Borderline Personality Disorder (BPD) -
Facts, symptoms, causes, treatment

Borderline Personality Disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2% of adults, mostly young women or by another estimate, 1-3% of the general population.

Some suggest that the name itself, Borderline Personality Disorder, is an inappropriate term for this disorder, or "a misleading label". The disorder has nothing to do with neurosis or psychosis, but rather involves emotional volatility, what one reporter described as "a [very] thin emotional skin". Self-loathing, poor self esteem and suicidality are also part of the profile of BPD.

2. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. (NIMH). Forty percent of the highest users of inpatient psychiatric services receive a diagnosis of BPD. Many are helped through psychiatric services. However about 1/2 or 46% have repeat hospitilization despite long-term or extended-term care. (Tucker, L.).

These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Self hate, self loathing. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy.

With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships. [Mayo Clinic].

They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. Mayo Clinic: Often a result of childhood sexual or other abuse.

While those in DBT therapy were less likely to take medication while on therapy, those in expert community care were both more likely to be on medication or much more likely to be hospitalized. This raises the tought that, either community therapy is much more likely to recommend hospitilization, depend more on drugs for treatment, or is less effective than more intensified therapy through specific well-trained therapists.

Also of note is that most of the symptoms of borderline personality disorder can basically described as the intense side of the risidual effects of child abuse. That is, child abuse, especially sexual child abuse, produces most of the symptoms in later life, for some people, as described for borderline personality disorder. If a client is treated for child abuse, if there has been such, then it might be the best way of dealing with the issues, rather than focusing on labeling and medicating.

*iatrongenic-(of a medical disorder) caused by the diagnosis, manner, or treatment of a physician.

1. Borderline Personality Disorder. (May 13, 2009). National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml

2. Borderline Personality Disorder. (May 14, 2008) Mayo Clinic. http://www.mayoclinic.com/health/borderline-personality-disorder/ds00442

3. Brody, J. (June 15, 2009). An Emotional Hair Trigger, Often Misread. New York Times. http://www.nytimes.com/2009/06/16/health/16brod.html?_r=1&scp=6&sq=borderline%20%20personality%20disorder&st=cse

4. Marsha M. Linehan, PhD; Katherine Anne Comtois, PhD; Angela M. Murray, MA, MSW; Milton Z. Brown, PhD; Robert J. Gallop, PhD; Heidi L. Heard, PhD; Kathryn E. Korslund, PhD; Darren A. Tutek, MS; Sarah K. Reynolds, PhD; Noam Lindenboim, MS. (July 2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Arch Gen Psychiatry. 2006;63:757-766. http://archpsyc.ama-assn.org/cgi/content/full/63/7/757

5. Tucker, L, Ph.D., et al., (1987). Long Term Treatment of Borderline Patients: A Descriptive Outcome Study. American Journal of Psychiatry, 144:1443-1448. http://ajp.psychiatryonline.org/cgi/reprint/144/11/1443?ijkey=7b3811f2d7dd690d7517c475e263ed11ea22e967