Do you sometimes feel like you can't control your emotions, and things are coming at you so fast? Or do you know someone whose moods change so suddenly that they often interfere with their relationships with others? Perhaps the underlying cause of these feelings is the mental condition we're going to talk about today. This is called Borderline Personality Disorder (BPD) .
What is this so-called borderline personality disorder (BPD)?
Simply put, borderline personality disorder (BPD) is a mental health condition that is characterized by extreme mood fluctuations , instability in interpersonal relationships , and impulsivity .
People with BPD have an intense fear of abandonment . They also have difficulty regulating their emotions, especially anger. They may also act impulsively, sometimes dangerously (for example, driving recklessly, threatening to harm themselves) . All of these behaviors can make it difficult for them to maintain good relationships with others.
Borderline personality disorder is a type of personality disorder called ``Cluster B``. This ``Cluster B`` personality disorder is characterized by a dramatic, often bizarre behavior pattern. Personality disorders are chronic, dysfunctional behavior patterns that interfere with daily functioning . These behaviors are difficult to change, are ubiquitous, and can lead to social problems and psychological distress.
Often, people with BPD don't know they have the condition, and they don't realize that they can behave and relate to others in a healthier way.
Are these two conditions called BPD and bipolar disorder?
Yes, there is a clear difference between the two. Although bipolar disorder also involves major changes in mood and behavior, it is different from BPD.
In BPD, mood and behavior can change rapidly and suddenly when experiencing significant stress, especially when dealing with others . In bipolar disorder, moods are more sustained , and they don't respond as quickly to external events. People with bipolar disorder have large swings in energy and activity, which is different from people with BPD.
Who is affected the most by this situation?
Most personality disorders begin in the teenage years, when your personality is still developing and maturing . Therefore, most people diagnosed with borderline personality disorder are over the age of 18.
Although anyone can develop BPD, you are more likely to develop it if someone in your family has BPD (a family history of BPD) . This risk is also higher for people who have other mental health conditions, such as anxiety, depression, or eating disorders .
About 75% of people diagnosed with BPD are women , but research suggests that men can be affected by the condition as well. However, they may be misdiagnosed as having Post-Traumatic Stress Disorder (PTSD) or depression.
How common is this condition?
Borderline personality disorder is a relatively rare condition , affecting only 1.4% of the adult population in the United States.
What are the symptoms of borderline personality disorder (BPD)?
Symptoms of BPD usually appear in your late teenage years or early adulthood . These symptoms can be triggered or worsened by a traumatic event or stressful experience.
Over time, these symptoms usually decrease and may even disappear completely.
Symptoms can range from manageable to very severe. You may see any combination of the following symptoms:
- Fear of abandonment: It's common for people with BPD to feel uncomfortable being alone. When they feel abandoned or ignored, they can feel overwhelming fear or anger. They may seek out their loved ones and try to stop them from leaving. Or, they may push someone away before they get too close, fearing rejection. Imagine a friend who gets upset when you're a little late in replying to a message and says, "You left me."
- Unstable, intense relationships: People with BPD have a challenge maintaining healthy personal relationships because they can suddenly and dramatically change the way they think about others. They may treat someone like a god one moment and then treat them as worthless the next. This can also be the other way around. Their friendships, marriages, and relationships with family are often chaotic and unstable.
- Unstable self-image or sense of self: People with BPD often have a distorted, unclear self-image. They often feel guilty, ashamed, and see themselves as "bad." They may suddenly change their goals, opinions, jobs, and friends, and they may also try to sabotage their own development. For example, they may try to "fail" exams, sabotage relationships, or get fired from their jobs.
- Rapid mood changes: People with BPD may experience sudden changes in how they feel about others, themselves, and the world around them. Irrational emotions such as anger, fear, anxiety, hatred, sadness, and love can change rapidly and suddenly. These changes usually last only a few hours, rarely more than a few days.
