Borderline Personality Disorder

Borderline Personality Disorder

Introduction

Borderline personality disorder (BPD) refers to a mental sickness that is characterized by unstable relationships, behaviors, and moods. Individuals suffering from this disorder might struggle with issues of self-image, self-doubt feelings, low self-worth, and abandonment fears. These individuals are often unable to control their emotions, and this leads to suicidal and self-harm behaviors. They are also vulnerable to other co-occurring disorders, such as depression, anxiety, eating disorder, and substance abuse (“13.5 Personality Disorders – Introduction To Psychology – 1St Canadian Edition”).

BPD impacts negatively on a patient’s life and how they interact with other people. People with this disorder do not really know who they are due to the instability behaviors and moods that are caused by the illness. The individuals experience a lot of challenges in how they feel about themselves. Their self-image feelings fluctuate from one point to the other; at one point, they might feel they are good people, but later on, they might feel they are evil or wicked people. With such feelings about who they are, it becomes challenging for them to interact well with other people. Their behaviors and characters are so inconsistent and so unpredictable; hence, it becomes a challenge to deal with them.

Treatment of Borderline Personality Disorder

Earlier on, it was believed by experts that BPD could not likely be treatable. However, in 2017, there was research that was published showing that the disorder is highly treatable. Individuals suffering from this disorder are advised to seek help from professionals of mental health; this is essential, for it will help the person fewer symptoms related to BPD, and as such, one can live a healthy life. The treatment helps curb some of the risky behaviors associated with BPD, such as suicide and self-harm behaviors (“BPD Treatment At Mclean Hospital”). It is very crucial for the patient to get treatment from a specialist in BPD in order to ensure that the treatment that is given targets the disorder and is effective.

There are various treatment methods that can be used to treat BPD. Psychotherapy can be used; it is known to be the standard treatment method for BPD. In this method, cognitive behavioral therapy and dialectical behavior therapy can be used because they majorly target BPD. During the treatment process, the patient’s caregivers, friends, and family are involved. Another method that can be used for treatment is the use of medication. With the help of a mental health practitioner, the patient can be recommended to use drugs that can help in the treatment of some of the symptoms of BPD, for instance, depression, anxiety, and mood swings. Other treatments can also be used on occasions where the patient’s symptoms cannot be stabilized by medication and psychotherapy methods. In cases where the patient is at risk of suicide or self-harm, more intensive methods such as hospitalization of the patient are recommended. Hospitalization will give room for the patient’s behavior to be monitored closely and the right medication to be given by mental health practitioners (“BPD Treatment At Mclean Hospital”).

There is no research showing that BPD can be cured. Most of the methods used work on reducing the effect caused by some of the symptoms. For instance, the medication that is mostly given treats the symptoms of mood instability, depression, and anxiety. With the therapies used, the patient is taught how to view and react to various issues that could be triggering BPD symptoms. Often, these symptoms come back after treatment and the use of therapy.

Causes of Borderline Personality Disorder

BPD is believed to be caused by genetic and environmental factors. Based on genetics, research shows that individuals with this disorder often have imbalances of neurotransmitters (Zweig-Frank et al., 2006). Research also shows that the disease is heritable (Minzenberg, Poole, & Vinogradov, 2008) since it is common for a family to have more than one-member suffering from the disorder.

Environmental factors leading to BPD mainly focus on the environment in which a child is brought up. During early childhood, many children tend to retain so many memories of various incidences that happen in their life. The memories of these incidences trigger a lot of feelings and reactions as they grow up in life. Bad or disturbing relationships between children and their parents or guardians might lead to the development of BPD. In the early stages of development, a child requires a lot of care and attention; it is important for the feelings of the child to be attended to well. When children grow up in an environment where they are neglected or ignored, they most of the time end up feeling not wanted or not important in life. When these children grow up, most of them suffer from low self-esteem, and they often doubt their self-worth.

