Borderline Personality Disorder

The National Alliance on Mental Illness (NAMI) reports that about 1.6 percent of adults in the United States have borderline personality disorder, a condition that is associated with challenges with emotional regulation and involves symptoms such as poor impulse control, unstable relationships, self-harming behaviors, and a negative view of the self. Some information suggests that the prevalence of borderline personality disorder could be as high as 5.9 percent. 1

Borderline personality disorder can create difficulties with relationships and daily functioning, but treatment is available. Researchers have conducted studies to determine who is affected by borderline personality disorder and what treatments are most effective for improving mental health and quality of life among individuals with this diagnosis.

What is Borderline Personality Disorder?

The American Psychiatric Association has described borderline personality disorder as a condition involving poor or unstable self-image or difficulty persisting with goals and career aspirations, combined with deficits in social functioning, which can include difficulty with empathy or a pattern of tumultuous relationships. Individuals with a diagnosis of borderline personality disorder also experience difficulty with emotional regulation, which may present itself in the form of frequent changes in emotion, intense emotional reactions under normal circumstances, or feelings of anxiety and depression.2

In addition, borderline personality disorder involves feelings such as a fear of abandonment. A person diagnosed with borderline personality disorder may frantically attempt to avoid abandonment and may appear very dependent upon their romantic partners. Individuals with this diagnosis also experience feelings of anger or hostility, and they may engage in risk-taking or self-harming behaviors.2 In extreme cases, a person with borderline personality disorder may experience psychosis, especially when faced with stress.1

A person who is diagnosed with borderline personality disorder may appear especially anxious or agitated, and he or she may perceive minor misunderstandings more intensely than the typical person and have a dramatic emotional reaction to these misunderstandings. A person with a diagnosis of borderline might also appear “needy” and have an intense fear of rejection or of being separated from a romantic partner.

Other behaviors that might occur with borderline personality disorder include the following:

  • Engaging in a pattern of “love-hate” relationships
  • Self-mutilation
  • Suicide threats or ideation
  • Spending money excessively
  • Periods of substance abuse
  • Angry outbursts

Other behaviors that might occur with borderline personality disorder include the following:

  • Engaging in a pattern of “love-hate” relationships
  • Self-mutilation
  • Suicide threats or ideation
  • Spending money excessively
  • Periods of substance abuse
  • Angry outbursts

Causes of Borderline Personality Disorder

There are multiple theories regarding the causes of borderline personality disorder, but it is difficult to determine one single, specific cause of this condition. There do appear to be factors that increase a person’s risk of developing borderline personality disorder.

According to NAMI, genetics appear to play a role in borderline personality disorder, with twin research suggesting a genetic component and other studies indicating that a diagnosis of borderline personality disorder is five times more likely among individuals who have a close relative with the disorder. NAMI also reports that child abuse and neglect, as well as neurological and cognitive deficits, can contribute to the disorder. 1

There are also specific alterations in brain physiology linked to borderline personality disorder. Researchers writing for a 2009 publication of the Journal of Personality Disorders reviewed the results of six studies and found that the amygdala and hippocampus were significantly smaller in the brains of individuals with borderline personality disorder when compared to those without the disorder.3 It is possible that alterations in the functioning of these structures, which are associated with fear and memory, are responsible for some of the behavioral and emotional abnormalities seen with borderline personality disorder.

Treatment for Borderline Personality Disorder

Psychological interventions are effective for the treatment of borderline personality disorder. A 2017 report in the journal JAMA Psychiatry reviewed the results of 33 studies and found that psychotherapy is moderately effective when compared to control groups. Psychodynamic therapy and dialectical behavioral therapy in particular were found to be helpful in treating individuals with borderline personality.4 NAMI has reported that these two therapies, as well as cognitive behavioral therapy, are the preferred options for treating borderline personality disorder.1

With quality psychological therapies, individuals with borderline personality disorder can learn the skills necessary for coping and responding to stressors in an appropriate manner. Psychotherapy can also help them to challenge irrational thoughts and change behaviors that contribute to the mental illness.

