The term Borderline Personality Disorder (BPD) was originally coined as it was believed that those who suffer from this, were on the ‘borderline’ between neurosis and psychosis.
Neurosis is defined as mild mental health such as low-level depression, stress and anxiety.
Psychosis is defined as being a severe mental health disorder where the individual has severely impaired thoughts and emotions, leading them to lose touch with reality, for example, schizophrenia.
Mental health, unfortunately, is often side-lined in conversations pertaining to overall well-being. However, it is as crucial as physical health and significantly impacts quality of life. One's emotions, psychological state, and social wellbeing collectively constitute mental health. It essentially determines how individuals handle stress, relate to others, and make choices.
Importance of Mental Health
It goes beyond merely being ‘free of mental illness’. It encompasses a more holistic view of individuals’ emotional, psychological, and social wellness. Mental health impacts every aspect of our lives, from how we think and feel, to the ways we interact with others, handle stress, and make decisions. Poor mental health can lead to increased risk of physical health problems, relationship issues, impaired functionality, and a diminished quality of life.
Borderline Personality Disorder (BPD)
Borderline Personality Disorder is also referred to as Emotionally Unstable Personality Disorder and Emotional Regulation Disorder. In the diagnostic manual, the ICD-10, which was produced by the World Health Organization (WHO), this disorder is defined as Emotionally Unstable Personality Disorder. Among the myriad of mental health issues, Borderline Personality Disorder is one that significantly impairs an individual's thoughts, feelings, and ability to function in daily life. It is essentially characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions. People with BPD often exhibit intense bouts of anger, depression, and anxiety that can last from a few hours to a whole day. Understanding BPD is pivotal to managing its effects and facilitating well-being for those affected.
What is Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is a serious mental health disorder that primarily affects the way individuals perceive themselves and others. This self-perception often results in turbulent relationships and impulsive behavior. People with BPD may struggle with their self-image, have bouts of intense emotions, and display inconsistency in their behavior. This often leads to difficulties in maintaining relationships, steady employment, and a stable sense of self.
Personality Disorders
Personality disorders, such as BPD, are identifiable by persistent patterns of behavior, thinking and feelings that differ significantly from what is generally expected in the individual's culture. These patterns are inflexible and encompass many areas of the person's life. They can cause severe functional impairment and distress. It’s an umbrella term for a range of conditions, and BPD is one form.
Types of Borderline Personality Disorder
According to Borderline Personality Disorder expert Theodore Meldore, there are four different types of BPD. These are:
1. Petulant Borderline
The Petulant Borderline is irritable and unpredictable. This individual will have extreme emotions of anger and resentment both toward themselves and others. They can appear to be easily disappointed by others and never reach a sense of fulfilment.
It has been seen that those who fall into this category engage in dangerous self-harming behaviours to vocalise to others the mental pain they are in.
2. Impulsive Borderline
The Impulsive Borderline is energetic and highly charismatic. Those who fall into this category may become bored very easily, which leads to dangerous and impulsive behaviours such as binge drinking. Sufferers have described it as ‘acting first and thinking later.
It has been observed that individuals who are Impulsive Borderlines will likely have a substance abuse problem and self-harm regularly, due to constantly seeking approval from others by not wanting to disappoint and/or be abandoned.
3. Discouraged Borderline
The Discouraged Borderline is seen to co-depend on others and will do anything to make others happy even if it means sacrificing their own happiness.
Individuals in this category usually constantly seek approval from others, however, they also tend to avoid other people so as not to let others or themselves down, causing a constant inner conflict.
4. Self-destructive Borderline
The Self-Destructive Borderline tends to not be aware of their behaviour which usually includes self-loathing, a fear of being abandoned, no sense of self, an engagement in risky behaviour and a tendency to hurt themselves to make them feel something.
Causes of Borderline Personality Disorder
Understanding the causes of Borderline Personality Disorder (BPD) can be quite challenging as the condition is multifactorial, meaning it is likely influenced by more than one factor. Here are some of the key potential causes of BPD:
1. Genetics
Genetics plays a crucial role in the development of various mental health disorders, and BPD is no exception. Research indicates that the risk of developing BPD is significantly higher for individuals who have a first-degree family member suffering from this disorder. Therefore, BPD could potentially arise due to a complex interplay of genetic vulnerability and other factors.
2. Biochemical Factors
Biochemical factors also play a crucial role in the development of BPD. People with this disorder may have imbalances in their brain chemistry, specifically in neurotransmitters, which are the chemical messengers that transmit signals in the brain. Variations in certain neurotransmitters such as serotonin, dopamine, and norepinephrine may contribute to the development of BPD.
3. Environmental Factors
Environmental factors like traumatic experiences, abuse, neglect, and unstable family relationships in childhood may predispose an individual to develop BPD. Prolonged exposure to these adversities can result in emotional instability, a core characteristic of this disorder.
4. Psychological Factors
The psychological standpoint emphasizes the impact of early developmental experiences. The emergence of BPD is often associated with childhood emotional neglect, early loss, or separation from parents. Such experiences can elicit significant distress and increase the vulnerability to BPD.
Symptoms of Borderline Personality Disorder
Borderline Personality Disorder is a severe mental health condition characterized by distinct clinical symptoms. Recognizing these symptoms is the first step towards understanding and providing needed help or support.
