What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is an illness characterized by marked difficulty maintaining a stable emotional state. Sufferers experience atypically wide swings in their moods, their feelings about themselves and others, and in their behavior. These swings can be extreme and can last for up to days at a time.
The consequences of BPD include difficulties in maintaining stable relationships, engaging in impulsive or risky behavior, and self-harming behaviors.
Symptoms of Borderline Personality Disorder
Many of the symptoms of BPD involve emotional instability, relationship conflict, and fluctuating self-image. Common symptoms include:
- Fear of abandonment or betrayal by friends, family, or loved ones. These fears can lead to behaviors meant to prevent this abandonment.
- Instability in the perception of relationships. Sufferers often fluctuate between thinking that a relationship is unrealistically ideal and thinking that the relationship is extremely negative.
- Impulsive behavior, including excessive spending, risky sexual behavior, or physical risk-taking (e.g., reckless driving).
- Self-harming behaviors. These behaviors can take the form of non-life-threatening self-harm or suicidal thoughts/attempts.
- Negative mood swings, including depression, anxiety, or irritability.
- Feelings of lethargy, emptiness, or boredom.
- Intense anger. These angry episodes are often irrational, and they are often followed by periods of guilt or shame.
- Episodes of “dissociation,” in which the sufferer feels as if they are disconnected from their body or outside reality, or paranoia. In severe cases, clinically diagnosable psychotic episodes (breaks from reality) are possible.
What Causes Borderline Personality Disorder
The exact cause of BPD has not yet been discovered. Several factors, however, seem to put an individual at increased risk of BPD.
- Family history and genetics. People who have a parent or sibling with BPD seem to be at an increased risk of having BPD themselves.
- Brain physiology. Scientists have identified differences in the structure and function of the brains of people with BPD as compared to those without the disorder. The differences are primarily in the parts of the brain that control decision-making, judgment, and emotional responses. However, it is unclear whether these brain differences cause the disorders or whether the disorder causes changes in the sufferer’s brain.
- External factors. Many people with BPD have encountered situations and events that may have influenced the development of BPD. These factors include physical, emotional, or sexual abuse; unstable relationships; traumatic experiences; and abandonment or neglect.
Is Borderline Personality Disorder Hereditary?
Most scientists agree that there is some component of heritability for BPD. The disorder appears to run in families, and those with a close relative who has the condition seem to have an increased risk of having the disorder themselves. However, studies have disagreed about the significance of the risk, putting the heritability rate anywhere between 32% and 72%. A recent large-scale study has suggested that the actual rate of inheritance is somewhere in the middle, in the vicinity of 50%.
Scientists have not yet been able to identify a specific genetic component that increases the risk of BPD. Inherited genes may likely increase an individual’s susceptibility to BPD, but the disorder’s actual development may result from external triggering circumstances.
How is Borderline Personality Disorder Detected?
Borderline personality disorder most often first shows up in young adulthood, but it may first appear in childhood, too. Warning signs of BPD include:
- Fear of being alone
- Angry outbursts that are out of proportion to the trigger
- Unstable or rapidly shifting relationships
- Impulsive behavior
- Sudden changes in opinions or attitudes
- Changes in sexual identity
- Difficulties at work or school
- Self-harming behavior
- Suicidal thoughts or suicide attempts
Don’t hesitate to seek treatment for yourself or a loved one if any of these signs interfere with daily functioning or if the danger of self-harm is imminent.
How is Borderline Personality Disorder Diagnosed?
There is no laboratory test or medical exam that can diagnose BPD. Even the presence of some of the disorder symptoms is often not enough to make a definitive diagnosis. The signs of BPD are often similar to those of other mental illnesses, and many of those illnesses commonly occur in conjunction with BPD.
The diagnostic process is usually conducted by a mental health practitioner who has experience identifying and diagnosing BPD. The process includes psychological assessments, medical histories, and interviews with the sufferer and, often, family members or loved ones.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How is Borderline Personality Disorder Treated?
There is no definitive cure for BPD, and there are no medications that are commonly used to treat the core disorder itself. The most common treatment course involves psychotherapy, with drugs sometimes used to treat other mental illnesses from which the patient suffers.