While psychotherapy can be beneficial, some with borderline personality disorder will have a need for pharmacological treatment. According to NAMI, medications can be necessary for treatment, but there are no medications specifically intended for the treatment of borderline personality disorder. Instead, medications designed to control conditions that often occur in borderline personality disorder, such as anxiety, depression, or unstable moods, can be useful for treating symptoms of borderline personality disorder. While medications can be provided on an outpatient basis, clients who present a risk of harm to themselves because of extreme risk-taking behavior or suicide attempts may require treatment in a hospital or inpatient facility until they are stabilized.

Beyond medication and counseling, individuals with borderline personality disorder may benefit from attending education or support groups or reaching out to friends and family. NAMI also recommends that it is important to practice self-care, which can involve eating a nutritious diet, managing stress, and getting sufficient amounts of exercise. It is also advisable to avoid drugs and alcohol, which NAMI reports can worsen unstable moods. 1

Misconceptions about Borderline Personality Disorder

Borderline personality disorder can involve intense moods and unsettling behaviors, making this diagnosis seem rather unpleasant. Because of the severity of borderline personality disorder, there are misconceptions about this mental health condition.

Reality : It is true that 75 percent of those diagnosed with borderline personality disorder are women, but NAMI reports that the occurrence could be higher than reported among men, due to some men with borderline personality being misdiagnosed with other conditions, such as depression.1

Reality: While the risk of substance abuse is elevated among individuals with borderline personality disorder, not everyone with this condition uses drugs or alcohol. A 2018 report in Borderline Personality Disorder and Emotion Dysregulation reviewed the research regarding the co-occurrence of borderline personality disorder and substance use disorders. Results of the review showed that 45 percent of people with borderline personality disorder report a current substance use disorder, and 46 percent experience a current alcohol use disorder.5

Reality: Some features of borderline personality disorder can appear similar to characteristics of bipolar disorder, but the two conditions are separate diagnoses. Bipolar disorder involves cycling between depressed moods and more elevated moods, called mania or hypomania. In some cases, depression and mania can occur at the same time. Depressive episodes in bipolar disorder can appear similar to the depressed moods seen in borderline personality disorder, and individuals experiencing mania or hypomania may display irritability and risk-tasking behavior, much like those with borderline personality disorder.

What distinguishes the two conditions is that individuals with a borderline personality diagnosis experience a weak, unstable self-image as well as conflictual relationships, intense anger, and extreme mood swings. While those with bipolar disorder do experience shifts in mood, they tend to experience longer periods of either mania or depression, whereas a person with borderline personality disorder will experience rapid shifts in emotion, often in response to events occurring around them. Despite being a separate diagnosis, borderline personality disorder can sometimes be misdiagnosed as bipolar disorder, leading to worsened treatment outcomes for some individuals with the condition. An accurate diagnosis is essential for recovery.1

Reality : The complexity of borderline personality disorder can make this condition seem untreatable. Even mental health professionals may hold stigmatized views of people with borderline personality disorder, but the research shows positive outcomes. In a review of 11 studies, researchers from the University of Barcelona determined that 50 to 70 percent of patients with borderline personality disorder experience remission over the long run.6

Treatment of borderline personality disorder is possible, despite the fact that this condition can involve challenging behaviors and emotions. With effective treatment, such as dialectical behavioral therapy, those with borderline personality disorder can recover and lead satisfying, productive lives.


Resources

  1. https://nami.org/#
  2. http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf
  3. https://guilfordjournals.com/doi/abs/10.1521/pedi.2009.23.4.333
  4. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2605200
  5. https://bpded.biomedcentral.com/articles/10.1186/s40479-018-0093-9
  6. https://www.sciencedirect.com/science/article/pii/S0924933818301937