Borderline Personality Disorder (BPD) is a serious cluster B mental health condition that affects approximately 2% of the population. Its sufferers experience episodes of emotional intensity that are difficult to contain, meaning that they lose control of their feelings and reactions to given situations. BPD is a medical diagnosis recognized in the Psychiatric Diagnostic and Statistical Manual (DSM) and is more common in women than men. Only 1 in 4 diagnosed is male. In 1938, the American psychoanalyst Adolph Stern first described most of the symptoms that are now considered as diagnostic criteria of borderline personality disorder. BPD is related to a condition called Emotional Dysregulation, a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. Emotional Dysregulation is also referred to as labile mood (a marked fluctuation of mood) or mood swings. BPD also used to known as Emotionally Unstable Personality Disorder.
Borderline Personality Disorder often co-occurs with other disorders, such as Bipolar II, ADHD and substance misuse disorders.
Description of BPD;
When the average person feels anger, sadness, or emotional pain, adaptive (well-functioning) coping mechanisms kick-in to contain the feelings. These coping skills ensure that the intensity of feeling does not overwhelm the individual and cause them to express feelings in destructive ways such as violence toward self or others. This is described as having the ability to self-soothe, i.e. think and behave in ways that help one feel calmer and in control of emotions and behaviours.
Under extreme emotional distress, such as natural disaster, loss of a loved one, or a threat to one’s sense of emotional or physical safety, even the average person’s ability to manage painful feelings may become overwhelmed. An individual may experience the sense of losing touch with the current reality, becoming numb (shut down emotionally) or demonstrate an extreme and immediate deterioration of the ability to take care of him or herself, (e.g. having a “nervous breakdown”). Sometimes a person in this situation will act out with rage as in a “crime of passion.”
Individuals with BPD often have difficulty with self-soothing and may have a biological predisposition to feel things more deeply than the average person. They may more readily perceive threats to their emotional or physical safety in situations that most people do not interpret as dangerous. They may express anger as rage and verbally or physically attack the source of such anger. Emotional pain is felt with extreme intensity and can be unbearable. Many with BPD have suicidal thoughts and approximately 10 percent will commit suicide. Some may cut or otherwise harm themselves to manage their internal suffering.
Borderline Personality Disorder is caused by a genetic predisposition to personality disorders, environment can then increase the risk of one or more developing, although it is not needed in all cases. Biological and environmental risks interact to cause a brain dysfunction that rises beyond a critical level, leading BPD symptoms to appear. One key trigger for emotional or physical outbursts is the threat of abandonment. Researchers have found that a high percentage of individuals with BPD have come from families where there was physical, emotional, or sexual abuse. An estimated 8 out of 10 people with BPD experience parental neglect, and children need nurturing and consistent attention to having their basic needs met to develop in healthy ways. In an environment of abuse, a child’s ability to develop the tools for adaptive functioning is compromised.
The essential features of Borderline Personality Disorder are a pattern of marked impulsivity and instability of affects (expressed feelings or emotions), and instability of interpersonal relationships and self-image. The pattern is present by early adulthood and occurs across a variety of situations and contexts.
According the DSM IV, BPD is “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”
Below are the criteria that a clinical psychologist would use in order to diagnose someone with BPD, a service user must meet 5 or more.
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour 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., spending, casual sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
- 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, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms
Currently there are several treatment options for those who suffer from BPD. They include Dialectical Behaviour Therapy (DBT), Cognitive Behavioural Therapy (CBT), Schema Therapy, and Psychodynamic therapy approaches. Many people with the condition find one or more of the therapies to be helpful, even life-changing.
They believe that the therapy (whichever one has chosen) has helped them in changing the way they would react to any given situation. With all conventional therapies, it would be trial and error in finding a therapy that suits the individual. With therapy and understanding (professional or personal) BPD is a condition that can be managed.
PDAN wants to spread awareness of the help available all over the world and support those living with the condition- whether that is the sufferer or their loved ones.
If you are in a relationship with someone with BPD, there are resources to help you understand and manage the impact of this illness on your everyday life. Some helpful information for anyone interested on learning more about Borderline Personality Disorder may be found on the PDAN resources page.