Other theories based on environmental factors show that physical and sexual abuse in one’s childhood life, alcoholism, and divorce of parents could lead to the development of BPD (Lobbestael & Arntz, 2009). Most of these events, such as sexual abuse and alcoholism, are traumatizing to a child, and they trigger a lot of fear and uncontrolled emotions whenever they are remembered. Children who have been brought up in a violent environment tend to react violently to any issue that annoys them, or similarly, some respond with a lot of fear whenever they encounter an extreme situation. It is often difficult to control the reaction and emotions of such kids even when they grow up because certain events trigger their memories and affect how they behave. With traumatizing happenings in a child’s life, it is easier for them to harm themselves. The problem of BPD worsens when it comes along with other disorders such as depression, post-traumatic stress, and substance abuse (Skodol et al., 2002).

According to Marsha Linehan, disabling environments that can lead to the development of PBD are environments where the caregivers of children do not recognize the emotions and feelings of the children. The caregivers do things for the children based on their own emotions and what they think is right for the children. As the children grow up, they end up doing things based on the experiences they have had with their caregivers; they cannot act on their own and know what is right or wrong without using their caregiver’s judgment or reaction that was used as they were growing up. This hinders the identity development of the children, and as they grow, they are not sure of who they are; this brings about self-doubt feelings. During the early developmental stages of a child, it is essential for parents and guardians to pay attention to the emotions of their children; they should let the children express themselves without their interference. This will help build the confidence of the kids in what they do, and they will end up trusting themselves; this will highly build on the development of self-identity as the child grows

Symptoms of Borderline Personality Disorder

The symptoms of BPD are much similar to the symptoms of other disorders such as Bipolar disorder. Due to this similarity, it is important for one to seek treatment from professionals in the field of BPD in order to void misdiagnosis of the disease, which can be detrimental to one’s health. Some of the symptoms of BPD are (“Borderline Personality Disorder Symptoms, Causes, And Treatment”):

• Unstable relationship patterns; the individual believes the person is good, but this changes suddenly with the BPD individual feeling the person is cruel of bad.
• Drastic changes in self-image and self-identity, including shifting values and goals, and one feels as though they are bad people.
• Depersonalization: This is the separation feeling between oneself and their body. This feeling makes one feel as though they are in a dream, and from the outside, they can see their bodies.
• Derealization; a person experiencing derealization feels detached from people or the external world. This feeling makes things that are familiar to look unreal or strange. The feeling is similar to that of depersonalization. Often, derealization and depersonalization occur together.
• Amnesia: At times, one cannot remember past events.
• Identity confusion, where one cannot tell who they really are, and they struggle to find their identity.
• Alteration of identity: the individual senses they are acting differently from who they are. People around the person can notice this change. Some people even change their names, and this is mostly accompanied by behavior or mood changes that are beyond the person’s control.
• Feeling of dissociation. Not every BPD patient experiences dissociation, but it is a common symptom amongst BPB individuals. This involves daydreaming and zoning out such that one cannot remember what they were doing or thinking
• Stress-related paranoia period and losing contact with real things. This lasts for some hours or minutes.
• Engaging in risky and impulsive behavior, for instance, drug abuse, binge eating, spending sprees, unsafe sex, reckless driving, or gambling.
• Self-injury, suicidal behavior, or threats. Often, this is in response to rejection or separation fears.
• Emptiness feelings that might continue for some time.
• Mood swings that might include intense anxiety, shame, irritability, or happiness.
• Intense anger that is mostly inappropriate or has no cause such as, losing one’s temper frequently, being bitter or sarcastic, or engaging in physical fights with people.

Association of BPD with self-harm and suicide

Self-harm and suicidal behaviors are highly associated with BPD. About 10% of individuals with BPD commit suicide. The available methods of treatment of the disorder have been reported not be effective enough to prevent the patients from suicidal behaviors. The most used method of treatment that is evidence-based is psychotherapy. Suicidal occurrences in patients often happen after a long period of ineffective treatment. In a fifteen year follow up study, the mean age for suicide in patients was found to be thirty, while in another twenty-seven year follow up study, the mean age was thirty-seven. Research shows that young people are not at a high risk of commit suicide when suffering from BPD.

