Borderline personality disorder (BPD) is a major psychiatric disease, characterized by intense and rapidly changing relationships, rapid mood swings, extreme impulsiveness and a weak self-image. People with borderline think black-and-white and respond extreme. The condition is often associated with other mental disorders, such as depression or addiction.
Borderline can have various causes. It is often a combination of factors that allowes a person to develop this personality disorder:
- Biological factors. Predisposition and heredity are biological factors that can play a role in the development of borderline. Thus, people with borderline are potentially impulsive and emotionally instable. This has to do with processes in the brains and with hormones.
- Environmental factors. Unpleasant experiences or feelings in childhood play an important role in the development of borderline. People with borderline often felt unsafe in their youth. Half of people with borderline has been abused or sexually exploited. When emotional abuse is included, this number is even higher.
Several signs and symptoms could indicate borderline:
- Self-injury (self-harm).
- Dissociative symptoms, also known as states of altered consciousness. Bystanders may suspect this sign as someone is somewhat absent, makes a strongly distracted impression, responds unclear or inadequate.
- Sense of emptiness or loneliness.
- Difficulty with (daring to) enter into and maintain contacts.
- Negative self-image.
- Mood swings.
- Suicidal thoughts/attempts.
- Separation anxiety.
- Angry outbursts.
- Black/white (all or nothing) thinking.
The diagnosis of borderline is made on the basis of a comprehensive review of the observed symptoms, the history of the person in question and his or her family and the assessment of the mental condition by the doctor. A psychiatrist or psychologist talks to the patient and asks for his or her ideas about life and work. These ideas and other features associated with it, are assessed to arrive at a diagnosis.
The treatment of borderline personality disorder includes psychotherapy and medication.
The psychotherapy covers short-term crisis management during periods of stress and long-term therapy. During therapy, patients are supported to build a stable relationship with the therapist and others, to reduce suicidal tendencies and to understand their impulsive actions and emotional upheaval.
In addition to psychotherapy, the use of medication is recommended. This could be mood stabilizers and antidepressants to counter the attacks of emotional confusion and outbursts.
Although borderline is difficult to treat, the prognosis with treatment is better than without treatment. If people with borderline approach middle-age, the symptoms are usually less severe. They learn to accept society and their family and have fun in their daily activities or work. For recovery, the support of friends and relatives is of great importance.
The possible complications of borderline personality disorder are sometimes fatal. Drug abuse, mood swings, a disorderly life and insecurity may negatively affect social contacts of patients. Possible consequences are a broken marriage, loneliness or frequently changing jobs, which can worsen depression again. In people with this disorder, depression can lead to frequent suicide attempts.
- A patient can prevent a crisis by realizing where he or she is sensitive for. People with borderline personality disorder are often vulnerable to a (potential) loss.
- If one feels getting violently angry, it is better to withdraw from the suction, in which one reproach evokes another. Then one could just say not to respond at the moment.
- In case of very alternating moods and feelings, patients should better not look for a very stressful job. They can better work somewhat under their own level in a quiet department.
- The contact with long-known people is important. Should something go wrong in it, it’s important to come back when the storm has calmed down.
- The indication ‘borderline’ was introduced in 1938 by the American psychoanalyst Adolph Stern.
- The term ‘borderline’ was conceived as ‘border between neurosis and psychosis’, but this is not true. Borderline has some characteristics of neurosis and psychosis, but also differs in many respects.
- The prevalence of borderline is 1.5%.
- Women run a higher risk of having this condition than men.
- Borderline is less common in people of 50 years and older.