BORDERLINE PERSONALITY DISORDER

BORDERLINE PERSONALITY DISORDER

A. Introduction

Borderline Personality Disorder (BPD) is a serious mental illness which the

sufferer cannot control their emotions, thoughts, and behaviors adequately. BPD
is considered as a mental illness which in the border of neurosis and psychosis.
The sufferers tend to have a mood instability, a long episode of extreme
emotion, problematic relationships, and self-harm. BPD sufferers have extreme
mood-swings and view things in extreme, for instance all good or all bad. That
results in unstable relationships with others. They may view others as their friends
one day, and then enemy or traitor the next day.
Because they cannot control their thoughts, BPD sufferers likely to view
themselves as unworthy and they often have suicidal thoughts which can result in
suicide attempts if go untreated.

B. Symptoms and Causes

Another signs or symptoms of BPD is:

a. Efforts to avoid real or imagined abandonment, such as rapidly initiating
intimate (physical or emotional) relationships or cutting off communication
with someone in anticipation of being abandoned
b. A pattern of intense and unstable relationships with family, friends, and loved
ones, often swinging from extreme closeness and love (idealization) to
extreme dislike or anger (devaluation)
c. Distorted and unstable self-image or sense of self
d. Impulsive and often  dangerous behaviors, such as spending sprees, unsafe
sex, substance abuse, reckless driving, and binge eating. Please note: If these
behaviors occur primarily during a period of elevated mood or energy, they
may be signs of a mood disorder—not borderline personality disorder
e. Self-harming behavior, such as cutting

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f. Recurring thoughts of suicidal beh
g. aviors or threats
h. Intense and highly changeable moods, with each episode lasting from a few
hours to a few days
i. Chronic feelings of emptiness
j. Inappropriate, intense anger or problems controlling anger
k. Difficulty trusting, which is sometimes accompanied by irrational fear of
other people’s intentions
l. Feelings of dissociation, such as feeling cut off from oneself, seeing oneself
from outside one’s body, or feelings of unreality
Borderline personality disorder usually begins in early adulthood, and can get
worse or better with age.
The cause of BPD is still unknown, but there are few risk factors that can
increase the chance to develops BPD. Such factors are:
a. Family History. People who have a close family member, such as a parent or
sibling with the disorder may be at higher risk of developing borderline
personality disorder.
b. Brain Factors. Studies show that people with borderline personality disorder
can have structural and functional changes in the brain especially in the areas
that control impulses and emotional regulation. But is it not clear whether
these changes are risk factors for the disorder, or caused by the disorder.
c. Environmental, Cultural, and Social Factors. Many people with borderline
personality disorder report experiencing traumatic life events, such as abuse,
abandonment, or adversity during childhood. Others may have been exposed
to unstable, invalidating relationships, and hostile conflicts.

C. Diagnose

Borderline personality disorder is diagnosed based on a:

a. Detailed interview with your doctor or mental health provider
b. Psychological evaluation that may include completing questionnaires

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c. Medical history and exam
d. Discussion of your signs and symptoms
BPD is hard to diagnose because of the heterogenity of BPD, which has
characterize by four main components from DSM criteria: emotion dysregulation,
impulsivity, interpersonal turmoil, along with cognitive and identity disturbances.
The diagnostic system contributes to the heterogeneity as no single criterion is
required to be present for this diagnosis. The presence of any 5 out of the 9
criteria warrants a diagnosis, resulting in 126 possible combinations of symptoms
that would result in a diagnosis. Moreover, the high rate of concurrent comorbid
psychiatric disorders and physical health problems leads to complications that
must be considered when providing treatment or designing a research study for
BPD sufferers.

D. Treatments

Treatments for BPD sufferers include:

a. Psychotherapy
Psychotherapy is the essential treatment for BPD sufferers. It’s goals are
to:
1. Focus on your current ability to function
2. Learn to manage emotions that feel uncomfortable
3. Reduce your impulsiveness by helping you observe feelings rather than acting
on them
4. Work on improving relationships by being aware of your feelings and those
of others
5. Learn about borderline personality disorder
There are different types of psychotherapy used to treat BPD:
 Dialectical Behavior Therapy (DBT): This type of therapy was developed
for individuals with borderline personality disorder. DBT uses concepts of
mindfulness and acceptance or being aware of and attentive to the current
situation and emotional state. DBT also teaches skills that can help: Control

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 intense emotions, reduce self-destructive behaviors, and improve
relationships.
 Cognitive Behavioral Therapy (CBT): This type of therapy can help people
with borderline personality disorder identify and change core beliefs and
behaviors that underlie inaccurate perceptions of themselves and others, and
problems interacting with others. CBT may help reduce a range of mood and
anxiety symptoms and reduce the number of suicidal or self-harming
behaviors.
 Schema-focused therapy: Schema-focused therapy can be done individually
or in a group. It can help you identify unmet needs that have led to negative
life patterns, which at some time may have been helpful for survival, but as
an adult are hurtful in many areas of your life. Therapy focuses on helping
you get your needs met in a healthy manner to promote positive life patterns.
 Mentalization-based therapy (MBT): MBT is a type of talk therapy that
helps you identify your own thoughts and feelings at any given moment and
create an alternate perspective on the situation. MBT emphasizes thinking
before reacting.
 Systems training for emotional predictability and problem-solving
(STEPPS): STEPPS is a 20-week treatment that involves working in groups
that incorporate your family members, caregivers, friends or significant others
into treatment. STEPPS is used in addition to other types of psychotherapy.
 Transference-focused psychotherapy (TFP): Also called psychodynamic
psychotherapy, TFP aims to help you understand your emotions and
interpersonal difficulties through the developing relationship between you
and your therapist. You then apply these insights to ongoing situations.
 Good psychiatric management: This treatment approach relies on case
management, anchoring treatment in an expectation of work or school
participation. It focuses on making sense of emotionally difficult moments by
considering the interpersonal context for feelings. It may integrate
medications, groups, family education and individual therapy.

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b. Medications
Although there are no specific medications to treat BPD, a psychiatrist
may prescribe medications to treat BPD symptoms such as, depressions,
impulsiveness, mood swings, anxiety, or agresiveness.

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 REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of

Mental Disorders (4th ed., Text Revision Author). Washington, DC:
American Psychiatric Publishing..
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of
Mental Disorders (5th ed.) Washington, DC: American Psychiatric
Publishing.
Stepp, Stephanie D. (2012). Development of Borderline Personality Disorder in
Adolescence and Young Adulthood: Introduction to the Special Section.
Journal of Abnormal Child Psychology, 40, 1-5. doi:  [10.1007/s10802-
011-9594-3].