What is Borderline Personality Disorder? (BPD)

What is borderline personality disorder?

An Internship Honors Project by wonderfulHart1330

Borderline Personality Disorder

Borderline Personality Disorder (BPD) differs from the other Personality Disorders (PDs) in important ways. It is probably less stable and lifelong than other PDs. It appears to be less pervasive, meaning people with BPD tend not to present in the same way in different situations. This is curious, as pervasiveness is a central element of the personality disorders. People with BPD are also more likely to seek treatment than people with other PD diagnoses; the majority of people receiving treatment in specialist centres suffer from BPD, often with one or more other PDs.

The most prominent features of BPD are self harm/suicidality, emotional instability (unpredictable variations in mood, both sad/happy and angry/irritable), impulsivity (doing things on impulse without due consideration of the consequences) and disordered attachment (stormy relationships, very strong feelings of abandonment when a close relationship ends). It is the first two of these that most commonly lead to people seeking help.

BPD has no clear reason why some people experience BPD however more women are diagnosed with BPD than men, but it can affect anyone regardless of gender and background. Research into BPD have found that the following combination of factors can increase the risk of causing BPD, the factors are spilt into two categories, Stressful or traumatic life events and Genetic factors:

Stressful or traumatic life events

- Often feeling afraid, upset, unsupported or invalidated

- Family difficulties or instability, such as living with a parent who has an addiction

- Sexual, physical, or emotional abuse or neglect

- Losing a parent.

Genetic factors

Some evidence suggests that BPD could have a genetic cause, because youre more likely to be given this diagnosis if someone in your close family has also received it.

For a long time, there had been no effective treatment for BPD, there is still no fully effective treatment but evidence-based treatments have proven to help reduce the number of symptoms or the severity of the symptoms a patient had, but if treatment is not given by someone trained to treat BPD they can make the symptoms far worse

Methods of treating BPD:

There are many ways of treating BPD and these methods can be done by an individual or as a large group in sessions, normally known as a CMHT (Community mental health team). These teams are made up of a wide range of professionals which can include:

Social workers,

Pharmacists,

Counsellors,

Community Mental health nurses,

Psychologists and Psychiatrists,

Therapists and psychotherapists.

The first method of treating BPD is Care Programme Approach (CPA), CPA is a treatment method used on cases of BPD that have moderate to severe symptoms, a CPA ensures that the treatment is specialist to the individual as there are 4 stages to a CPA

Stage 1 is an assessment of health and social needs

Stage 2 a care plan is created to meet an individuals health and social needs

Stage 3 is where an appointment of a care coordinator, who is usually a social worker or nurse, who becomes the first point of contact with other members of the CMHT for anyone on a CPA.

Stage 4 is when the overall treatment is reviewed – this is where the treatment is reviewed at regular intervals to make sure it is the best for the individual, and if it is not then any necessary changes to the care plan can be agreed by the individual and the CMHT.

Psychotherapy is another treatment type that is commonly used, as most treatments that will be below involve psychological therapy in some form. The main objective of psychotherapy is the it makes the individual gain a better understanding of how they think and feel, this is normally achieved by a psychotherapist discussing important issues and aiding with methods of problem resolution and attitude/behaviour therapy if required. Psychotherapy is normally done in combination with one or more of the following methods DBT, MBT, TC or AT.

DBT (Dialectical Behaviour Therapy) is one of the methods.

Signs and symptoms

Individuals who have Borderline Personality Disorder are diagnosed when there are 5 of the following 9 signs and symptoms are present. These symptoms can vary from person-to-person.

- Frantic efforts to avoid real or imagined abandonment. Suicidal or self-mutilating behaviour are not included in this symptom by most doctors and psychologists.

- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

- Identity disturbance: markedly and persistently unstable self-image or sense of self.

- Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self- mutilating behaviour covered in Criterion 5.

- Recurrent suicidal behaviour, gestures, or threats, or self- mutilating behaviour.

- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

- Chronic feelings of emptiness.

- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

- Transient, stress-related paranoid ideation or severe dissociative symptoms.

What causes Borderline Personality Disorder?

The exact cause of Borderline Personality Disorder is not known yet, as doctors believe there is no single factor that causes it. There are 4 main factors that are believed to cause BPD, they are Genetics, Problem with brain chemicals, Problem with brain development and Environmental Factors

Problem with brain chemicals:

It's thought that many people with BPD have issues with the neurotransmitters in their brain, the one in particularly is normally serotonin. Altered levels of serotonin have been linked to depression, aggression and difficulty controlling destructive urges.

Problem with brain development:

Researchers can use used magnetic resonance imaging (MRI) scans to study the brains of people with BPD. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body. The scans revealed 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 Problems with these parts of the brain may well contribute to symptoms of BPD. The development of these parts of the brain is affected by your early upbringing (see below). 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.

Genetics:

Genes you inherit from your parents may make you more vulnerable to developing BPD. 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. However, these results should be treated with caution, as there is currently no evidence that there's a gene for BPD.

Environmental Factors:

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:

~ Dealising others

~ Expecting others to be a parent to you

~ Expecting other people to bully you

~ Behaving as if other people are adults and you're not

Facts/Trivias

• BPD is less known than Schizophrenia and Bipolar Disorder, yet it is more common than both.

• 25% of people diagnosed with BPD are male, 75% are female.

•BPD increases the risk of suicide by 50 times.

•BPD affects a predicted 1.6% of adults.

• People with BPD are often underdiagnosed or misdiagnosed with other mental illnesses.

Help and resources

Nimh- BPD– Offers a wide range of information about Borderline Personality Disorder, including medication and living with BPD.

NHS- BPD– Learn the basics about Borderline Personality Disorder, including diagnosis, treatment and causes of BPD.

Mind.org – Borderline Personality Disorder – Learn about the stigma against BPD and real-life stories of people who live with BPD.

ChildMind - BPD – Information about BPD in children. (Teenshealth)

Sources

https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/causes-of-bpd/#.Wwlp_ojwaUk

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

https://personalitydisorder.org.uk/borderline-personality-disorder/

https://www.nhs.uk/conditions/borderline-personality-disorder/treatment/

https://www.nhs.uk/conditions/borderline-personality-disorder/causes/

https://childmind.org/guide/guide-to-borderline-personality-disorder/

Questions for Forum Discussion

• Do you have any experience with BPD, either from yourself or a loved one, if so, would you like to share you experience with us? But only if you are comfortable!

• What type of support have you received or are you receiving from the people around you?

• How long did it take for a correct diagnosis to be given for you?, only share if you are comfortable to do so.