Borderline Personality Disorder

Overview An overview of borderline personality disorder.

What is borderline personality disorder (BPD)? Signs of a problem Types of treatment What to do if someone you know has the disorder Where to get help or more information

Some people go through life as if they are riding on an emotional roller coaster. Troubled by dramatic shifts in mood, they have no consistent sense of identity and often change personalities like changing an outfit, depending on their surroundings. As a result, they often act impulsively -sometimes dangerously -- and have fragile self-esteem. People who are stuck in this pattern of chaotic behavior dont choose to act this way, but are suffering from a serious mental health problem called borderline personality disorder (BPD). The term borderline was originally coined to describe a disorder that was neither a neurotic or psychotic state, but fell somewhere in between. Todays psychiatrists use a different framework for understanding BPD, which includes looking at typical patterns of behavior to make a diagnosis. These behaviors include a pattern of seeing things as either all good or all bad, a pattern of unstable relationships, a history of self-destructive or self-mutilating behaviors, a pattern of rapid and dramatic shifts in mood. People with BPD tend to have stormy intimate relationships, but often function very well in a work setting where the expectations of them are clear and consistent. In recent years, mental health professionals have made some breakthroughs in understanding and treating BPD, but there is still controversy about how to treat the disorder and whether it is treatable. Mental health treatment, which involves learning new coping skills, offers some hope that people with BPD can recover to lead healthier and more productive lives. What is borderline personality disorder (BPD)?
BPD is a common mental disorder that afflicts about 6 million Americans. More than 10 percent of all people who receive psychiatric treatment suffer from BPD. Women are three or four times more likely to be diagnosed with this disorder than men. People with BPD are overwhelmed by intense feelings of rage and anxiety, have a shaky sense of who they are, and suffer from profound depression under the emotional extremes. They often engage in impulsive behavior such as
67010-0402

Borderline Personality Disorder

angry outbursts, excessive spending, risky sex, and binge eating. BPD makes it difficult to maintain stable relationships, since borderlines will often flip flop between lashing out and clinging to the people connected to them. In addition, more than 75 percent of people with the disorder engage in self-destructive behavior such as self-mutilation or drug and alcohol abuse. BPD also carries a serious risk of suicide. About 10 percent of people with BPD do eventually kill themselves. The symptoms of BPD usually begin in late adolescence. There is no single known cause for BPD. A history of childhood trauma such as sexual abuse, physical abuse, or neglect, which is present about 75 percent of the time, may play a key role in the onset of BPD. There is also evidence that children who, for any of a variety of reasons, have been separated from the primary caregiver in early childhood are more likely to develop the disorder. Impaired brain functioning, which may be due either to abuse or to faulty genes, may also be a risk factor. For example, researchers have noticed that some people with BPD have a damaged amygdala, a small almond-sized structure deep inside the brain that regulates negative emotion.

Signs of a problem
You may be suffering from BPD if you have five (or more) of the following symptoms:
fragile sense of self excessive fear of abandonment self-mutilating behavior (such as burning oneself on the arm) a pattern of love/hate relationships intense mood swings chronic feelings of emptiness or boredom impulsive behavior (such as reckless driving) frequent displays of anger frantic attempts to avoid real or imagined abandonment feelings of unreality

These symptoms, in turn, reflect difficulties in four areas of life:

inability to regulate emotions negative self-image

Borderline Personality Disorder

unstable relationships impulsive behavior

Another characteristic of BPD is the tendency to be victimized. For example, studies show that women with BPD are more likely to be a victim of rape than women without the disorder. Experts attribute this pattern to impaired judgment. For example, a woman with BPD may not be hesitant to date a man who has a long history of violent relationships with women, or may stay with an abusive partner out of intense fear of being alone.

