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Borderline
Personality Disorder (BPD) is characterized by impulsivity
and instability in mood, self-image, and personal relationships.
It is fairly common and is diagnosed more often in females
than males.
What
are the symptoms of BPD?
Individuals with BPD have several of the following symptoms:
-
marked mood swings with periods of intense depression, irritability,
and/or anxiety lasting a few hours to a few days;
-
inappropriate, intense, or uncontrolled anger;
- impulsiveness
in spending, sex, substance use, shoplifting, reckless driving,
or binge eating;
- recurring
suicidal threats or self-injurious behavior;
-
unstable, intense personal relationships with extreme, black
and white views of people and experiences, sometimes alternating
between "all good" idealization and "all
bad" devaluation;
- marked,
persistent uncertainty about self-image, long term goals,
friendships, and values;
- chronic
boredom or feelings of emptiness; and
-
frantic efforts to avoid abandonment, either real or imagined.
What
causes BPD?
The causes of BPD are unclear, although psychological and
biological factors may be involved. Originally thought to
"border on" schizophrenia, BPD also appears to be
related to serious depressive illness. In some cases, neurological
disorders play a role. Biological problems may cause mood
instability and lack of impulse control, which in turn may
contribute to troubled relationships. Difficulties in psychological
development during childhood, perhaps associated with neglect,
abuse, or inconsistent parenting, may create identity and
personality problems. More research is needed to clarify the
psychological and/or biological factors causing BPD. The field
is also actively looking at genetic vulnerabilities.
How
is BPD treated?
A combination of psychotherapy and medication appears to provide
the best results for treatment of BPD. Medications can be
useful in reducing anxiety, depression, and disruptive impulses.
Relief of such symptoms may help the individual deal with
harmful patterns of thinking and interacting that disrupt
daily activities.
Long-term outpatient psychotherapy and group therapy (if the
individual is carefully matched to the group) can be helpful.
Short-term hospitalization may be necessary during times of
extreme stress, impulsive behavior, or substance abuse. More
structured cognitive interventions like dialectical behavioral
therapy (DBT) are now widely used.
Can
other disorders co-occur with BPD?
Yes. Determining whether other psychiatric disorders may be
involved is critical. BPD may be accompanied by serious depressive
illness (including bipolar disorder), eating disorders, and
alcohol or drug abuse. About 50 percent of people with BPD
experience episodes of serious depression. At these times,
the "usual" depression becomes more intense and
steady, and sleep and appetite disturbances may occur or worsen.
These symptoms, and the other disorders mentioned above, may
require specific treatment. A neurological evaluation may
be necessary for some individuals.
What
medications are prescribed for BPD?
Antidepressants, anticonvulsants, and the new atypical antipsychotics
are common for BPD. Decisions about medication use should
be made cooperatively between the individual and the therapist
or psychiatrist. Issues to be considered include the person's
willingness to take the medication as prescribed, and the
possible benefits, risks, and side effects of the medication,
particularly the risk of overdose.
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more in-depth information about mental illness, treatments
and supports, and medications;
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