Understanding Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline personality disorder (also known as BPD) is a mental illness characterized by an inability to regulate moods, difficulty with interpersonal relationships, identity struggles, and impulsive behaviors. Borderline personality disorder can often be overlooked because of its similarity to other psychiatric disorders. However, it’s important to note that BPD can occur alongside other disorders such as anxiety disorders, substance use disorders, depression, and eating disorders. There is no single test or exam that can diagnose BPD - a thorough psychiatric evaluation is needed for diagnosis. The onset of borderline is typically in late adolescence to young adulthood. BPD is more common in females but is also seen in males. BPD is found in approximately 5.9% of the population (Nea.bpd, 2014).

What does Borderline Personality Disorder look like? People with BPD may display some of the following characteristics:

Frantic search for companionship
Unstable or failed interpersonal relationships (i.e. rollercoaster type relationships)
Chronic real or perceived abandonment; going to extremes to prevent someone from leaving
Self-harm or other unhealthy methods to get their needs met (e.g. cutting or suicide attempts)
Emotionally labile: Severe mood fluctuation from rage to depression to anxiety in a short period of time
Sensitive to rejection
Concrete thoughts: People can be good or bad
Distorted sense of self that is always shifting
Impulsivity: Behaving without thinking about the consequences (e.g. binge eating, spending, sexual activity, substance use)
Feeling as if things around you are unreal or out of body experiences

Why do people develop Borderline Personality Disorder?

Research suggests that there are genetic, social, and environmental components to the development of BPD. Risk factors include having a close relative with BPD, trauma, abuse, and abandonment in childhood (Kaplan et al., 2015).

Why is diagnosis important? And what treatment options are available?

It’s important to note that no medication will alleviate the core BPD symptoms such as abandonment, self-doubt, and identity disturbance. However, medication along with therapy can help decrease symptoms that disrupt functioning, relationships, and stability.

The correct diagnosis can provide a patient and their loved ones with a better understanding of their illness, clinical course and treatment options. Early intervention can be helpful in building coping skills early on.

The primary treatment for BPD is Dialectical Behavior Therapy (DBT). DBT focuses on mindfulness training to change behaviors, improve relationships, and control emotions. These symptoms may change over time, therefore the course of treatment should be closely monitored. The following medications may be used to manage these symptoms:

Atypical antipsychotics: can be helpful with aggression, hostility and psychosis
Antidepressants: can help manage depression and anxiety
Mood stabilizers: can help with impulsivity

There is no “one size fits all” treatment for BPD. It is important that each patient work with professionals to individualize treatment and achieve optimal wellness.