- Impulsive and dangerous behavior: Impulsive driving, fighting, gambling, drug use, binge eating, and/or unsafe sexual activity are common among people with BPD.
- Repeated self-harm or suicidal behavior: People with BPD may cut, burn, or self- harm themselves, or threaten to do so. They may also have thoughts of suicide. These self-harm behaviors often occur when someone rejects them, feels abandoned, or is disappointed in them by a caregiver or loved one.
- Persistent feelings of emptiness: Many people with BPD feel sad, bored, unfulfilled, and "empty." Feelings of worthlessness and self-loathing are also common.
- Anger management issues: People with BPD have difficulty controlling their anger, and they get very angry. They may vent their anger through harsh jokes, harsh words, or outright yelling and swearing. They may feel ashamed and guilty after such moments.
- Temporary paranoid thoughts: Sometimes you may experience dissociative episodes , paranoid thoughts, and sometimes you may see or hear things that are not there (hallucinations). These usually occur when you are under a lot of stress, especially when you are afraid of being abandoned. These symptoms are temporary and usually not severe enough to be considered a separate illness.
The important thing is that not everyone with borderline personality disorder has all of these symptoms. The severity of the symptoms, how often they occur, and how long they last vary from person to person.
What could be the reasons for this?
Doctors believe that a combination of factors contribute to the development of BPD. The main ones are:
- Childhood abuse and trauma: About 70% of people with BPD have experienced sexual, emotional, or physical abuse as children. Separation from the mother, a poor relationship with the mother, inappropriate boundaries within the family, and parental drug addiction are also associated with BPD.
- Genetics: Studies have shown that borderline personality disorder runs in families. If someone in your family has BPD, you are more likely to develop it, but it is not a guarantee that you will.
- Brain changes: The parts of the brain that control emotions and behavior in people with BPD don't communicate with each other properly. These problems affect the way their brain works.
How do you recognize this condition?
Because personality continues to form during childhood and adolescence, doctors usually do not diagnose someone with borderline personality disorder before the age of 18. However, rarely, a person under the age of 18 may be diagnosed with BPD if their symptoms are very severe and have been present for at least a year.
Borderline personality disorder, including other personality disorders, can be a bit tricky to diagnose because many people with a personality disorder are unaware of the behaviors and ways of thinking that bother others.
Even if they do seek help, it is not because of the personality disorder itself. Instead, they are seeking help for situations such as anxiety or depression that are caused by problems related to their personality disorder (e.g., divorce, loss of relationships).
A licensed mental health professional – a psychiatrist , psychologist , or clinical social worker – can diagnose BPD. They use the criteria for BPD in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) .
To do this, they:
- A full interview is conducted and symptoms are discussed.
- Personal medical history and family medical history are asked, especially about mental health conditions.
- Asking about previous jobs.
- They ask if they can control their sudden thoughts.
Mental health professionals often talk to the person's family and friends to gather more information about their behavior and history.
What are the treatments for this?
Historically, treating BPD has been a challenge. However, with new, evidence-based treatments, many people with BPD have experienced a reduction in symptoms, reduced severity, improved functioning, and improved quality of life.
However, effective treatments take time, patience, and commitment . Treatments may include psychotherapy (talk therapy), medication, or both.
If you are under a lot of stress or are at risk of harming yourself or others, your doctor may recommend that you be hospitalized for a short period of time. During your stay in the hospital, your doctor will work with you to develop a treatment plan.
People with borderline personality disorder often have other mental health conditions:
- Mood disorders (between 80% and 96% of people with BPD)
- Anxiety disorders (88%)
- Substance use disorder (64%)
- Eating disorders (53%)
- Attention-deficit/hyperactivity disorder (ADHD) (between 10% and 30%)
- Bipolar disorder (15%)
- Somatoform disorders (10%)
If they have another condition like this, they need to get treatment for that too.
