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Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) affects 5.9% of adults, which means it affects 50% more people than Alzheimer’s disease and affects nearly as many as schizophrenia and bipolar combined. It affects 20% of patients admitted to psychiatric hospitals and 10% of people in outpatient mental health treatment. So why do we hear so little and know so little about it?

Borderline personality disorder (BPD) is a condition that centres on a person’s inability to manage thoughts, emotions and behaviours effectively. Individuals may be high functioning in many areas of their lives but their relationships, their private lives may be in turmoil. Their feelings and behaviours seem appropriate and justified to the person experiencing them, even though these feelings and behaviours cause a great deal of problems in that person’s life. For this reason they tend not to look for counselling BECAUSE they have BPD but because they are suffering from depression, anxiety, addictions or relationship problems. Both men and women can suffer from borderline personality disorder but it seems to be more common in women than in men. Some sufferers can have difficulty in keeping a job or progressing in a course of study. One of the very sad features of this disorder is that people with BPD may crave closeness, but their intense and unstable emotional responses tend to alienate others, so they can feel very isolated.

What are the three key symptoms of Borderline Personality Disorder?
  • Inappropriate or extreme emotional reactions and intense mood swings
  • Highly impulsive behaviour
  • A history of unstable relationships that can change drastically from intense love to intense hate
Other symptoms of Borderline Personality Disorder
  • Having an unstable or dysfunctional self-image or a distorted sense of self (how one feels about one’s self)
  • Feelings of isolation, boredom and emptiness
  • Difficulty feeling empathy for others
  • A persistent fear of abandonment and rejection, including extreme emotional reactions to real and even perceived abandonment
  • Strong feelings of anxiety, worry and depression
  • Impulsive, risky, self-destructive and dangerous behaviours, including reckless driving, drug or alcohol abuse and having unsafe sex
  • Hostility
  • Unstable career plans, goals and aspirations
  • Suicidal behaviours are very common, including suicide attempts and self-harming.

What seem to be ordinary events to those around the BPD sufferer, may trigger symptoms. They may even see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

What causes BPD?

The short answer is that we still don’t know for sure. Genes may have a part to play – one study found that if one identical twin had BPD, there was a two-in-three chance that the other identical twin would also have BPD. But this does mean that there is BPD gene. MRI scans have shown that in many people with BPD, three parts of the brain were either smaller than expected or had unusual levels of activity. These parts were:

  • the amygdala – which plays an important role in regulating emotions, especially the more “negative” emotions, such as fear, aggression and anxiety
  • the hippocampus – which helps regulate behaviour and self-control
  • the orbitofrontal cortex – which is involved in planning and decision making

The development of these parts of the brain is affected by your early upbringing .These parts of your brain are also responsible for mood regulation, which may account for some of the problems people with BPD have in close relationships. A number of environmental factors seem to be common and widespread among people with BPD. These include:

  • being a victim of emotional, physical or sexual abuse
  • being exposed to chronic fear or distress as a child
  • being neglected by one or both parents
  • growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem

A person’s relationship with their parents and family has a strong influence on how they come to see the world and what they believe about other people. Unresolved fear, anger and distress from childhood can lead to a variety of distorted adult thinking patterns, such as idealising others, expecting others to be a parent to you or expecting other people to bully you.

Diagnosing and Treating Borderline Personality Disorder

The diagnosis was officially recognised in 1980 by the psychiatric community but in terms of understanding, research and treatment options it lags far behind other mental and emotional conditions. Even worse, the diagnosis of BPD is frequently missed and this can prevent recovery.  It can be confused with bipolar disorder because both involve unstable moods. One key difference is that for the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and can even occur within the day, or even from moment to moment.

The emotionally intense and unstable personality found in those with BPD has meant that health professionals have considered it among the most challenging to treat. This may often be because they are seeing the individual at a time of crisis. Marsha Linehan developed  what is called Dialectical Behaviour Therapy (DBT) specifically for the treatment of BPD (although it has been applied to other mental health problems with some success). It combines the usual CBT techniques of reality testing and regulation of emotions with acceptance, distress tolerance and mindful awareness taken from Buddhist meditation. The emphasis is on acceptance and change, with the therapist as an ally rather than an enemy encouraging self-motivation and setting clear boundaries.

Need some advice and support?

If either you or someone close to you thinks that they are struggling with Borderline Personality Disorder and would like to talk it over in complete confidentiality, call Alison Winfield, Mindfully Well Counselling Cork on 087 9934541.

Book a counselling session today!

See also: Relationships and Borderline Personality Disorder