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Borderline Personality Disorder

Borderline personality disorder (BPD) is an enigmatic and potentially dangerous psychiatric condition. Characterized by fast-cycling, manic-depressive mood swings, unstable relationships, an incapacity to hold a job or have a stable living situation, drug and alcohol abuse, self-mutilation, extreme mood reactivity, intense anger or violence, and depression, BPD is a very potent psychiatric disorder, with the power to rule over the sufferer’s life for as long as it goes unchecked.

For people living with a borderline sufferer, it can be veritable hell. There is often infidelity in relationships. Manic episodes, including intense enthusiasm, compulsive spending, an inability to relax, and extreme impulsivity, are often followed by depressive episodes, characterized by inactivity, complete apathy, sleeplessness or sleeping too much.

What it all comes down to is that the person with BPD is rarely the person, more often the disorder. When living with an untreated borderline, you never know what you’re going to get: Little Miss Sunshine, Debbie Downer, or Freddie Kruger. But there are treatments. Moodiness, rage, self-mutilation can be alleviated, even eradicated. But the borderline must be committed to treatment, as must anyone close to him/her.

The cause of BPD is still very much a debate. It was originally thought that such acute anger, anxiety and dissociation could only be caused by severe childhood trauma, as it widely is. But recent research shows that the problems experienced by BPD sufferers may have more to do with misfiring neurotransmitters than just childhood trauma. Backing this up is researcher John D. Preston’s finding that 20-25 percent of patients come from intact families with no history of abuse or dysfunction (1997). But what it boils down to is, in most cases, a combination of biochemical dysfunction and a history of abuse or trauma.

A personality disorder is, paraphrasing the Diagnostic and Statistical Manual (DSM), a consistent pattern of behavior that deviates markedly from the expectation of an individual’s culture, that is pervasive and unlikely to change, and that leads to distress or impairment in interpersonal relationships. This description has a very negative tone; it even sounds to a degree like nihilism. Some other personality disorders include, antisocial personality disorder, schizoid personality disorder, schizotypal personality disorder and paranoid personality disorder.

BPD has a short history, which includes originating as a ‘dumpster diagnosis’ for people with symptoms that don’t seem to fit anywhere else. But let us start by going over, in short, the DSM criterion:

1. Frantic efforts to avoid real or imagined abandonment. The BPD sufferer often feels like a child lost in a crowd: Nervous, anxious. A warm, welcoming face is embraced passionately. But the moment that warm face gives an inkling, real or imagined, that they are going to leave, the BPD sufferer becomes angry, reactive, begs the person to stay, or crossly rejects them.

2. Intense and unstable relationships, characterized by alternating between extremes of idealization and devaluation (the love-hate complex). The BPD sufferer often swings between either loving someone completely, forming that person in their mind as a sort of demigod; or thinking of them as the lowest form of life, deserving no respect, loyalty, compassion, or love.

3. & 7. Markedly and consistently unstable self-image. The BPD sufferer usually has a chronic feeling of emptiness. Most people, by their sub-middle age years, have a pretty whole and stable idea of who they are, what they are good at, etc. But a BPD patient will spend years longer, sometimes his/her whole life searching for these things. They are afloat in an arcane life, clinging to whatever comes close. Their passions will change often; one day they may want to be a biologist, the next day they may have dreams of becoming a professional curler. They never seem to find their niche in life.

4. Potentially damaging impulsivity in at least two areas: Spending, sex, substance abuse, reckless driving, binge eating. Borderline sufferers are impulsive creatures. They may, without provocation, go on a drinking or drug binge, turning up two weeks later, asking what the big deal is. Or they may suddenly go out and buy a $100,000 Mercedes. All in all, borderline sufferers are incredibly unpredictable.

5. Recurrent suicidal behavior, gestures or threats. Borderline sufferers may randomly appear with cuts on their arms or wrists, may threaten to leap from a tall building when faced with abandonment, may dream of ending it all. This behavior in a borderline sufferer is consistent and chronic.

6. Emotional instability due to extreme mood swings. Borderline sufferers will, without a catalyst, almost instantly become dysphoric, extremely irritable or anxious. These violent mood swings can last anywhere from an hour to a day, but rarely more than that. They are on an emotional rollercoaster, and their hapless loved ones are often dragged along with them. They also often have a very hard time finding ways to cope with these emotions.

8. Inappropriate, intense anger, or difficulty controlling anger. A borderline sufferer may become implacably belligerent because his/her spouse forgot to do the dishes. He/she may kick the cat for scratching on the couch. In short, the borderline sufferer is extremely volatile, easily enraged by something trivial, and has a very hard time controlling his/her anger.

9. Transient, often severe dissociative symptoms. A mild dissociative episode, something almost all of us experience from time to time, is something like spacing out while your boss is talking to you, wondering about those football tickets your buddy said he was going to buy, and not remembering a word that was said. Or maybe you’ve been thinking about that new, attractive co-worker at the office, and know absolutely nothing about the TV program you just watched. But the borderline sufferer will dissociate often to the extreme of someone with Dissociative Identity Disorder (commonly known as Multiple Personality Disorder), in an attempt to escape stress or emotional pain. The greater the negative emotion, the more extreme the dissociation. Some borderline sufferers will remember absolutely nothing from a time-span of an hour or an entire day. They report feeling gone, or out of it.
Other borderline traits may include intense feelings of shame or guilt, inability to set or identify personal boundaries, control issues or extreme sensitivity.

After all this, it is very hard to have any sort of positive outlook on the borderline condition. The life of the BPD sufferer is often tumultuous, painful, loveless, inconsistent, confusing, unsatisfying, and even violent. Lovers come and go quickly, children are left emotionally or physically scarred, jobs are erratic, and life is utterly chaotic and unpredictable.

But there is treatment available.

Medication is often used as a first method of treatment when BPD is diagnosed, but medications treat only the symptoms, not the disorder itself. For example, mood-stabilizers like depakote or lithium may be used to treat mood swings, or antidepressants like SSRIs may be used to treat depressive symptoms.

But medication is rarely enough. Therapies such as Dialectical Behavior Therapy, created by psychologist and researcher Marsha Lineman (dept. of psychology, University of Washington), are very helpful in treating the anger and self-mutilation of a borderline sufferer, and may reduce inpatient stays in psychiatric hospitals. But the borderline sufferer and his/her family must be fully committed to recovery if any progress is to be made.

Shown here is a brief image of Borderline Personality Disorder. The life of a BPD sufferer can be chaotic and painful for both the family and the patient, but recovery is possible. The BPD sufferer does not have to live a life of chronic instability, infidelity, drug and alcohol addiction, and stays in psychiatric wards. A life left afloat in a sea of misery can be saved, but there is much work to be done.