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Borderline Personality Disorder: Signs, causes and treatment options



 

Adolph Stern, a psychoanalyst and psychiatrist, who in 1938 identified a group of patients as “between,” neurotic and psychotic, coined the term, ‘borderline personality.’ In 1975, Otto Kernberg elaborated on Dr. Stern’s observations by describing patients who were at times, full of confidence and later fell into absolute despair, with pervasive fears of abandonment and rejection (National Collaborating Centre for Mental Health (UK).

 

People often envision those with borderline personality disorder or BPD as the "crazy girlfriend," in the context of a relationship.  However, there are certain discrepancies in the literature as a well as the trusted DSM IV suggesting that women are more likely to have BPD. However, studies are revealing biases in assessments that have led females being diagnosed more often than men; a large study of over 30,000 participants was conducted and a non-significant difference was found between men (5.9%) and women (6.2%) (Grant et al., 2008).

 

BPD is identified as a cluster B disorder in the DSM 5 along with histrionic, narcissistic, and antisocial personality disorder. For a diagnosis, patients will usually have 5 out of 9 symptoms listed on page 753 of the DSM 5 that include:

 

·       Frantic efforts to avoid real or imagined abandonment

·       pattern of unstable relationship

·       identity disturbance

·       impulsivity

·       recurrent suicidal behavior

·       affective instability

·       chronic feelings of emptiness

·       inappropriate intense anger

·       transient stress related paranoia

 

The symptoms that those with BPD experience are situation specific. Research is inconsistent on the prevalence of one symptom versus another. But there are symptoms that are highly specific for BPD in comparison to other mental health conditions. Individuals with BPD participated in weekly assessments for two weeks to determine which symptoms were most prevalent. These patients reported unstable identity and unstable relationships much more often in contrast to impulsivity and suicidality that were the least reported (Hawkins et al., 2014).

 

When identifying symptoms, it is helpful to have examples. When someone with BPD imagines "abandonment," it could be a co-worker who needs to leave lunch slightly early, a cancelled date, or a change in plans. Often the symptoms are triggered when "faced with a time-limited separation." (American Psychiatric Association, 2022 p. 1004). Unstable relationships are explained by the person's cyclic ideation and devaluation of their partner, withholding personal and intimate details, and feeling rejected when their attempts to forge a connection are not immediately reciprocated-this may be a struggle for those with BPD.

Without a partner or the feeling of being supported, an individual with BPD often has chronic feelings of emptiness and despair. This despair increases their risk of self-injury to rid themselves of feeling "dissociated." Once their partner or nurturer returns, their symptoms lessen. Because of the overwhelming internal conflict that characterizes BPD, these patients often exhibit self-injurious behavior and at times suicide, this occurs in 10% of BPD patients (Paris, 2019).

 

What triggers a person with borderline personality disorder?

Triggers include being rejected, betrayal, abandonment, self-identity threatened, boring situations and being alone (Berenson et al., 2011).

 

What causes borderline personality disorder?

There are many nonspecific factors that may lead to BPD; a team of researchers found that of 70% of patients with BPD; 43.7% were neglected, 43% witnessed violence, 9.3% were physically neglected and 36.4%  endured sexual abuse-with patients who were abused by their caretaker; those with BPD had a higher chance of being sexually abused by a male counterpart, physically abused by a caregiver and being raised by a temperamental female caretaker (Bourvis et al., 2017).

Parent-infant biological biases are a theoretical framework for a lot of psychiatric conditions.

Disruption of the early childhood attachment style is discovered in about 90% of patients. The importance of the child-parent dynamic is observed on a neurobiological level as demonstrated by the neurotransmitter oxytocin. Because of the importance of the child-parenting relationship in the early development stages-researchers have questioned the role of oxytocin in mental illnesses' such as BPD, it appears to decrease the reactivity to social threats and lessens attention to anger and hostility in participants (Bartz et al., 2010).

From a neurobiological perspective those with BPD are biased to finding negative emotions and ascribing unworthiness to the faces of others (Domes et al., 2008).

Patients with BPD have a tendency to ruminate and suppress negative emotion have difficulties expressing and processing their emotions, difficulties with interpersonal relationships with distrust and uncooperativeness being major facets (King-Casas et al., 2008).