Several different types of psychotherapy have proven to be effective at managing the effects of BPD. Various therapies may be more or less effective for each individual, and the most effective treatment may change over time, even in individual cases.
Commonly used therapeutic approaches include:
- Dialectical behavior therapy (DBT). This type of treatment was developed specifically to treat BPD. It uses one-on-one and group therapy sessions to help the patient develop skills for managing emotions, stress, and relationships.
- Cognitive behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and to develop strategies for dealing with these misperceptions when they occur.
- Mentalization-based therapy (MBT). This type of treatment helps the patient develop a perspective that differs from the atypical, harmful one. The therapy also helps the patient to build the ability to think before reacting to an emotional trigger.
- Transference-focused psychotherapy (TFP) or psychodynamic psychotherapy. This type of therapy uses the relationship between the patient and the therapist as a model for other outside relationships. It focuses on building skills that can be transferred to other relationships.
Medications are usually not used to treat BPD itself. However, medicines may treat symptoms such as depression, anxiety, anger, psychosis, or impulsivity. Classes of drugs used to treat these symptoms include antidepressants, mood stabilizers, and anti-psychotics.
How does Borderline Personality Progress?
Borderline personality disorder most often appears in adolescence or early adulthood, when sufferers are in their 20s. However, most BPD cases get better over time, with nearly all sufferers experiencing a remission of symptoms within a decade or two after being diagnosed. Some symptoms (such as impulsive behavior) may be more likely to disappear than others.
Some researchers have also suggested that diminishment of unstable relationships over time might be due to the sufferer giving up on relationships rather than learning how to maintain healthy ones.
While BPD is active, it can have significant effects on the sufferer’s life, including:
- Lack of success at work or school
- Legal problems
- Financial difficulties
- Abusive relationships
- Exposure to sexually transmitted diseases or unplanned pregnancies
- Risky behaviors that can cause injury or death
- Suicide risk
BPD is also often coincident with other mental disorders that carry their own risks. These disorders include:
- Attention-deficit/hyperactivity disorder (ADHD)
- Eating disorders
- Depression and anxiety
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Alcoholism or substance abuse
How is Borderline Personality Disorder Prevented?
There may be no way to prevent borderline personality disorder from developing. Still, there is evidence that early intervention can successfully prevent the condition from becoming more severe down the road. However, the disorder is usually not diagnosed until young adulthood at the earliest, after its effects are already disrupting the sufferer’s life in significant ways. Furthermore, many sufferers don’t have access to expensive therapies to help them cope with the disorder.
Some researchers are encouraging mental health practitioners and caregivers to be alert to the warning signs of BPD in children and adolescents. These researchers emphasize that the disorder can be diagnosed in children and that early therapeutic intervention can have a significant positive impact.
Borderline Personality Caregiver Tips
Because borderline personality disorder is characterized by unstable, conflict-filled relationships, dealing with your loved one’s disorder can be especially difficult. Caregivers should learn all they can about the condition to understand how it affects their loved one. Education is the best defense against the relationship stresses that BPD always causes.
As you help your loved one cope with the disorder, keep these tips in mind:
- Watch for warning signs and encourage treatment if you suspect that BPD might be the problem. Look for impulsive behavior, unstable relationships, fluctuating self-image, and atypical reactions to stress.
- Don’t get wrapped up in the relationship drama. Your loved one will probably think you’re the greatest one moment and that you’re their worst enemy the next. Understand that this kind of instability is part of the disorder, and try to keep yourself emotionally above the turmoil.
- Be calm, supportive, positive, and honest in your responses to your loved one’s behavior.
- Be prepared to get involved with the treatment plan yourself. Many practitioners believe that it’s essential for family and loved ones to be involved in therapy, too. By being part of the treatment process, loved ones can learn how to best support the sufferer and avoid reactions that might worsen the disorder’s symptoms.
Borderline Personality Brain Science
Scientists have been able to identify some fundamental differences in the brains of people with borderline personality disorder compared to the brains of people who don’t have the condition. The differences lie in how the brain functions and how certain chemicals are processed within the brain.