1. Emotional Instability
People living with BPD often experience significant emotional instability. Individuals tend to experience intense mood swings over a short space of time, sometimes these mood changes can last a matter of minutes, hours, or days. This can manifest as rapidly fluctuating moods that can last for hours or days. These mood swings may include periods of intense happiness, irritability, shame, or anxiety. Emotional instability can make it exceedingly complex for those with BPD to manage their emotions in a balanced way.
2. Interpersonal Relationships Challenges
One moment, the individual may feel as if people abandon them when they need them the most, then the next moment they may feel that they are overwhelmed and smothered by people. Another conspicuous symptom of BPD is difficulties in interpersonal relationships. People diagnosed with this disorder often have volatile relationships characterized by intense love and extreme dislike. The patterns of behavior often lead to a cycle of relationships that start with an intense, passionate attraction, only to end in disappointment and anger, causing much emotional distress.
3. Impulsivity
Impulsivity is a significant characteristic of BPD. People coping with this disorder may demonstrate impulsive behaviors, like reckless driving, binge eating, unsafe sex, or overspending. These risky behaviors can have dire consequences, including legal troubles, financial distress, and physical harm.
4. Black-and-white thinking
Lastly, black-and-white, or 'all-or-nothing' thinking, is a common symptom in people with BPD. They view things as either good or bad, with no middle ground. This extreme thinking pattern can impact their perception of themselves and others around them, leading to strained relationships, mental distress, and impaired decision-making abilities. Understanding these symptoms is instrumental in helping individuals with BPD seek appropriate help and reassurance that their feelings and experiences are valid.
5. Diagnosis of Borderline Personality Disorder
Diagnosis of Borderline Personality Disorder (BPD) is an intricate procedure, as it closely resembles other mental health conditions. It begins with a detailed investigation into the patient's behavioral patterns, typically encompassing the following steps.
6. Diagnostic Criteria
In making a BPD diagnosis, healthcare professionals refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. According to DSM-5, a person is diagnosed with BPD if they exhibit at least five of the following traits:
Persistent fear of abandonment and extreme reactions to it.
Unstable relationships characterized by intense love or hate.
Unstable self-image and constant changes in values or goals.
Impulsive and risky behaviors.
Sensitivity toward feelings of emptiness.
Extreme emotional instability or mood swings.
Inexplicable and severe anger.
Suspicion about the loyalty of others or paranoid thoughts.
7. Medical Evaluation
Medical evaluation involves a thorough physical examination and patient interview to rule out physical illness effects. In some cases, additional psychological evaluations may be necessary.
Differences from other mental health conditions
The key differentiating factor for BPD from other mental health disorders can often be the intensity and rapid fluctuation of moods, lack of strong self-identity, fear of abandonment, and a pattern of unstable relationships. Despite the overlap in symptoms and perils of misdiagnosis, mental health professionals are trained to recognize and distinguish BPD from other psychiatric conditions like Bipolar Disorder, Depression, and Anxiety Disorders.
There are four modules to DBT that aim to help the individual through their day-to-day life. These are as follows:
Mindfulness- This is a skill that aims to help the individual focus and live in the present.
Interpersonal relationships/effectiveness- This teaches ways for the individual to ask for things they would like and how to say no to people, all the while maintaining their important relationships and self-respect
Emotional regulation - Will help the individual gain more skills to be able to understand, have more control, and be more aware of their emotions
Distress tolerance - The aim of this module is to help the individual learn ways to cope in a crisis more efficiently without resorting to destructive behaviours, such as self-harm
Diagnosis of Borderline Personality Disorder
No individual with BPD will present the same as another which further adds to the difficulty of diagnosis as no size fits all. For example, you could have 10 people with BPD in one room, however, each will be different: their BPD will present differently in each individual and there may be no similarities at all.
Initially, an individual will attend an appointment with a General Practitioner (GP) to discuss their mental difficulties. A GP will then refer this individual for diagnosis to a mental health team. Typically, in the UK, two healthcare professionals, usually a community psychiatric nurse and a psychologist, will interview the individual based on their medical history, their symptoms and their difficulties.
The two healthcare professionals then have a meeting with a psychiatrist to present their findings and together, come up with a diagnosis. This typically is done the same day. This procedure may differ if they have been committed to hospital as an inpatient, where the GP will not make a referral to this service. However, typically the manner of diagnosis is similar.
1. Diagnosis Tool
There are two medical classifications used to diagnose mental health disorders, these being:
International Statistical Classification of Diseases and Related Health Problems (ICD):-The ICD-10 is a diagnostic tool created by the World Health Organisation (WHO) and used in the United Kingdom that helps psychiatrists efficiently diagnose mental health disorder. The ICD-10 refers to BPD as Emotionally Unstable Personality Disorder
Diagnostic Statistical Manual (DSM):- The Diagnostic Statistic Manual (DSM) is another commonly used medical classification that was created by the American Psychiatric Association (APA) which is now in its fifth edition. This refers to this disorder as Borderline Personality Disorder.
Conclusion
BPD is a complex mental health disorder, typically rooted in a combination of genetic, environmental, and social factors.
It is characterized by intense mood swings, relationship instability, poor self-image, and impulsive behaviours.
Effective treatment plans often involve therapy, medication, and self-care strategies.
Achieving a good understanding of BPD is the first step towards fostering empathy towards those affected. By comprehending what causes this condition, how it manifests itself, and how it can be treated, we can begin to contribute positively to the alleviation of its effects.
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