What is Borderline Personality Disorder?

What is borderline personality disorder? Despite its prevalence in today’s society information about borderline personality disorder (BPD) is not very well known or understood.People with BPD were originally thought to present at the border of psychosis and neurosis and therefore the primary characteristics of BPD revolve around a pervasive instability in mood, interpersonal relationships, self-image and behaviour. While these attributes may present themselves in varying manners on a person-by-person basis – they often tend to be the primary issue in maintaining friendships, familial relationships, work and a sense of identity.So what does BPD look like?Fear of abandonment is central to that of the BPD sufferer and this is often reflected in their relationship with others. People with BPD will often quickly shift from loving admiration of another to feeling extreme anger and resentment toward them. This is often seen particularly when the BPD sufferer interprets their behaviour as being critical or cold. This is because people with BPD tend to be highly sensitive to rejection. They often lack control over their emotions leading to these deregulation's in mood – many have been observed to often go from feeling very depressed to feeling very angry in a very short space of time.This instability can often lead to impulsive and self-destructive behaviour including extreme spending sprees, binge eating, unsafe sex or even more concerning behaviours such as self-mutilation and suicide. Suicide is unfortunately relatively high in this group with approximately 6% following through with it. The internal narrative of the BPD sufferer can be very chaotic; therefore it is unsurprising that many of these people experience a distorted and unstable sense of self and identity. Feeling misunderstood, empty and confused is unfortunately very common and these feelings may particularly intensify when they perceive that they are socially isolated – feeling alone is a big trigger.So what causes BPD? While there does not appear to be one specific cause of BPD it is fairly well established that there are both environmental and genetic factors that cause a predisposition to it. Studies examining the rates of BPD in twins indicated that identical twins had a higher concordance rate compared to fraternal twins further substantiating the theory of genetic predisposition. On a neurological level, enhanced amygdala activation is commonly observed in BPD sufferers. The amygdala is primarily responsible for emotions and may therefore explain the heightened and intense response that people with BPD have to even low-level stressors and how long it takes for them to come back down to a baseline from these emotions. Furthermore when compared to a group of controls, people with BPD were found to have a reduction of volume in the hippocampus (another part of the brain assisting in the regulation of emotion) and amygdala. This may provide some basis for understanding the impulsivity and aggression exhibited in this group of people.One of the most commonly observed environmental risk factors for BPD however is that of early trauma; this may include neglect, physical abuse, verbal abuse and in particular sexual abuse. A number of studies report that people with BPD are more likely than people with any other disorder to report neglect or abuse early on in life. As sexual abuse is typically more common in females this may also explain why BPD is more commonly observed in women.So are there treatment options available for people with BPD? Yes. In fact, treatment options appear to look relatively promising as a lot of people with BPD are able to recognise their distress and are willing to seek treatment for it. While there are particular drugs – commonly mood stabilizers that can be effective for people with BPD, from a cognitive-behavioural standpoint, dialectal behaviour therapy (DBT) appears to be effective. This form of therapy specifically targets behaviours that may result in harm, behaviours that interfere with therapy and behaviours that interfere with the client’s quality of life. Strategies are learned and developed to handle stressful situations, address past traumas (if there were any) and learn to trust ones self instead of relying on the validation of others – visualization is often used in therapy to practice these.So while BPD can be quite a complex, intense and debilitating mental illness with a lot that is still unknown, treatment options do look promising and many people learn to deal with these symptoms and live a high quality life in accordance with their goals and needs.