Borderline personality disorder (BPD)
Borderline personality disorder is the most commonly recognized personality disorder. It is a mental illness that severely impacts a person’s ability to regulate their emotions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others.
How do people with BPD act?
People with a borderline personality disorder may experience intense mood swings and feel uncertainty about how they see themselves. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike. These changing feelings can lead to unstable relationships and emotional pain.
People with a borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their interests and values can change quickly, and they may act impulsively or recklessly.
They might also show symptoms as below:
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Efforts to avoid real or perceived abandonment, such as plunging headfirst into relationships—or ending them just as quickly.
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A pattern of intense and unstable relationships with family, friends, and loved ones.
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A distorted and unstable self-image or sense of self.
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Impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.
Please note: If these behaviours happen mostly during times of elevated mood or energy, they may be symptoms of a mood disorder and not a borderline personality disorder.
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Self-harming behaviour, such as cutting.
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Recurring thoughts of suicidal behaviours or threats.
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Intense and highly variable moods, with episodes lasting from a few hours to a few days.
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Chronic feelings of emptiness.
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Inappropriate, intense anger or problems controlling anger.
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Feelings of dissociation, such as feeling cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.
Not everyone with a borderline personality disorder may experience all of these symptoms. The severity, frequency, and duration of symptoms depend on the person and their illness.
People with borderline personality disorder have a significantly higher rate of self-harming and suicidal behaviour than the general population. And if they are thinking of harming themselves or attempting suicide, they need help right away.
Who is prone to have BPD?
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Family history: People who have a close family member (such as a parent or sibling) with the illness may be at a higher risk of developing a borderline personality disorder.
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Brain structure and function: Research shows that people with a borderline personality disorder may have structural and functional changes in the brain, especially in the areas that control impulses and emotion regulation. However, the studies do not demonstrate whether these changes were risk factors for the illness or if such changes were caused by the disorder.
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Environmental, cultural, and social factors: Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or hardship during childhood. Others may have been exposed to unstable, invalidating relationships or conflicts.
Although these factors may increase a person’s risk, it doesn’t mean it is certain that they will they’ll develop a borderline personality disorder. Likewise, people without these risk factors may also develop the disorder in their lifetime.
How are they treated?
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Individual Psychotherapy: Often, psychotherapy is required to achieve lasting personality change. Short-term or brief therapy may help stabilize immediate crises. Dialectical Behaviour Therapy, this treatment was developed specifically for individuals with BPD.
It uses concepts of mindfulness or awareness of one’s present situation & emotional state. As well as also teaches skills to help people control intense emotions, reduce self-destructive behaviours, and improve relationships. Cognitive-Behavioural Therapy has proven helpful in altering negative patterns of thinking and emotions, and in learning new behaviours and coping strategies. Helps to reduce mood swings, anxiety symptoms and self-harming or suicidal behaviours. -
Psycho Nutritional Medication: Psycho Nutritional Medications can help reduce symptoms of depression, anxiety, irritability and paranoid thoughts. It may also help improve emotionally and impulse control, thereby reducing stress in marital or family relationships and making it easier to develop new interpersonal or stress management skills in psychotherapy. Unlike pharmaceutical medication, it does not have side effects and you will not develop a dependency on them.
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Marital or Family Therapy: Marital therapy can help stabilize the marital relationship and in reducing marital conflict and stress that can worsen BPD symptoms. Family Therapy or Family Psychoeducation can help educate family members regarding BPD, improve family communication and problem-solving, and provide support to family members in dealing with their loved one's illness.
Therapy for family members
Having a relative or loved one with the disorder can be stressful, and family members or caregivers may unintentionally act in ways that can worsen their loved one’s symptoms.
Family therapy helps by:
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Allowing the relative or loved one to develop skills to understand and support a person with a borderline personality disorder.
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Focusing on the needs of family members to help them understand the obstacles and strategies for caring for someone with the disorder.
Here are some ways to help a friend or relative with the disorder:
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Take time to learn about the illness and understand what your friend or relative is experiencing.
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Offer emotional support, understanding, patience, and encouragement. Change can be difficult and frightening to people with borderline personality disorder, but things can improve over time.
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Encourage your loved one in treatment for a borderline personality disorder to ask about family therapy.
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Seek counselling for yourself. Choose a different therapist than the one your relative is seeing.
However, if the “limit” has been reached. It is important to know when to protect yourself.
When to draw that line?
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Physical violence. Nobody should stay in a relationship where there is continuous physical violence.
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Too many boundaries. When there are so many topics or different types of interactions you need to avoid to prevent your partner from lashing out; you’ve removed most of the sources of the potential communication, intimacy, and connection.
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Your partner is unwilling to make changes.
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Your mood is consistently bad.
Read about narcissistic personality disorder (NPD)
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Medically reviewed by Ashwini Nair, MB BCh BAO.
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References:
1. Borderline Personality Disorder. National Institute of Mental Health (NIMH). Accessed May 4, 2022. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
2. Borderline Personality Disorder Treatment in Malaysia | Borderline Personality Disorder Assessment in Malaysia. Accessed May 4, 2022. https://www.psychology.com.my/Borderline-Personality-Disorder-Treatment-Assessment/#.YnKI4PNBw6A
