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Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline Personality Disorder is a Cluster B Personality Disorder.

Instability in interpersonal relationships, affect, and self-image are some of the fundamental features associated with borderline personality disorder (BPD). Individuals diagnosed with BPD are often incredibly impulsive and symptoms begins in early adulthood. External factors and fears of real or imagined abandonment negatively impact these individuals. Relationships with potential caregivers and lovers are extremely intense; however feelings often switch between idealizing others who will “be there” to devaluing individuals who do not live up to their expectations. Impulsive suicide gestures/attempts and self-harm (with no intention of death) are often used in manipulative ways motivated by fears of abandonment. Finally, people diagnosed with BPD often experience intense emotions and reactivity to mood (e.g. intense episodic dysphoria, irritability, or anxiety lasting for hours or a few days), are easily bored, and may be disturbed by feelings of emptiness. Physical/sexual abuse, neglect, hostile family dynamics, and early parental loss are more common in individuals who are diagnosed with BPD.

Who is Diagnosed with Borderline Personality Disorder?

Approximately 75% of individuals who are diagnosed with borderline personality disorder are females. Borderline personality disorder is more common among first-degree biological relatives with this disorder than in the general population. Typically, individuals diagnosed with this disorder are children whose mothers are also diagnosed with mental health disorders, and fathers who are absent or not a part of child rearing.

Symptoms of Borderline Personality Disorder

Beginning in adulthood, an instability of interpersonal relationships, self-image, and affect are present. They are often marked by impulsivity in a variety of contexts as indicated by the following DSM-5 symptoms:

  •         Frantic efforts to avoid real or imagined abandonment
  •         A pattern of unstable and intense interpersonal relationships (fluctuating between extremes of idealization and devaluation of the same person)
  •         Unstable self-image or sense of self (continually undermining their sense of self)
  •         Self-damaging impulsivity in at least two areas, such as, substance abuse, promiscuous sex, binge-eating
  •         Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior (without an intent to die)
  •         Affect instability due to reactivity of mood (intense dysphoria, irritability, anxiety)
  •         Chronic feelings of emptiness
  •         Inappropriate and intense anger
  •         Fleeting, stress related paranoid ideation or severe dissociative symptoms.

Treatment for Borderline Personality Disorder

One of the most common therapeutic treatments for borderline personality disorder is Dialectical Behavioral Therapy (DBT). Goals of DBT include development and committing to treatment; establishing security and safety; emotional processing; increasing self-respect, and setting and achieving goals. Other treatment includes cognitive behavioral therapy and psycho-education/skill building. Brief hospitalization may be necessary, especially if an individual is acutely suicidal. Family therapy to improve communication between dysfunctional family members has also been shown to improve unhealthy familial patterns. Psychopharmacology to alleviate secondary symptoms of anxiety and depression are used, and some antipsychotic medications have also been proven to be helpful.

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