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Borderline Personality Disorder

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(BPD)

Definition

Borderline personality disorder (BPD) is a mental health disorder. People with BPD may often have dramatic, emotional, erratic, and attention-seeking moods. This behavior disrupts family and work life, long-term planning, and the individual’s sense of self.
Treatment options have improved as BPD is better understood. Many BPD sufferers are helped by psychotherapy and medicines.

Causes

The causes of BPD are not fully understood. It is thought to be a combination of brain chemistry, genetics, and environmental factors. People who develop BPD are probably born vulnerable to the illness. Certain experiences and types of stress may then further increase their chance of developing BPD. Many BPD sufferers are often found to have experienced childhood abuse, neglect, separation, sexual abuse, violence, or brain injury.
Central Nervous System - Brain
Brain face skull
BPD is thought to develop from a combination of chemical imbalances in the brain and traumatic life experiences.
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Risk Factors

The following factors increase your chances of developing BPD:
  • Sex: female
  • A history of abuse, neglect, or abandonment as a child
  • A history of sexual abuse or violence
  • Inborn sensitivity to stress
  • Poor self-image, not having a clear sense of who you are
  • Mother, father, or sibling with BPD

Symptoms

The symptoms of BPD vary. People with BPD tend to be extremely sensitive to rejection. They may react with anger and be upset at even mild separation from friends or family. Symptoms often become more acute when people with BPD feel isolated and lonely or during times of particular stress.
Traits that are common to people with BPD include:
  • Fears of being left alone—resulting in frantic behaviors to avoid being left alone
  • Extreme mood swings and difficulty managing emotions
  • Difficulty in relationships—characterized by dramatic swings viewing people as all good or all bad
  • Unstable self-image
  • Impulsive behavior
    • Excessive spending
    • Promiscuity, risky sexual behavior
    • Gambling
    • Drug and alcohol abuse
    • Binge eating
  • Repetitively injuring themselves through cutting, scratching, or burning
  • Feeling misunderstood, bored, and empty
  • Having deep-seated feelings of being flawed or bad in some way
  • Using defense mechanisms to avoid taking responsibility for behavior, or to blame others
  • Unpredictable mood and difficulty regulating mood
  • Problems with anger management, manifested as periods of intense, uncontrollable and often unreasonable anger
  • Episodes of intense paranoia, dissociation, or thought patterns bordering on psychosis—often provoked by stress

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. This is to rule out other possible causes for mood and behavior problems. If BPD is suspected, you may be referred to a psychiatrist who specializes in personality disorders.
BPD can affect anyone. It is usually diagnosed in adolescents and young adults. A diagnosis of BPD may be made if a person has a history of the symptoms listed above. In addition, BPD patients almost always have other mental health problems such as:
  • Depression
  • Alcohol or drug abuse
  • Eating disorders
  • Anxiety disorders
  • Bipolar disorder
  • Compulsive spending, gambling, or risky sexual behavior

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Psychotherapy

Individual, group, and family therapy form the basis of BPD treatment. Individual psychotherapy usually consists of 2-3 sessions a week for a period of years. Group therapy may focus on the same goals but take place in a group of fellow participants. The goal of therapy is to help the person with BPD:
  • Understand his or her behavior
  • Improve his or her ability to tolerate frustration, anxiety , loneliness, and anger
  • Control impulsive behavior
  • Improve social skills
Family therapy may help family members deal with the effects of BPD. It can also provide additional support for the person with BPD.

Medication

Medication may be prescribed and adjusted based on your symptoms. Medication options may include:
  • Antidepressant drugs
  • Mood stabilizers
  • Antipsychotic drugs—may be used in low doses to control distorted thinking or anxiety

Prevention

There are no guidelines for preventing BPD.

RESOURCES

Borderline Personality Resource Center http://www.bpdresourcecenter.org/

National Institute of Mental Health http://www.nimh.nih.gov/

National Mental Health Association http://www.nmha.org/

CANADIAN RESOURCES

Borderline Personality Disorder http://www.borderlinepersonality.ca/

Canadian Psychiatric Association http://www.cpa-apc.org/

References

Borderline personality disorder. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated September 28, 2012. Accessed December 28, 2012.

Borderline personality disorder: fact sheet. National Mental Health Association website. Available at: http://www.nmha.org/infoctr/factsheets/borderline.cfm . Accessed December 28, 2012.

Borderline personality disorder: raising questions, finding answers. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/topics/topic-page-borderline-personality-disorder.shtml . Accessed December 28, 2012.

Feldman MD, Montandon M. “Borderline personality disorder” in Ferri’s Clinical Advisor: Instant Diagnosis and Treatment , 8 th ed. Philadelphia, PA: Mosby; 2006.

Mason PT, Kreger R. Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder . Oakland, CA: New Harbinger Publications; 1998.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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