 

How to treat borderline personality disorder:

 Although there are several treatment options for BPD, including but not limited to: dialectical behavioral therapy (DBT), mentalization-based therapy (MBT), transference-focused therapy (TFT), good psychiatric management, of these, the most efficacious is dialectical behavioral therapy. DBT was founded by Dr. Marsha Linehan who also suffers from BPD. She explains her therapy works when patients focus on “accepting,” and then “changing” self-destructive behavioral practices. A longitudinal study conducted in Germany found that of those diagnosed with BPD at the beginning of the study, 77% of patients no longer met the criteria for BPD by the end of the first year (Stiglmayr et al., 2014). This was possible by adherence to sessions and self-reflectiveness which is part of one of the four components of dialectical behavior therapy. The focus of DBT is to bring awareness to the mental processes activated when an individual is experiencing conflict. Since affective instability is a specific symptom for BPD, it is best for those struggling with this inner conflict to reason through it (Paris,2019).  Another systematic study focused on the results of five trials to determine the outcome of suicide in BPD patients who had either self-injurious or attempted suicide in the past. The systematic review found that the odds of suicide decreased by two-thirds -a significant outcome since 70-80% of those diagnosed with BPD exhibit self-injurious behavior (Panos et al., 2014). One should seek out a licensed psychologist, trained to deliver therapies that can alleviate the symptoms, self-destructive behaviors, and complexities of BPD. The prognosis depends on the individual’s desire to seek out a diagnosis and appropriate therapy. Therapy has excellent potential to enhance the quality of life depending on its duration and patient’s adherence to it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References


American Psychiatric Association. (2022). Diagnostic And Statistical Manual of Mental

Disorders (5th-TR). American Psychiatric Association.


Bartz, J., Simeon, D., Hamilton, H., Kim, S., Crystal, S., Braun, A., Vicens, V., & Hollander, E. (2010). Oxytocin can hinder trust and cooperation in borderline personality disorder. Social Cognitive and Affective Neuroscience, 6(5), 556–563. https://doi.org/10.1093/scan/nsq085


Berenson, K. R., Downey, G., Rafaeli, E., Coifman, K. G., & Paquin, N. L. (2011). The rejection–rage contingency in borderline personality disorder. Journal of Abnormal Psychology, 120(3), 681–690. https://doi.org/10.1037/a0023335


Bourvis, N., Aouidad, A., Cabelguen, C., Cohen, D., & Xavier, J. (2017). How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder? Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.02054


Domes, G., Czieschnek, D., Weidler, F., Berger, C., Fast, K., & Herpertz, S. C. (2008). Recognition of Facial Affect in Borderline Personality Disorder. Journal of Personality Disorders, 22(2), 135–147. https://doi.org/10.1521/pedi.2008.22.2.135


Free vector flat illustration of person being overwhelmed


Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M.,

Dawson, D. S., Pulay, A. J., Pickering, R. P., & Ruan, W. J. (2008). Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder. The Journal of Clinical Psychiatry, 69(4), 533–545. https://doi.org/10.4088/jcp.v69n0404


Hawkins, A. A., Furr, R. M., Arnold, E. M., Law, M. K., Mneimne, M., & Fleeson, W. (2014). The

structure of borderline personality disorder symptoms: A multi-method, multi-sample examination. Personality Disorders: Theory, Research, and Treatment, 5(4), 380–389. https://doi.org/10.1037/per0000086


King-Casas, B., Sharp, C., Lomax-Bream, L., Lohrenz, T., Fonagy, P., & Montague, P. R.

(2008). The Rupture and Repair of Cooperation in Borderline Personality Disorder.


National Collaborating Centre for Mental Health (UK. (2009). BORDERLINE

PERSONALITY DISORDER. Nih.gov; British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK55415/

 

Stiglmayr, C., Stecher-Mohr, J., Wagner, T., Meiβner, J., Spretz, D., Steffens, C., Roepke, S.,

Fydrich, T., Salbach-Andrae, H., Schulze, J., & Renneberg, B. (2014). Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 20. https://doi.org/10.1186/2051-6673-1-20


Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-Analysis and Systematic

Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Research on social work practice24(2), 213–223. https://doi.org/10.1177/1049731513503047


Paris J. (2019). Suicidality in Borderline Personality Disorder. Medicina (Kaunas,


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