A person with a personality disorder thinks, feels, perceives, behaves or relates to others quite differently than the average person. Signs of a personality disorder usually emerge in adolescence and can range from mild to severe.
The handbook called the DSM-5 that’s used by healthcare professionals as the guide to mental disorders diagnosis lists ten specific personality disorders. These are paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive.
Borderline personality disorder (BPD) is one of the most commonly recognized of these. In a 2008 study the lifetime prevalence of BPD was found to be 5.6 percent of men and 6.2 percent of women.
The word “borderline” to describe the condition was first used in 1938. This was because it was thought to be somewhere between anxiety disorders and psychotic disorders.
It makes normal living seem almost impossible to anyone with it. It is among the most complex to treat.
What is borderline personality disorder?
Sometimes also called emotionally unstable personality disorder (EUPD), someone with it will feel as if they are on a constant emotional rollercoaster. Because of this their relationships are also very unstable.
Their self-image, ambitions, hobbies and things they like or dislike often change. This leaves them confused – and it means they frequently change such as friends, partners, values, aims or jobs.
They will experience acute feelings of emptiness. They will also have an extreme fear of any abandonment.
Consequently a large part of their life usually sees them in a series of intense but volatile relationships. Health writer Hal Straus and psychiatrist Jerold J. Kreisman’s book on BPD has a title that perfectly sums this up: I Hate You – Don’t Leave Me.
Someone with BPD will be prone to impulsive behavior where they frequently act without thinking. This can lead to reckless and sensation-seeking actions such as promiscuity, driving too fast, binge eating, uncontrolled spending or shoplifting.
They will also be likely to have angry outbursts. They can sometimes become physically violent, particularly in response to any perceived or actual criticism.
Even seemingly small things can trigger severe reactions, and someone with BPD can find it difficult to calm down. Suicidal threats and acts of self-harm are not uncommon.
What are the symptoms of BPD?
BPD is characterized by:
- Emotional instability and mood swings, including explosive anger. This anger is sometimes directed inwards.
- Thinking or perceptual distortions.
- Impulsive and often reckless behavior.
- Unstable relationships that are often intense and short-lived.
- Markedly disturbed and changeable sense of who they are. They may think they are good, but soon after feel they are bad or even evil. Ambitions are muddled.
- Feeling suspicious.
- Expecting others to be a parent to them and generally behaving as if other people are adults and they’re not.
- Thinking other people are likely to bully or criticise them.
- Making drastic efforts to avoid real or imagined abandonment.
- Intense reactions if they are abandoned. Or to something else, when the reaction seems excessive for what has happened (or has been perceived to happen).
- “Black-and-white” thinking, known as “splitting”. Such as idealizing someone one day and then detesting them the next.
- Self-harm and suicidal threats, thoughts or attempts.
- Dissociation, ranging from a mild emotional detachment from immediate surroundings, to a severe disconnection from physical and emotional experiences.
- Extreme feelings of emptiness, as if there’s a void inside like they are “nothing”.
Many people with BPD also have another mental health condition. This is often in an attempt to numb the pain of such as their fear of abandonment or being in another unstable relationship.
- Alcohol and/or drug addiction.
- Anxiety disorders.
- Bipolar disorder.
- Eating disorders, such as anorexia or bulimia.
- Another personality disorder.
What causes BPD?
Most mental health experts believe BPD is caused by inherited or internal biological factors combined with external environmental factors.
MRI brain scans revealed that in many people with BPD some parts of the brain were smaller than expected or had unusual activity levels. These were parts that affected such as fear, aggression, anxiety, self-control, mood regulation and decision-making.
Brain development can be affected in childhood. How people see the world and respond in certain situations can be altered a great deal by such as how a child’s relationship is with their parents.
Many people with BPD will have experienced parental neglect or emotional, physical and/or sexual abuse while growing up. Frequently too, a family member may have had a mental health condition, such as alcoholism, another addiction or bipolar disorder.
Can BPD be treated?
Around 50 percent of people with BPD who receive treatment improve over a ten-year period. In fact, the prognosis for BPD is better than for depression.
However, it needs to be the right approach to treatment. Beliefs and destructive patterns of thinking can then be changed.
When BPD is successfully treated not only can it enable the person to know a fulfilling happy life, any other conditions usually vastly improve as well.
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