Borderline Personality Disorder

Loss of ego boundaries, an identity based on multiple contradictory unintegrated self-images that are experienced as an inner void, and aggression that “breaks through” defenses are key characteristics, according to Goldstein (1995).

Distrust, all-or-nothing thinking, extreme sensitivity to unfair treatment, and an appearance of normality that quickly unravels stress are additional features he discusses.

People with borderline personality disorder (BPD) exhibit persistent instability in mood, interpersonal relationships, and self-image and engage in frequent impulsive behavior.

These characteristics largely deteriorate one’s personal, social, and occupational functioning. People with BPD have emotional lability (mood swings) accompanied by episodes of angerOpens in new window, depressionOpens in new window, and anxietyOpens in new window, lasting anywhere from a few hours to a few days; they are also prone to physical aggression and impulsivity. They tend to direct their anger inward, leading to a high rate of self-injury.

Self-destructive behaviors with BPD include substance abuse (e.g., drugs or alcohol), binge eating, unsafe sex, reckless driving, and self-cutting. Past research indicates that 60 to 80 percent of people with BPD have attempted suicideOpens in new window at least once in their life time, while 10 percent of them die of suicide (James & Taylor, 2008).

Risk factors for people with BPD completing suicide include those with comorbid major depressive disorderOpens in new window, antisocial personality disorderOpens in new window, those who are older with children, have less education, and have a family history of substance use (Soloff, Fabio, Kelly, Malone, & Mann, 2005). Many of those with BPD suffer from deep feelings of emptiness, boredom, and confusing about their identity.

Many people may be misdiagnosed with BPD, especially adolescents or young adults who use psychoactive substances (e.g., drugs or alcohol) or have identity problems. These individuals may temporarily display behaviors associated with BPD.

According to the Diagnostic and Statistical Manual of Mental DisordersOpens in new window (American Psychiatric Association, 2000), a description of mental health disorders used primarily in the United States, women account for about 75 percent of the patients diagnosed with BPD.

The frequency of BDP is higher than that of schizophreniaOpens in new window or bipolar disorder (manic depression)Opens in new window, though BDP is higher than that of schizophrenia or bipolar disorder (manic depression), though BDP is less familiar than that these other disorders.

BPD is estimated to occur in about 2 percent of the general population, in about 10 percent of people seen in outpatient mental health clinics, and about 20 percent of psychiatric inpatients (American Psychiatric Association, 2000).

Indviduals differ in the course of the disorder. However, commonly, the instability and the risk of suicide reach their peak during young adulthood and, as people get older, seem to decrease.

People with BPD usually form unstable relationships with others. They often develop intense attachments to others even if their feelings are not mutual.

Since people with BPD are highly sensitive of rejection, they tend to display intense anger when their relationship is different from their expectations. Typically, they experience increased distress during short-term separations from others.

Self-destructive behaviors take place along with these disappointments and the fears of rejection. In addition, impulsive behaviors such as drinking a large amount of alcohol and binge eating are common in BPD.

Past studies suggest that both environmental and biological factors contribute to the onset of BPD. Many people with BPD report that as young children, they were neglected or rejected by their parents.

Additionally, people with BPD often report an unstable childhood environment that may involve witnessing violence or physical or sexual abuse (Sansone, Songer, & Miller, 2005). Biological characteristics associated with BPD include lower serotonin (a chemical messenger in the brain) activity, which has been found with BPD who exhibit high impulsivity (Norra et al., 2003).

One way of viewing BPD is through a biosocial modelOpens in new window (Linehan, Cochran, & Kehret, 2001). First, an internal factor, such as difficulty identifying and controlling one’s emotions or abnormal serotonin activity, may create vulnerability, then social factors contribute to development of the disorder.

For instance, parents may interpret a child’s intense emotionality as overdramatization or an attempt to manipulate, then may punish or trivialize the emotions of the child. The child then may punish or trivialize the emotions of the child. The child then devalues or doubts his own emotions and never learns how to recognize and cope with intense emotional reactions.

Treatment Approaches

Group and individual psychotherapy are commonly used as treatments for BPD. In recent years, dialectical behavioral therapy has been used to treat BPD, and it receives more empirical support than any other treatment (Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004).

Dialectical behavior therapy involves a combination of cognitive and behavioral techniques and humanistic philosophy. The therapist plays a supportive role, listening and empathizing. She identifies the accurate perceptions of the client and helps the client to think about alternative ways of viewing situations and of responding emotionally to particular events. Social skills training may also be involved, sometimes in group therapy settings, where clients can learn new ways of interacting with others.

AntidepressantOpens in new window, mood-stabilizing, antianxiety, and antipsychotic drugs are also sometimes used to treat people with BDP, although medication treatment is controversial given the high rate of suicide attempts among those suffering from BPD. Over the past two to three decades, treatments for BPD have improved, and many sufferers can live productive lives.