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Borderline Personality Disorder
Individuals suffering from borderline personality disorder have extreme and chronic instability in their emotional lives, as well as in their behavior and their self-image. This instability has a devastating and sometimes fatal effect on the individual's life. Those with BPD experience great difficulty in developing and maintaining relationships in both personal and professional areas of their life, and spend much of their time alternating between extremes of anger, depression, and emptiness.
Borderline is not an uncommon disorder, and is estimated to affect up to 2% of the general population. Up to 3/4 of individuals with BPD self-injure or engage in other self-destructive acts such as alcohol or drug abuse, sexual promiscuity, or overspending.
Borderline individuals lead tumultuous lives. Their moods and relationships are unstable, and usually they have a very poor self-image. They can rapidly alternate from one emotional extreme to the other, sometimes in a matter of minutes. At times these emotional shifts may be precipitated by external events, while at other times the trigger might be internal. BPD sufferers often feel empty and are at a great risk of dying by their own hands.
Borderlines fear abandonment and tend to have great difficulty forming and maintaining close relationships with others. They frequently engage in suicidal and/or self-mutilative behaviors, cutting or burning or punching themselves. Because their self-image is unstable, they frequently change jobs, friends, goals, and even personalities. Anxiety and depression are very common in individuals suffering from borderline personality disorder.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) 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)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
The characteristics of this personality disorder, including unstable relationships, lack of trust, and intense anger, often interfere with establishing the therapeutic relationship that is necessary for treatment to be successful. In addition, many mental health professionals are reluctant to treat individuals with this disorder and often experience "burn out" due to the high levels of anger directed toward the therapist. The extremely long course of treatment, and the energy and maintenance involved in working with someone persistently suicidal, can be a significant drain on the therapist. This not only makes it difficult for the borderline individual to find help, but it also adds to the feelings of low self-worth the individual already feels. This is very unfortunate as therapy is the treatment of choice for this personality disorder.
In order for therapy to be as effective as possible it should be highly structured and consistent, with appointments as often as possible for the patient. Many borderline individuals also benefit from participating in support groups or group therapy sessions. Dialectical Behavioral Therapy is believed to be the most effective type of psychotherapy for treating borderline personality disorder. DBT teaches the individual behavioral skills for interpersonal relationships and ways to effectively cope with sudden surges of emotion.
Medications such as antidepressants, mood stabilizers, and antipsychotics can also be very useful in the treatment of borderline personality. They can assist during times of heavy stress as well as ease some of the more distressing symptoms of the disorder long enough for therapy to be effective. Brief hospitalization may sometimes be necessary if suicide or other self-destructive behavior is threatened.
"I think the biggest problem I have had is always thinking my friends don't really like me. I misinterpret half of what they say to me and translate it to mean they don't want to be my friend anymore. Why should they? I am not worth their time or love or attention. Then I get angry with them and I turn on them. Hurt them before they can hurt me. It is so stupid, and I realize it later, but only after it is too late. And then I really do lose them. I hate this disorder!"
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This Site Updated 04/09/11
