suddenly from positive to negative within an instant, especially if they believe there is a risk of abandonment or loss.
However, this alone should not be taken as an indication of the disorder being present, as Borderline Personality Disorder goes a lot deeper than this.
What Are The Symptoms Of BPD?
Typically, the classic symptoms of a Borderline personality are unstable relationships, affective distress, impulsiveness and problems with an unstable self-image.
Borderline personalities often show extreme variability between anger, depression and anxiety and are extremely sensitive to any and all kinds of emotional stimulation.
The negative emotional states of a Borderline personality tend to fall into four categories: destructive/self-destructive feelings, fragmentation (lack of identity), feeling victimized and generally extreme emotions.
It's important to understand that Borderline personalities view the world as being hostile and full of dangers; living out in the big wide world is seen as being a risk. Borderline personalities may hide themselves away from the outside world in order to reduce this perceived risk factor.
Borderline Personality Disorder is also characterized by high levels of chronic stress, emotional abuse in relationships, dissatisfaction with relationship partners and even unwanted pregnancies; issues which are also often related to other personality disorders.
Impulsive behaviour is not uncommon for BPD's and can include alcohol/drug misuse, promiscuous/intense sexual behaviour, gambling and recklessness in general.
Whilst research indicates that BPD's can be novel, fun and that they have a high level of intimacy, studies also show that Borderline personalities are hyper-sensitive to signs of rejection and, in relationships, they often become insecure, preoccupied and/or avoidant at perceived external risk factors.
Borderline's tend to either idealize or demonize others, often switching between one or the other (Splitting). This undermines the relationships between friends, family and associates.
The most significant trait of the Borderline Personality Disorder is the process of self-harming.
In may cases, without the right treatment and the right diagnosis, self-harming can gradually worsen over time sometimes leading (in very extreme cases) to suicide.
However, self-harming is not always carried out with the intention of suicide although it is very common.
Why Do BPD's Self Harm?
Many BPD sufferers show mixed feelings about why they actually harm themselves, although most admit that they do not do it with the intention of suicide.
They most certainly do not do it for attention either - the self-harm is often carried out in private on a part of their body which will not be seen publicly.
Many reasons have been given for the act of self-harm including to help regulate internal memories, thoughts and emotions, to release anger, to slow down racing thoughts and to escape from emotional pain or periods of dissociation.
In terms of personal experience, many self-harmers seem to have an overwhelming sense of anger and frustration as a result of the underlying factors that contribute towards Borderline Personality Disorder.
They need to release this anger and frustration bit by bit to prevent it from sending them over the edge.
They cannot take these feelings out on other people, as other people may be innocent and ultimately other people do not deserve to be physically abused, therefore they take it out on themselves instead - it's their only release.
Borderline's care less about their physical self but are majorly concerned with their emotional self.
How Is BPD Diagnosed?
According to the DSM-IV-TR, there are a total of nine criteria, five of which must be present for an official diagnosis of Borderline Personality Disorder.
Although BPD was previously classed as a subset of Schizophrenia, BPD is now used more generally to explain emotional dysfunction and instability.
BPD is described as:
"a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms "
Whilst the onset of BPD (Borderline Personality Disorder) often occurs during adolescence, therapists are reluctant to offer an official diagnosis to a patient who is not yet eighteen years old.
The DSM-IV states "To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year."
What Causes BPD?
As with most personality disorders, the causes of the disorder are not fully understood.
However, it's not unusual for someone inflicted with BPD to have experienced abandonment, childhood trauma or abuse.
Other more diverse possibilities have also been suggested, such as genetic predisposition, brain abnormalities and neurobiological factors.
Many studies have shown a strong link between childhood sexual abuse and BPD. Incidentally, there have also been many reports of incest during the childhood of BPD sufferers.
Further research also shows how parents (of both genders) have often detached themselves emotionally during childhood and therefore the children's emotional needs had not been catered for sufficiently.
Rather interestingly, one study showed that if one identical twin was diagnosed with BPD the other twin also met the criteria in 35% of cases therefore many of the traits present in BPD could be influenced by genes.
Rather than having just one single cause, Borderline Personality Disorder (BPD) seems to be caused by a variety of different factors.
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How Is BPD Treated?
Research shows that BPD is not affected significantly by any medication.
However, some medications were shown to subtly alter mood and help prevent the risk of suicide but the long term effects of these medications are still unknown and prescribing medication to BPD patients is not recommended.
Whilst there is a variety of treatment available for Borderline Personality Disorder, the disorder is not curable.
The most effective treatments for BPD to be analyzed so far are two forms of CBT (Cognitive Behavioural Therapy) - Dialectical Behaviour and Schema-focused - and two forms of Psychodynamic treatments - mentalization based and transference-focused.
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