Borderline Personality Disorder (BPD)

Borderline Personality disorder (BPD) is a serious mental illness exemplified by instability in moods, intrapersonal relationships, self-image and behavior. Within the fields of psychiatry, it's defined as a mental condition characterized by emotional dysregulation, extreme "black and white" thinking or "splitting" (when you believe that someone or something is only one of two possible things, ignoring the possibility of any "in-betweens" ), and chaotic relationships. It's also characterized by a disturbance in the person's sense of self. In extreme cases, it can lead to moments of dissociation.

Although it's a less well known than other disorders like schizophrenia or bipolar disorder, BPD is more common, affecting two percent of adults, mostly young women. There has been a high rate of self-injury without suicide attempt, and in other cases failed suicide attempts and completed suicide in extreme cases. Extensive medical services are often required, and account for twenty percent of psychiatric hospitalizations. Many BPD patients improve over time and are able to lead productive lives.

Symptoms:

A person with depression or bipolar disorder can have the same mood for weeks, whereas a person with BPD may only experience a few hours (or up to a day) of intense bouts of anger, anxiety, and depression, which can be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. People with BPD may often view themselves as basically bad or unworthy. They may feel quite misunderstood or mistreated, and can also feel bored and empty, and as if they have little idea of who they are.

People with BPD usually have unstable patterns of social relationships. Their attitudes towards their friends and family and loved ones can shift suddenly from great admiration and love to dislike, hate, and intense anger. A person with BPD is highly susceptible to rejection, even with their family.The fears of abandonment are apparently related to difficulties of feeling emotionally connected to persons important to them when they are physically missing, usually leaving the person with BPD feeling worthless and lost; occasionally suicide threats and attempts occur because of the anger at perceived abandonment and disappointments.

Other impulsive behaviors related to BPD can be excessive spending, binge eating and risky sex.

Treatment:

There is a number of treatment approaches, many including the usage of seritongergic medications like Prozac, mood stabilizers like Tegretol, and low-dose neuroleptics like Haldol. In the 1990s, a new psychosocial treatment termed dialectical behavioral therapy (DBT) became established in the treatment of BPD, having originally developed as an intervention for patients with suicidal behavior. It's derived from cognitive-behavioral techniques, yet it emphasizes an exchange and negotiation between therapist and client, between the rational and emotional and between the acceptance and change. The learning of new skills is a core component that includes mindfulness, interpersonal effectiveness, coping adaptively with distress and crises; and identifying and regulating emotional reactions. DBT can be based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation in a social environment experienced as invalidating by the borderline patient. DBT has been found to reduce self-injury and suicidal behavior in many of the individuals with BPD.

Other treatments include Schema Therapy, Cognitive Behavioral Therapy, Marital or Family Therapy and Psychoanalysis.

Medication:

There are many medications that are used with conjunction with BPD treatments, although the evidence base is limited. Medication is intended to treat attending symptoms, such as anxiety and depression, not exactly BPD itself.

The types of medication used are antidepressants (such as Prozac) and antipsychotics.