Types of treatment
Since the symptoms of BPD are usually deeply entrenched, BPD is not easy to treat. If you are in crisis (say, you are having difficulty controlling self-mutilating behavior) you may need a brief hospital stay of a week or two before you are stable enough to begin outpatient psychiatric treatment. Most experts maintain that long-term psychotherapy is necessary for helping people change the selfdefeating pattern of behavior associated with BPD. Successful therapy typically takes at least a couple of years. Medication can also be helpful in reducing specific symptoms (such as depression, for example), but it cant serve as a substitute for therapy.

Psychotherapy
A new form of psychotherapy called dialectical behavior therapy (DBT), which was specifically designed to help people with BPD, has emerged as the treatment of choice. For example, research shows that DBT is much more effective in reducing both self-mutilating behavior and in-patient hospital stays than nonspecialized psychotherapy. Based on the principles of cognitive-behavioral therapy, DBT helps people examine the irrational thoughts that can lead to their symptoms. DBT usually begins with a pre-treatment phase in which the therapist conducts a thorough assessment and provides an overview of the therapy process. Therapists who use DBT require a commitment of at least a year. There are three stages of treatment:
Stage 1 addresses self-destructive behavior such as self-mutilation. The therapist teaches strategies for helping people refrain from hurting themselves when they feel angry or upset. Stage 2 focuses on processing traumatic memories. A history of abuse or neglect can often give rise to many troubling feelings. For example, if you were neglected as a child, you may be preoccupied by fears of abandonment. By examining such

Borderline Personality Disorder

painful events in your past, you can begin to relate to others in more selfassertive ways.
Stage 3 helps you to improve your self-image and address current life issues. Once you are better able to regulate your emotions, you can set goals for yourself in other areas of your life. For instance, since BPD often leads people to be underemployed, you might want to work on building your career.

Skills training is often an important part of treatment. For example, you might benefit from learning how to express your anger constructively. Sometimes, in addition to individual therapy, people attend specialized groups to learn these skills, which can be instrumental in helping them to build more stable relationships.

Medication
Medication can be a useful addition to psychotherapy for most people suffering from BPD. And it is not uncommon to take more than one type of medication. Most medications are prescribed for relief of symptoms like anxiety or depression. Persons with BPD should talk to their primary care physician or therapist to find out if medication is right for them.

What to do if someone you know has the disorder

If a friend or family member has BPD, you can help by doing the following:
Educate yourself about BPD. Understanding the symptoms can lead you to become more compassionate. Its important to separate the person from the behavior. Even though a person with BPD may act in ways that are harmful to herself or others, she isnt a bad person. Encourage the person to seek help. People with BPD are often reluctant both to seek psychotherapy and to stick with it. You might need to serve as a sounding board as the person expresses fears about the treatment process. However, youll need to accept that all decisions about treatment are out of your hands. Ultimately, only he can make the commitment to change his behavior. Take all acts of self-mutilation and any talk of suicide very seriously. If you discover that the person has hurt herself (cut her wrists, for example), you should take her to the emergency room or contact her therapist immediately.

Where to get help or more information

To get a mental health evaluation, find a therapist, or learn more about BPD, you might consider the following options:
Make an appointment with your primary care physician. Your primary care physician can both give you a mental health evaluation and make a referral to a therapist. In fact, in some health plans, your primary care physician serves as the gate-

Borderline Personality Disorder

keeper for all mental health referrals. Youll probably want to request a therapist who has experience in working with people with BPD. Since the therapeutic relationship is critical for the success of treatment, you may want to meet with a few therapists before selecting one.
Contact your employee assistance program (EAP). Your EAP can set up a mental health evaluation with an employee assistance professional -- a therapist who typically has an advanced degree in psychology or social work. If this counselor suspects that you have BPD, he can refer you to another mental health professional for long-term psychotherapy. Log on to www.bpdcentral.com or www.mhsanctuary.com/borderline. These Web sites can provide you with educational materials along with information about support groups and other resources.

2002 Ceridian Corporation. All rights reserved.