Psychotherapy for BPD
Psychotherapy is the main treatment for BPD. The goal of therapy is to help you identify the motivations and fears behind your thoughts and behaviors, and to help you learn to relate to others in more positive ways.
There are several treatments that can help with BPD:
- Dialectical Behavior Therapy (DBT): This type of therapy is specifically designed for people with BPD. DBT focuses on helping you accept the reality of your life and your behaviors, and learning to change your life, including unhelpful behaviors. It teaches skills to help you manage strong emotions, reduce self-harming behaviors, and improve relationships.
- Cognitive Behavioral Therapy (CBT): This is a structured, targeted treatment. Your therapist or psychologist will help you look at your thoughts and feelings. You will learn how your thoughts affect your actions. Through CBT, you can learn to let go of negative thoughts and behaviors and develop healthier thought patterns and habits.
- Group therapy: This is a type of psychotherapy. In this, a group of people come together, explain and discuss their problems under the supervision of a therapist or psychologist. Group therapy can help people with BPD interact more positively with others and express themselves more effectively.
Medications for BPD
Because the benefits of medication for borderline personality disorder are unclear, doctors do not usually prescribe medication as the main treatment for BPD.
However, in some cases, a psychiatrist may prescribe medication to treat specific symptoms or other coexisting mental health conditions. Medications can help treat anxiety and depression, manage mood swings, or control impulsive behavior. Antipsychotic/Neuroleptic drugs help some people with BPD.
What is the outlook for this condition? (Prognosis)
In most cases, BPD symptoms gradually improve with age. Some people's symptoms go away by their 40s. With the right treatment, many people with BPD learn to manage their symptoms and improve their quality of life.
Without treatment – or if treatment fails – people with borderline personality disorder are at increased risk for:
- Substance use disorder and alcohol use disorder.
- Depression.
- Self-harm.
- Suicide.
The risk of suicide among people with BPD is 40 times higher than the general population. Between 8% and 10% of people with BPD die by suicide.
Many people with untreated BPD have unstable and chaotic personal relationships, and have difficulty holding down a job. They are at increased risk of divorce, estrangement from family, and the breakdown of friendships. Legal and financial problems are also common.
Can this situation be prevented?
Unfortunately, there is no way to prevent borderline personality disorder.
BPD often runs in families, meaning that if someone in your family has BPD, you are at higher risk of developing it. Ask your doctor how to recognize the symptoms of this disorder so you can get treatment as soon as possible.
How can you help someone with BPD?
If you know someone living with borderline personality disorder, here are some ways you can help them:
- Take the time to learn about BPD to understand what your loved one is going through.
- Encourage your loved one to seek treatment for BPD. If you are a relative, ask about family therapy.
- Provide emotional support, understanding, and patience. Change can be difficult and scary for people with BPD. However, with treatment, their symptoms can improve over time.
- If you are feeling stressed or have symptoms of a mental health condition like anxiety or depression, consider seeking therapy. Choose someone other than your loved one who is your therapist.
Self-harm and suicidal behaviors are significantly higher among people with BPD than in the general population.
People with BPD who are thinking about harming themselves or attempting suicide need help quickly.
If you or someone you know is experiencing immediate distress or is thinking about harming themselves, call 1926 (Sri Lanka's suicide prevention hotline).
The most important thing to remember (Take-Home Message)
It's important to remember that borderline personality disorder (BPD) is a lifelong mental health condition. However, long-term, ongoing treatments, such as medication and talk therapy, can help you manage your symptoms. It's important to meet with your healthcare team regularly to review your treatment plan and symptoms. Know that your doctors and loved ones are there to support you.
Family members and loved ones of people with borderline personality disorder often experience stress, depression, sadness, and loneliness. It is important to take care of your own mental health and seek help if you are experiencing these symptoms.
` BPD, Borderline Personality Disorder, Mental Health, Personality Disorders, Emotional Regulation, Relationship Problems, Behavioral Problems
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