Personality disorders are psychiatric disorders that typically develop in adolescence and become deeply ingrained, pervasive and inflexible ways of interacting with, coping in, and perceiving one’s environment by the time the person reaches adulthood. Unlike other disorders which may be episodic, such as depression or anxiety, personality disorders are ongoing, and can cause significant problems for the individual in all aspects of their life.
Borderline Personality Disorder (BPD) was given its name due to an early theory that individuals with this disorder seemed to be on the “border line” of psychosis and neurosis. Even though current conceptualization of the disorder no longer reflects that, its name has never changed despite pressure by advocates to do so. An alternative name that has been considered is “emotional regulation disorder”.
In outpatient settings, approximately one out of every ten individuals presents with BPD, and in psychiatric inpatient settings the number is nearly twice that. BPD is diagnosed nearly three times more often in females than in males. Of all the personality disorders, BPD is one of the most challenging to treat. The clinical presentation is also one of the most taxing on treatment providers. Many individuals with BPD are in and out of treatment throughout their lives, often making only limited progress in terms of developing truly helpful coping skills.
While there are nine clinical criteria for this disorder, an individual must meet at least five in order to qualify for a diagnosis of BPD. The nine indicators are; desperate attempts to avoid actual or perceived abandonment; intense and unstable relationship patterns; distorted and unstable self-image, impulsivity in at least two areas that are self-destructive, such as reckless driving, substance abuse or binge eating; recurrent suicide attempts, threats or gestures; difficulty managing intense emotions/frequent mood swings; a chronic sense of emptiness; intense, inappropriate feelings or displays of anger, and/or problems controlling their anger and fleeting paranoid ideation or dissociation during times of severe stress.
Many symptoms of BPD are in reaction to the borderline’s intense fear of being alone. Individuals with BPD are highly reactive to their environment and particularly sensitive to anything that taps into their deep-seated feelings of being worthless, unlovable, inherently bad or evil.
There is no known specific cause of BPD. Rather, it is believed that a combination of three factors – genetics, biology, and one’s environment during the developmental years – likely cause its development. It was once believed that individuals with BPD would never get better, and indeed many do not benefit from treatment. In fact, hospitalization is often contra-indicated for individuals with BPD as they often regress during hospital stays. However, it may be necessary to keep them safe if they are at imminent risk for suicide or self-harm.
In recent years, therapy specific to the treatment of BPD has been shown to be quite effective. Dialectical behavior therapy (DBT) is one of the most widely used treatments for BPD. DBT focuses on helping individuals with BPD learn coping skills, manage intense emotions and stress and interact more successfully in their relationships. Transference-focused psychotherapy, also developed specifically for the treatment of BPD, uses the therapist-client relationship as an integral part of the therapy process. While medication by itself is ineffective for treating BPD, it can be beneficial as an adjunct treatment. Medications prescribed may include antidepressants, mood stabilisers and antipsychotics.