Borderline Personality Disorder
What is Borderline Personality Disorder (BPD)?
Borderline Personality Disorder is a common mental health condition that is recognised by a person’s poor perception of themselves, risky behaviours, poor interpersonal skills and impulsivity that impacts poorly on the person. About 6% of the population will develop the disorder in their lifetime. There is an associated increase in suffer morbidity and mortality compared with the general population.
How do I know if I have it?
There is are criterion that must be fulfilled to make the diagnosis. The DSM V is the guide that medical professionals use to assess if Borderline Personality Disorder is present.
DSM-IV Criteria for Borderline Personality Disorder are:
- A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:
- Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)
- A pattern of unstable and intense interpersonal relationships characterised by alternating
between extremes of idealisation 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
If you think you or a friend may have BPD please arrange for review with your GP. They may request further assessment with a psychologist or psychiatrist.
How does this happen?
We do not know. There may be a genetic component with twin studies showing an increased rate in the second twin having the disorder if the first was diagnosed with BPD. However other studies have shown in twins an environmental influence. There is some evidence that there may be neurobiological changes, changes in neurotransmitters and anatomy, however it is not clear if this is as a result of the development of BPD or the cause of the BPD.
There is a strong relationship with childhood trauma. However, it is not thought that childhood trauma is the cause of BPD, as many who suffer childhood trauma do not develop BPD. Further and ongoing research is required in this area to fully develop an understanding of the relationship.
How do I fix it?
Despite what was previously thought, this is not a lifetime disorder. Studies have shown that remission can occur with 2 years for 35% of people and up to 99% after 16 years.
Treatment of BPD is possible. It is important that the correct diagnosis id made first, as there are many conditions that present in a similar manner, that may require slightly differing approaches. BPD is treated using psychological therapy. These therapies would include cognitive behaviour therapy (CBT), where the psychologist helps the person to change the way they think about and approach problems and dialectical behaviour therapy, which is a variation of CBT. An experienced psychologist may offer other treatment styles, but all will be related to the “talking style” of treatment. There does not appear to be a role for medication, though it is occasional used for very short timeframes for a very specific purpose.
Education about the disorder, so the person understands what is happening and how to deal with the variety of challenges it causes will help. Family and friends should be may aware of your condition, so they too can understand what is happening and why and how they can support you through this time. They will find it easier to cope and help you.
Where can I get more information?
The following website can assist with further information or see your GP: