BPD

Borderline personality disorder is a serious mental disorder that is characterized by a pattern of unstable moods, extreme emotions, distorted self-image, impulsiveness, and unstable intense relationships.

This illness can have an impact on the way you think and feel about yourself and others, causing problems functioning in everyday life. Most people with borderline personality disorder suffer from intense fear of abandonment or instability, and difficulty tolerating being alone. Inappropriate anger, impulsive and reckless behavior, frequent mood swings may push others away, even though you want to develop a loving and lasting relationship.

Borderline personality disorder usually appears by early adulthood. The condition may grow worse during young adulthood, but it gradually gets better with age.

People with this disorder are more likely to have co-existing disorders, such as anxiety disorders, depression, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

If you have borderline personality disorder, do not get depressed. Many people with this disorder have become better over time with treatment and also lead satisfying lives.

Signs and symptoms of Borderline personality disorder may include:

• An intense fear of abandonment, even showing extreme reactions such as panic, depression, rage and frantic actions in order to avoid real or percieved separation or rejection.
• A pattern of intensely unstable relationships with family, loved ones, and friends, such as being extremely close (idealizing) someone at one moment and then suddenly beginning to extremely dislike the same person and feeling that tha person does not care enough or is cruel.
• Distorted or unstable self-identity and self-image that includes suddenly changing plans, goals and values, opinions and seeing yourself as bad or as if you don't exist at all.
• Periods of stress-related paranoid feelings or dissociative symptoms such as loss of contact with reality or feeling cut off from oneself, lasting from a few minutes to a few hours.
• Impulsive and dangerous behaviors, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or substance abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship.
• Suicidal behaviors or threats of self-harm, often in response to the fear of separation or rejection.
• Intense mood swings, with every episode lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety.
• Chronic feelings of boredom and emptiness.
• Inappropriate, intense anger, such as frequent loss of temper, being sarcastic or bitter, or having physical fights.

Borderline personality disorder influences the way you feel about yourself, how you relate to others, and your behavior. 

When to see a doctor 

If you believe that you have any of the signs or symptoms explained above, talk to your doctor or a mental health provider.

If you find any of these signs or symptoms in your family member or friend, talk to that person about seeing a doctor or mental health provider. But you cannot force someone to seek help. If the relationship causes significant stress to you, it may be helpful if you consult a therapist yourself.

The causes of borderline personality disorder are not completely known, as with most mental disorders. Research to find out the possible causes and risk factors of borderline personality disorder is still at its initial stage.

In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder is more likely to be linked to:

• Genetics: Studies involving twins and families suggest that the personality disorders are inherited or strongly associated with other mental disorders among family members. One more study reveals that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. 
• Social or cultural factors: Exposure to a culture in which unstable family relationships are most common. 
• Brain abnormalities: Research has established that changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression are responsible for this type of disorder. In addition, certain brain chemicals such as serotonin that help in regulation of mood, may function abnormally.

A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. This is because what appears to be signs and symptoms of borderline personality disorder in children may disappear as they get older and become more mature.

You may initially consult your primary care doctor. After an evaluation, your doctor may refer you to a mental health provider, such as a psychologist or psychiatrist.

Here is some information to help you prepare for your appointment.

What you can do

Before going to your appointment, make a list of:

• All symptoms you or people close to you have noticed, and for how long
• Key personal information, including traumatic events in your past and any current major stressful situations
• Your medical history, including other physical or mental health conditions 
• All medications you take, including prescription and over-the-counter medications, vitamins and other supplements, and their doses 

Ask a family member or friend to accompany you, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health provider, with your permission.

Basic questions to ask your doctor or a mental health provider include:

• What is the likely cause of my symptoms or condition?
• Are there any other possible causes? 
• What treatments are most effective for me? 
• How much can I expect my symptoms to improve with treatment?
• How often do I need therapy sessions and for how long? 
• Do medications help my condition?
• Are there any side effects of the medication you have prescribed?
• Do I need to take any precautions or follow any restrictions? 
• How can I best manage my other health conditions together? 
• Can my family or close friends help me in my treatment? 
• Do you have any printed material that I can take home?
• What websites do you recommend?

What to expect from your doctor

A doctor or mental health provider may ask you a number of questions. Keeping the answers ready to these questions saves time for topics you want to discuss in detail.

Possible questions include:

• What are your symptoms, and when were these noticed first?
• How do these symptoms affect your life, including your personal relationships and work? 
• How often during a normal day do you experience a mood swing?
• How often have you felt betrayed, victimized or abandoned? 
• Why do you think that happened?
• How do you manage anger and loneliness? 
• How would you describe your sense of self-worth? 
• Have you ever felt you were bad, or even evil? 
• Have you ever had any problems with your self-destructive or risky behavior?
• Have you ever thought of or tried to harm yourself or attempted suicide? 
• Do you use alcohol or recreational drugs or abuse prescription drugs? If yes, how often? 
• How was your childhood, describe your relationship with your parents or caregivers? 
• Have you experienced physical or sexual abuse or were you neglected as a child? 
• Have any of your close relatives or caregivers been diagnosed with a mental health problem, such as a personality disorder? 
• Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
• Are you currently undergoing treatment for any other medical conditions?

If you have suicidal thoughts or fantasies or mental images about hurting yourself or have other suicidal thoughts, get help immediately by taking any of these actions: 

• Call 911 or your local emergency number immediately.
• Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to get in touch with a trained counselor.
• Call your mental health provider, doctor or other health care provider.
• Reach out to a loved one, close friend, trusted peer or co-worker. 
• Contact someone from your faith community.