Post-mortem interviews on deaths of people with BPD have shown that most of them killed themselves. Most of them were under thirty-five years of age at the time of death. Pompili et at. meta-analysis shows that suicidal behaviors are so high in young people with BPD. A majority of the patients with BPD and on treatment tend to improve with time. However, there are those who end up killing themselves, especially those who do not recover or improve after treatment. Approximately a third of male youths suffering from BPD commit suicide in the long run. Many studies have shown males to be at a higher risk of killing themselves as compared to the females with BPD. Most of those committing suicide are individuals who are not on any form of treatment.

Where to get help when having suicidal thoughts

There are various ways and places that one can seek help when having thoughts of committing suicide. Some of the actions one can take to get help are:

• Immediately dial 911 or any other local emergency contacts.
• Dial a hotline number that deals with suicidal issues. If in the U.S.A, one can call National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) at any time. The same number can be used by pressing 1 in order to access the Veterans Crisis Line.
• One can call their mental health practitioner or any other health care professional that can offer the required assistance.
• Contact any trusted family member, friend, colleague, or peer that can be in a position to help.
• Seek help from a trusted religious person within one’s religion or faith.

Family members and friends can play a crucial role in preventing BPD individuals from ending their lives through suicide; they can advise the person to seek treatment as early as possible. However, it is upon the individual with BPD to make that personal decision and find help from mental health professionals or therapists dealing with the management of BPD.

Risk Factors for Borderline Personality Disorder

Adults who have had past experiences of the death of loved ones, substance abuse, sexual abuse, neglect, and divorce are at a higher risk of suffering from a borderline personality disorder. Children having problems with learning things or any other temperaments are also at a higher risk of developing the disorder; the challenges the children experience tend to increase their likelihood of developing BPD. In adolescents, addiction, or any form of substance abuse increases the possibility for one to develop BPD. Substance abuse such as excessive drinking of alcohol and the use of drugs causes some imbalance in one’s brain, and this can lead to the development of mood swings, anxiety, depression, stress, which can cause one to develop BPD eventually.

Myths about Borderline Personality Disorder

Borderline personality disorder was not characterized as a valid psychiatric diagnosis in the past. At first, many health professionals had a problem with the name of the disorder. Many of the symptoms of the disorder are similar to those of other disorders such as bipolar disorder, and such, it was difficult for the health care practitioners to distinguish it from the other disorders and have its diagnosis. After some years of research about the disorder, borderline personality disorder was, for the first time, included in the Diagnostic and Statistical Manual (DSM-III), third edition, which was published in 1980 by the American Psychiatric Association.

From 1980, there has been a move to find a specific name for the diagnosis of borderline personality disorder. This is because a lot of research indicates that the disorder is closely related to specific and significant biological disturbances in one’s brain. Also, it is shown that the disorder is significantly attributed to genetic factors; effective medication for reducing some of the core symptoms act at receptor sites that are specific in some pathways of the neurons in the disturbed areas of the brain.

Before the age of 18 years, the disorder cannot be accurately diagnosed. In children, it is difficult to diagnose the disorder significantly with some level of certainty; however, during puberty, BPD’s symptoms appear clearly. At this moment, the disorder’s diagnosis can easily be made with some reasonable degree of surety. This shows why there has always been some reluctance for the psychiatrists and healthcare practitioners to diagnose borderline personality disorder in young people. When the diagnosis of the disorder is made in young people, there is a high possibility for misdiagnosis and hence, prescription of wrong medication. Whether the misdiagnosis was intentional or unintentional, the results can be so traumatizing to the patient, and this can cause stigmatization.

In the diagnosis of borderline personality disorder, the potential for causing considerable harm to the patients is so high. Many adolescents have been misdiagnosed with the disorder, and they have ended up under the care of psychiatrist with no success of recovery from the disorder. This has often led to hopelessness among the youths, and this can be very detrimental as some might start experiencing suicidal thoughts. When the diagnosis is properly made, and treatment commenced, most of the young people suffering from the disorder show significant improvement, and this restores their hope for a better future.

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