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Borderline personality disorder -

Borderline personality disorder is one of the 10 personality disorders currently recognized in the DSM (the official diagnostic manual used by medical professionals for the treatment of mental illness).

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Cluster B -

BPD is one of the Cluster B conditions, which also include antisocial personality disorder, histrionic personality disorder, and narcissistic personality disorder. These disorders are all characterized by intense or unusual emotions that are difficult to regulate.

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Emotional dysregulation -

For those with BPD, emotional regulation is the main challenge they face. The illness causes them to experience intense emotions and sudden mood swings. This can result in impulsive behavior, intense and unstable relationships, and frequent changes in self-image.

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Prevalence - It’s estimated that between 1% and 2% of the US population suffer from BPD, however it could be as high as 5.9%. The disorder was only officially recognized in 1980 and is a couple of decades behind most other common mental illnesses in terms of research.

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Causes -

It tends to affect women slightly more often than men and is more likely to occur in those who have a family history of the illness. Research is still in the early stages, but it’s believed that both genetic and social factors contribute to the manifestation of BPD.

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Family link -

According to the National Education Alliance for Borderline Personality Disorder, the illness is five times more likely to occur in those who have a close family member with the condition, such as a parent or sibling.

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Childhood trauma -

The environmental factor is also significant. Many people who suffer from BPD have experienced childhood trauma such as abuse or abandonment. Others were sensitive children who grew up in an unstable environment where they felt invalidated by those around them.

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The brain -

There is also research to suggest that people with BPD have structural and functional differences in their brains, particularly in the areas that contribute to impulsive behavior and emotional regulation.

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Heightened emotions -

Those who have BPD are often high functioning in many areas of their lives. It’s usually their personal lives where they may struggle and experience instability. They feel extreme emotions that might be triggered by an event that seems minor to others, and it’s much harder for them to return to their “emotional baseline” afterward.

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Four groups of symptoms -

The symptoms of borderline personality disorder can be grouped into four different areas. The first is emotional instability, or emotional dysregulation, which we've already outlined. The second group of symptoms are associated with distorted perception, meaning a disconnection from reality.

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Four groups of symptoms -

The third group of symptoms involve impulsive behavior, which can often be self-destructive. The final group is characterized by unstable relationships. The symptoms of a personality disorder can range from mild to severe. They usually start to emerge in adolescence or early adulthood.

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Reminder -

When it comes to many mental illnesses, the average person could scan the list of symptoms and say “oh my God, I have that!” Most symptoms merely describe normal parts of human life, such as feeling tired or anxious, fearing rejection, or struggling with low self-esteem.

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Reminder - When it comes to diagnosing an illness, it’s vital to qualify: how many of the symptoms does one person experience, and to what degree? How much does it impact their quality of life and ability to function? It’s important not to try to self-diagnose. With that in mind, let’s take a deeper look at the symptoms of BPD.

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Abandonment -

One of the main symptoms people with BPD experience is a fear of abandonment and rejection. They are intensely worried that even their closest friends and family will leave them, and will go to great lengths to avoid this nightmare scenario.

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Relationships -

People with BPD usually have a history of unstable relationships. They can be prone to drastic changes in the way they see their partners or friends, one day idealizing them and hating them the next. This negative switch is usually triggered by a feeling of insecurity that makes them think the other person is cruel and doesn’t care about them.

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Self-image -

Self-image and identity are difficult to pin down for someone with BPD. They sometimes feel like they’re a terrible person, other times they might feel like they don’t exist. There are frequent shifts in core values, life goals, and relationships.

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Loneliness -

Considering how difficult it is for someone with BPD to feel secure in their relationships and their own identity, the things that usually anchor us and make us feel connected, it’s no surprise that they experience intense feelings of loneliness. This can also manifest as a feeling of emptiness.

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Disconnection from reality -

In moments of severe stress, someone with BPD might become paranoid and even lose touch with reality for a period of a few minutes or a few hours. Psychosis can occur in extreme cases.

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Mood swings -

Persistent mood swings are another common symptom of BPD. Sudden changes in mood can last for hours or days, and may come with pleasant or unpleasant emotions, such as joy, excitement, shame, anxiety, or sadness.

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Anger -

One particularly problematic emotion of people with BPD is anger. They can have strong emotional reactions to issues that might seem small to someone else. Once they feel intense anger, it takes much longer for it to fade than it does for others. People with severe BPD who haven’t learned the skills to regulate their emotions may even end up in physical fights.

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Impulsive behavior -

Impulsive behavior is also common, particularly when it has a self-destructive outcome. Examples might include excessive spending, unsafe sex, gambling, suddenly quitting a good job, or ending a healthy relationship. Those for whom impulsive behavior is particularly problematic are more likely to engage in substance abuse.

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Dissociation -

People with BPD may sometimes feel disconnected from their bodies, their thoughts, or their identities. This “out of body” sensation makes the world feel less real.

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Self-harm -

Someone struggling with BPD is at a higher risk of harming themselves when things are particularly difficult. They may hurt themselves by cutting or burning, threaten to take their own lives, and even make an attempt to do so. This is one of the reasons it’s so important for them to seek help with their condition and improve their quality of life.

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Treatment and outlook -

Many of these symptoms sound scary, and they can be, but there is huge variation in how BPD can manifest itself in each person. Some people will experience much milder symptoms and are high functioning, while others may need inpatient treatment at some point. It’s thought that symptoms of BPD are more intense in youth and naturally lessen in middle age.

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Treatment and outlook -

Borderline personality disorder can be a scary diagnosis because it’s a highly stigmatized condition that’s widely misunderstood, but it is treatable. There are therapies and medications that can massively improve the symptoms and help patients live happy, fulfilling lives.

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Therapy -

The main type of therapy used to treat BPD is called dialectical behavioral therapy, or DBT. It’s a talk therapy that helps people with BPD understand and accept their emotions, as well as giving them the skills to manage them.

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Medication -

There isn’t one specific medication that is used to treat all cases of BPD. For some, anti-depressants or mood stabilizers may be used to help with anxiety, depression, and mood swings. For those who suffer particularly from paranoia and disorganized thinking, anti-psychotics are an option.

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Support -

Another important element for recovery from BPD is support from family and/or friends. It’s extremely helpful if loved ones understand the condition and also have the tools to deal with difficult situations that may arise. There are many support groups and educational resources available.

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Stigma -

Borderline personality disorder is still highly stigmatized, partly because even healthcare professionals didn’t understand the condition until recently. There’s a misconception that people who suffer from it are dramatic, manipulative, and attention-seeking.

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Stigma -

This misunderstanding is extremely detrimental as it can make those with the condition feel hopeless and wary of seeking help or confiding in others. It’s important to find support from a clinician with a deep and up-to-date understanding of the condition, to avoid misdiagnosis or mistreatment.

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There is hope -

Thankfully, we live in a time where mental illness is being destigmatized and we as a society are recognizing that no one goes through life without being touched by it.

Sources: (Mayo Clinic) (NIMH) (National Education Alliance for Borderline Personality Disorder) (Verywell Mind)

See also: Overcoming the stigma surrounding psychiatric medication

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