Borderline personality disorder: Let’s get it right

Borderline personality disorder is grossly misunderstood. And the stigmatic consequences wreak havoc on the lives of the diagnosed and those who won’t risk being labeled. It’s wrong, so let’s get it right.

We have tons to cover, so I’ll make a brief opening statement.

I have personal reasons for setting the record straight on borderline personality disorder.

‘Nuff said. Let’s get busy…

What is borderline personality disorder?

Borderline personality disorder (BPD) is an emotional/mental illness characterized by an ongoing pattern of shifting mood, fluctuating self-image, and dicey behavior.

Those with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to many days.

Other common BPD characteristics include quickly changing interests and values, impulsivity, uncertainty about one’s role in the world, viewing things in extremes, seesawing opinions of others, and intense and unstable relationships.

BPD is a cluster B personality disorder.

DSM-5 diagnostic criteria

To help us better understand BPD, here are edited portions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria.

According to the manual, meeting five or more qualifies for a diagnosis…

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships
3. Identity disturbance
4. Self-damaging impulsivity
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
6. Affective instability
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient stress-related paranoid ideation or severe dissociative symptoms

An individual is most often “officially” diagnosed with BPD at or above the age of 18. Now, there’s no rule saying it can’t be diagnosed before; however, practitioners typically avoid it.

The issue is, many of the presenting “BPD” symptoms come with the adolescent mind. And in the majority of cases, they don’t stick around. But if a pattern of symptoms lasts for at least a year, a diagnosis is justified.

Finally, as many as 6% of adults are believed to have been affected by BPD at some time in their lives.

It was believed that women were three times more likely to be diagnosed with BPD than men. More recent studies indicate that number is decreasing.

Comorbidity

BPD co-occurs with other emotional/mental disorders in 85% of cases. And that means a BPD diagnosis is frequently missed, bipolar disorder often being the wrongly chosen diagnosis.

By the way, check out Borderpolar: I’m thinking I know what it is. Do I?

Here are the numbers on BPD comorbidity (co-occurrence)…

• Persistent depressive disorder (dysthymia): 70%
• Major depressive disorder: 60%
• Self-injury: 55%-85%
• Substance abuse: 35%
• Eating disorders: 25%
• Narcissistic personality disorder: 25%
• Antisocial personality disorder: 25%
• Bipolar disorder: 15%

What causes borderline personality disorder?

Not near enough is known about the cause and risk factors of BPD. Sadly, research is in its infancy.

As long as we’re talking about cause, let’s quickly review something known as the diathesis-stress model (DSM).

The DSM suggests that predispositional vulnerabilities (diatheses) combine with stress from life experiences to generate, in our case, mood and anxiety symptoms and disorders.

So it’s this grand convergence of what was already in place and what was acquired.

The cause of BPD is no exception…

Environmental

Environmentally, childhood events play a significant role in the development of BPD. Included are emotional, physical, and sexual abuse, loss, neglect, abandonment, adversity, bullying, and being exposed to unstable and invalidating relationships, as well as hostile conflicts.

Genetics

Genetics (predispositional) appears to be involved, as having a close family member, such as a parent or sibling, with a BPD diagnosis points to higher risk.

Biology

Studies have shown that people with BPD may have structural and functional changes in the brain, especially in areas that control impulses and emotional regulation (predispositional). But, of course, are they contributors or caused by the wear and tear of BPD?

How is borderline personality disorder treated?

BPD has traditionally been viewed as difficult to treat. However, with newer, evidence-based treatments, hopeful prognoses are common.

One of the keys to a successful outcome is receiving specialized treatment from a qualified therapist. Getting along with, and trusting, that therapist is crucial. If there isn’t the right feel, the individual won’t be motivated to fully engage in treatment.

Therapy

Yes, psychotherapy is the first-line treatment for BPD. The most frequently used is a form of cognitive behavioral therapy (CBT) known as dialectical behavior therapy (DBT), which was developed specifically for BPD.

DBT incorporates concepts of mindfulness and acceptance – being aware of and attentive to the current situation and one’s emotional state.

It also teaches skills that can aid in controlling intense emotions, reducing self-destructive behaviors, and improving relationships.

Also used in the treatment of BPD is cognitive behavioral therapy. CBT can assist with identifying and changing core beliefs and behaviors that underlie inaccurate perceptions of self and others, which helps with social interactions.

CBT may also help reduce a number of mood and anxiety symptoms, and reduce the quantity of suicidal or self-harming behaviors.

As long as we’re talking about therapy, significant others may benefit from it. In fact, some BPD therapies include them.

Meds

Medications aren’t used specifically for BPD; however, they may be prescribed to address mood swings, depression, anxiety, and other comorbid conditions.

BPD treatment is most often conducted on an outpatient basis. However, inpatient treatment may be indicated.

Self-harm and suicide

Given BPDs higher incidence of self-harming and suicidal behaviors, it’s important for those diagnosed to seek immediate help if either make the scene. Those close to them need to be prepared to intervene.

988 is the number for the Suicide & Crisis Lifeline. And here’s some international help.

Let’s get it right

Again, misunderstanding borderline personality disorder has stigmatic consequences. And that’s incredibly harmful to diagnosed individuals and those who won’t risk a diagnosis.

I couldn’t possibly include all there is to know about BPD, so do all you can to learn…

Let’s get it right.

If you’re looking for a great BPD read: Borderline Personality Disorder Demystified by Robert O. Friedel, MD.

Thanks to the National Institute of Mental Health and the National Education Alliance for Borderline Personality Disorder for the resource material.

Hey, Chipur mood and anxiety info and information articles are waiting for you. Peruse the titles.