Borderline personality disorder

What is borderline personality disorder?

Borderline personality disorder (BPD) is a condition characterised by impulsive actions, mood instability, and chaotic relationships. A person with a borderline personality disorder often experiences a repetitive pattern of disorganisation and instability in self-image, mood, behaviour and close personal relationships. This can cause significant distress or impairment in friendships and work. People with this disorder can often be bright and intelligent, and appear warm, friendly and competent. They sometimes can maintain this appearance for a number of years until their defence structure breaks down, usually around a stressful situation like the break-up of a relationship or the death of a parent.

What is the cause?

BPD tends to occur more often in women than men. This may be related to genetic or hormonal influences. There may be an innate predisposition to this disorder in some people. The cause of BPD is unknown. People with BPD are impulsive in areas that have a potential for self-harm, such as drug use, drinking, and other risk-taking behaviours. Risk factors for BPD include abandonment issues in childhood or adolescence, sexual abuse, disrupted family life, and poor communication within the family.

What are the symptoms?

In BPD, relationships with others are intense and unstable, swinging wildly from love to hate and back again. People with BPD engage in frantic efforts to avoid real or imagined abandonment. They may also have uncertainties about their identity or self-image. They tend to see things in terms of extremes, either all good or all bad. Such people also typically view themselves as victims of circumstances and take little responsibility for themselves or their problems.

Other symptoms include:

• Frequent displays of inappropriate anger
• Recurrent suicidal gestures such as wrist cutting or drug overdosing
• Feelings of emptiness and boredom
• Intolerance of being alone
• Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting
• Difficulty in trusting others
• Emotional instability with marked and frequent shifts to an empty lonely depression or to irritability and anxiety
• Identity disturbances with confusion and uncertainty about self-identity, sexuality, life goals and values, career choices, friendships
• Unpredictable and impulsive behaviour that might include excessive spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating or physically self-damaging actions such as suicide gestures

What is the treatment?

Treatment includes psychotherapy that allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and a non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings. Sometimes medications such as anti-depressants or anti-psychotic medication are useful for certain patients or during certain times in the treatment of individual patients. Medications can help to level mood swings and to treat depression or other disorders, which may accompany this condition. Treatment of any alcohol or drug abuse problems is often mandatory if the therapy is to continue. Brief hospitalisation may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behaviour threatens. Hospitalisation may provide a temporary removal from external stress. Outpatient treatment is usually difficult and long-term - sometimes over a number of years.

The goals of treatment include increasing self-awareness with greater impulse control and increased stability of relationships. A positive result would be in one's increased tolerance of anxiety. Therapy can help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle.

What is the prognosis?

Borderline personality disorder has a poor outlook because non-compliance with treatment is common. It can lead to the following complications:

1. Drug abuse
   
2. Suicide attempts
   
3. Eating disorders
   
4. Depression