Borderline Personality Disorder

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NARSAD Borderline Personality
Borderline personality disorder (BPD) is a serious psychiatric disorder character-
ized by instabilty in a person’s actions, moods, relationships and self-image. The
instabilty as ociated with BPD can disrupt daily living, long-term planning and the
individual’s sense of self-identity.
People diagnosed with BPD have dif iculty regulating emotions, such as anger,
impulsivity, depression and anxiety, and have highly unstable pat erns of social
relationships. Patients often require extensive mental health services, and account
for 20 percent of psychiatric hospitalizations. But with appropriate help and inter-
ventions, many people with BPD can improve and lead productive lives.
Who Gets It
BPD is typicaly diagnosed in early adulthood, af ecting two percent of American adults, with more young
women af ected than men. The chronic symptoms and as ociated problems may continue for years but
sometimes "burn out" in middle age. Patients may function bet er after reaching their late 30s or early 40s.
BPD af ects emotions, behavior, self-image, and relationships. A person with BPD may experience intense
emotions such as anger, depres ion and anxiety lasting only a few hours, or, at most, a day. The feelings
may be accompanied by impulsive aggression, self-injury and drug or alcohol abuse.
People with BPD often have a distorted sense of self. They may view themselves as fundamentaly bad,
damaged, unworthy or misunderstood. This shaky self-image can lead to frequent changes in jobs, friend-
ships, goals, values and gender identity.
Highly unstable social relationships are another pat ern associated with BPD. People with the disorder
may idealize someone close to them in one moment and then abruptly shift to fury and hate over perceived
slights or misunderstandings. Even within familes, individuals with BPD are highly sensitive to rejection,
reacting with anger and distres to mild separations, such as a vacation, a business trip or a change in plans.
These abandonment fears seem to be related to a dif iculty feeling connected to significant persons when
they are physicaly absent, often resulting in feelings of worthles nes . Suicide threats and at empts may
occur along with anger at perceived abandonment and disappointments. Symptoms may be most acute
when a person with BPD feels isolated or without social support. These feelings of isolation may lead to
frantic ef orts by the person with BPD to avoid being alone.
Other impulsive behaviors may include: exces ive spending, binge eating, ilicit drug use, risky sex,
self-immolation and suicidal tendencies. People with BPD have a high rate of self-injury without suicidal
intent, suicide at empts and, in some severe cases, completed suicide. BPD may co-occur with other
psychiatric problems, including bipolar dis-order, depres ion, anxiety disorders, substance abuse and
other personality disorders.

How It Is Diagnosed
Clinicians diagnose personality disorders based on certain signs and symptoms and a thorough psychiatric
evaluation. To receive a diagnosis of BPD, at least five of the folowing signs and symptoms, which typicaly
begin in early adulthood, must be present:
• Dif icult and unstable relationships
• Poor self-image
• Intense but short episodes of anxiety or depression
• Dif iculty control ing emotions or impulses
• Fear of being alone and abandonment
• Frequent displays of inappropriate anger
• Recur ent acts of crisis such as wrist cut ing, overdosing, or self-mutilation
• Feelings of emptiness and boredom
• Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting
• Periods of paranoia and los of contact with reality
Risk Factors/Causes of BPD
The cause of BPD is unknown, but environmental and genetic factors are thought to play a role. Hereditary
pre-disposition, childhood abuse, neglect and abandonment is ues, sexual abuse and/or a disrupted family
life, can increase the risk for BPD.
Research has shown that various brain mechanisms are responsible for many of the features of BPD,
such as aggres ion, anger, mood instabilty, impulsivity and negative emotion. Impaired regulation of neural
circuits that control emotion, may account for impulsive aggression. Recent imaging studies indicate that
individual dif erences in the abilty to activate specific brain regions involved in inhibitory activity predict
the abilty to suppres negative emotion. Neurotransmit ers, such as dopamine, serotonin, acetylcholine
and norepine-phrine, which control the regulation of emotion, are also likely to play a role.
Treatments for BPD include behavioral therapy, medications and/or hospitalization. A behavioral therapy
known as dialectical behavior therapy (DBT) has shown some promise in the treatment of BPD. DBT teaches
patients how to regulate their emotions, tolerate distress, and improve relationships via a skils-based
approach. Recent research has shown that DBT (when compared with other types of psychotherapy)
reduced suicide at empts by half in individuals with BPD. The treatment also reduced the use of emergency
rooms, inpatient services and therapy dropout rates by more than half.
Medications used in the treatment of BPD may regulate mood, level mood swings and improve emotional
symptoms. The drugs are often prescribed based on the specific symptoms of an individual. Antidepres ant
drugs and mood stabilzers work on a depressed and/or labile mood; antipsychotic drugs may be used in
cases of distortions in thinking; and anti-anxiety medications treat anxiety.
Some people with BPD may need hospitalization during particularly stress-
ful periods, or if suicide or other self-destructive behaviors are occur ing.
For mor e infor mation
Research about BPD is continuing. Studies focus on understanding how
by NARSAD researchers
the neural information associated with BPD can be used to develop clinical-
about the latest advances
ly relevant treatments. Investigations examine how childhood abuse and
in the diagnosis and treatment
other stres es in BPD af ect the brain and they monitor the ef ectiveness
of borderline personality
of combining medication with behavioral treatments, such as DBT. A con-
tinuing longitudinal study, begun in the early 1990’s, should soon reveal
disorder and other
how treatments af ect the course of the ilnes and which environmental
serious brain disorders,
factors and specific personality traits predict a bet er outcome for people
with the disorder.
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