- Functional differences. Scientists have determined that in the brains of people with BPD, the parts of the brain that control emotion might not communicate effectively with the areas of the brain that control decision-making. These parts of the brain include the amygdala, the hippocampus, and the medial temporal lobes. The result of this miscommunication can be subtle but fundamental. Studies have shown, for example, that BPD patients often misidentify facial expressions, attributing negative emotions to neutral expressions.
- Chemical differences. Studies have shown that BPD sufferers may have problems processing or producing certain brain chemicals, such as the hormone oxytocin and the neurotransmitter serotonin. These chemicals are vital contributors to functions such as mood regulation, emotional responses, and social bonding.
Research is ongoing into these and other differences, and scientists are trying to understand the role the differences play in developing the disorder.
Borderline Personality Research
Title: Five Factor Model Treatment for Borderline Personality Disorder
Principal investigator: Shannon Sauer-Zavala
University of Kentucky
The primary purpose of this study is to explore acceptability, feasibility, and preliminary efficacy of a novel cognitive-behavioral treatment for borderline personality disorder (BPD). Extant treatments for this condition are intensive, long-term (usually at least one year), and have, understandably, focused on targeting the life-threatening and therapy-interrupting behaviors that often characterize this disorder. BPD, however, is a heterogeneous disorder with diagnostic criteria that can be combined to create over 300 unique symptom presentations (Ellis, Abrams, & Abrams, 2008); to date, no treatments have been explicitly designed with lower risk presentations of BPD in mind. This is unfortunate, as there is evidence to suggest that the majority of individuals with BPD do not demonstrate the recurrent life-threatening behaviors that warrant intensive, long-term care (Trull, Useda, Conforti, & Doan, 1997; Zimmerman & Coryell, 1989). Additionally, various studies have shown that the difficulties experienced by individuals with BPD can be understood as manifestations of maladaptive variants of personality traits (e.g., Mullins-Sweatt et al., 2012). Specifically, individuals with BPD demonstrate high levels of neuroticism, and low levels of agreeableness (antagonism) and conscientiousness (disinhibition); these traits may not be universally present across all individuals with BPD, perhaps underscoring the heterogeneity in presentations of this condition.
Title: An 18-Month Psychotherapy of Borderline Personality Disorder
Principal investigator: John F. Clarkin, PhD
Weill Medical College of Cornell University
White Plains, NY
Patients with borderline personality disorder (BPD) will be provided with an empirically supported form of psychotherapy for BPD patients called transference-focused psychotherapy (TFP) and medication treatment if indicated. The primary goal of the current study is to detect changes in psychological, psychosocial and work functioning over the course of 18-months of TFP. Previous research has shown that TFP is an effective treatment for BPD for one year, significantly reducing symptoms. An 18-month treatment period will most likely allow patients to achieve significant and lasting gains in work and psychosocial functioning. Each patient will be assessed before (baseline), at 3-month intervals throughout, and at the termination of the 18-month treatment period for symptoms, vocational status, and psychosocial functioning. In addition, patients and therapists will complete self-report measures every three months about the therapeutic relationship. After the 18-month treatment period, a final, brief assessment of vocational status, symptoms, and psychosocial functioning will occur.
Title: Ketamine in Borderline Personality Disorder
Principal investigator: Sarah Fineberg, MD/PhD
New Haven, CT
The purpose of this study is to test the potential of the rapid-acting antidepressant ketamine to decrease suicidality in Borderline Personality Disorder (BPD).
The rate of completed suicide in BPD is similar to that of depression or schizophrenia. There is currently no specific medication treatment for BPD.
Ketamine is an FDA-approved anesthetic agent that has been shown to rapidly decrease suicidality and improve mood in people with Major Depressive Disorder (MDD). Though symptoms overlap, effective treatments for MDD and BPD differ. This clinical trial tests if ketamine also decreases suicidality and improves mood in BPD.
This trial will also measure several other outcomes after ketamine versus placebo in BPD: adverse events, BPD symptoms, pain, social cognition, and neuroplasticity.