What is Borderline Personality Disorder? Symptoms, Causes, Types and Treatment
Introduction
Borderline Personality Disorder (BPD) is a mental health illness characterized by mood, behavior, and relationship instability. People with BPD tend to experience intense and rapidly-shifting emotions, have difficulty controlling behaviors that may be self-destructive, and struggle to maintain stable relationships.
Symptoms
The main symptoms of BPD include:
Unstable emotions - Emotions can shift very quickly and intensely from positive to negative. Feelings of emptiness, anxiety, sadness, irritability, and anger are common.
Unstable relationships - People with BPD tend to have intense but stormy relationships characterized by a pattern of idealization and devaluation. They may struggle with abandonment issues.
Impulsive, risky behaviors - These kind of behaviors include excessive drugs use, substance abuse, unproductive sex, involving in gambling, self-harm, or suicidal attempt.
Unstable self-image - Persons with BPD often have a poor sense of self and lack a clear identity. Their interests, values, and goals can change rapidly.
Dissociation - In some cases, people with BPD can feel detached from themselves or their surroundings. They may perceive themselves, others and the world around them differently.
Self-Harm - Many BPD victims engage themselves in self-destructive activities such as cutting or burning themselves. This is often done to manage intense and unpleasant emotions.
Causes
The exact causes of BPD are not fully understood, but research suggests that a combination of genetic, environmental, neurological and social factors are involved:
Genetics - BPD appears to run in families and some research shows that the condition may be inherited. However, no specific genes associated with BPD have been identified.
Brain abnormalities - Studies show that people with BPD can have differences in certain areas of the brain involved in emotion regulation, impulsivity and aggression compared to people without BPD.
Environmental factors - Experiencing childhood trauma, abuse or neglect appears to be a strong risk factor for developing BPD. An invalidating or unstable home environment is also thought to play a role.
Neurotransmitter abnormalities - Research indicates that people with BPD may have reduced serotonin levels which could contribute to impulsive aggression.
Types
There are four major subtypes of borderline personality disorder:
Discouraged borderline — Feels hopeless, depressed and pessimistic.
Borderline impulsive — Engages oneself in impulsive and self-destructive activities such as promiscuous sex, beating oneself, substance misuse, and spending sprees.
Borderline self-destructive – Inflicts self-harm, such as cutting, burning, or beating oneself. Suicidal threats or attempts, as well as other risky behaviors, are possible.
Treatment
Borderline personality disorder is treatable with psychotherapy, medication or a combination of both. Treatment focuses on symptom management, skills development and improving quality of life.
Medications may be used to help regulate mood swings, impulsive behaviors, depression or other symptoms:
- Antidepressants
- Anti-anxiety drugs
- Mood stabilizers
However, medications alone are usually not sufficient to significantly improve BPD symptoms. Psychotherapy is considered the mainstay of treatment. Types of therapy found to be effective include:
Dialectical behavior therapy (DBT) - Focuses on improving coping skills, mindfulness, emotion regulation and interpersonal skills.
Schema-focused therapy - Aims to change negative thought patterns developed during childhood.
Transference-focused psychotherapy (TFP)- An intensive type of psychoanalytic therapy that aims to resolve conflicts in relationships.
Mentalization-based therapy (MBT) - Helps patients differentiate thoughts from feelings and develop self-awareness.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) – Teaches coping methods using cognitive behavioral techniques.
With ongoing treatment, many people with BPD experience remission of symptoms and improved relationships and functioning over time. Support groups can also be helpful for some patients. However, symptoms may worsen during times of high stress.
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