Personality disorders, including borderline personality disorder, are diagnosed on the basis of the following: 

• Medical history and exam
• Detailed interview with your doctor or mental health provider
• Complete psychological evaluation that includes completing certain questionnaires
• Review of your signs and symptoms

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often referred by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.

Borderline personality disorder is mainly treated using psychotherapy, but sometimes medication may also be added to treat specific symptoms. Your doctor also may recommend hospitalization if you are at a risk of harming yourself.

Treatment is focused towards teaching the patient, certain skills to manage and cope with the condition. With treatment, you can feel better about yourself and live a more stable, rewarding life.

Psychotherapy

Psychotherapy — also called talk therapy — is usually a fundamental treatment approach for borderline personality disorder. Your therapist will decide on which type of therapy is best for your needs.

The goals of psychotherapy are to help you:

• Concentrate on your current ability to function.
• Learn to manage emotions that feel uncomfortable.
• Reduce your impulsiveness by helping you observe your feelings rather than acting on them.
• Work on improving relationships by being aware of your feelings and those of others.
• Learn about borderline personality disorder

Types of psychotherapy that have been found to be effective include:

• Dialectical behavior therapy (DBT): DBT can include group or individual therapy designed specifically to treat borderline personality disorder. This therapy focuses on the concept of concentrating or being attentive to the current situation. DBT uses a skills-based approach to teach you how to control your intense emotions, reduce self-harming behavior, tolerate distress, and improve relationships.
• Schema-focused therapy: Schema-focused therapy can be done individually or in a group. It help you recognize your unfulfilled needs that have led to your negative life patterns, which at some time may have been helpful for survival, but as an adult are harmful in many areas of your life. Therapy concentrates on helping you get your needs fulfilled in a healthy manner to promote positive life patterns.
• Mentalization-based therapy (MBT): MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and develop an alternate perspective on the situation. MBT emphasizes the principle of thinking before acting.
• Systems training for emotional predictability and problem-solving (STEPPS): STEPPS is a 20-week treatment which involves working with groups that include your family members, caregivers, friends or significant others into treatment. STEPPS is used along with other types of psychotherapy.
• Transference-focused psychotherapy (TFP): TFP is also called psychodynamic psychotherapy, and it aims towards helping you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You can then apply these insights to ongoing situations.

General psychiatric management

This treatment approach depends on case management and concentrates in making sense of emotionally difficult moments by taking into account, the interpersonal context for feelings. It may integrate medications, groups, family education and individual therapy.
Medications

Although no medications have been approved by the U.S. Food and Drug Administration specifically for the treatment of borderline personality disorder, certain medications may help in managing certain symptoms or co-existing problems such as depression, impulsiveness, aggression or anxiety.

Medications may include antidepressants, antipsychotics or mood-stabilizing drugs. Talk to your doctor about the benefits and side effects of these medications.

Hospitalization

Sometimes, you may need more-intense treatment at a psychiatric hospital or clinic. Hospitalization keeps you safe from self-injury or attempted suicides or suicidal thoughts or behaviors.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors needs some time. You may require several months or years of treatment, and you may need to struggle with some symptoms of borderline personality disorder. You may also experience times when your symptoms get better or worse.

But treatment can always improve your ability to function well and help you feel better about yourself. As treatment is going to be intense and long term, you have better chances of success when you consult mental health providers who have good experience in treating borderline personality disorder.

Lifestyle modifications are necessary in order to cope with borderline personality disorder.

Managing the symptoms of borderline personality disorder can be stressful as well as challenging for yourself and people around you. You may be aware of the fact that your emotions, thoughts and behaviors are self-destructive or damaging, but still you feel unable to manage them.

In addition to professional treatment, you can help yourself manage and cope with your condition if you:

• Learn about your mental disorder so that you can understand its causes and treatments well.
• Learn to identify the triggering factors of angry outbursts or impulsive behavior.
• Talk to your doctor about your treatment options, and stick to it — attend all your therapy sessions and take medications as directed.
• Discuss with your mental health provider and develop a plan of what should be done the next time a crisis occurs.
• Get treatment for related problems, such as substance abuse.
• Consider involving people close to you in your treatment to help them understand and support you.
• Manage intense emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation..
• Set limits and boundaries for yourself and others by learning how to appropriately express emotions in a manner that does not push others away or trigger abandonment or instability.
• Do not make assumptions regarding what people are feeling or thinking about you.
• Reach out to others with the same disorder to share insights and experiences.
• Recognize and seek out comforting situations, places, and people.
• Build a support system of people who understand and respect you.
• Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and engaging in social activities.
• Try to follow a regular schedule of meals and sleep times.
• Engage yourself in mild activity or exercise to help reduce stress.
• Do not blame yourself for the disorder, but recognize your responsibility to get it treated.
• Set realistic goals for yourself, expect your symptoms to resolve gradually, and not immediately.

Some people with borderline personality disorder have severe symptoms and need intensive inpatient care. Others may require outpatient treatment but never need to be hospitalized. Some people may even improve without any treatment.

Some of the factors related to personality development may increase your risk of developing borderline personality disorder.

These include:

• Family history: You are at a higher risk if a close relative — your mother, father, siblings— have the same or a similar type of disorder.
• Stressful childhood: Most people with borderline personality disorder report sexual/physical abuse or neglect during childhood. Some people have experienced separation from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health problems. Others have been exposed to hostile conflict and unstable family relationships. 
• Personality: Personality traits such as impulsiveness and aggression play an important role in the development of borderline personality disorder. 

Borderline personality disorder can negatively affect many areas of your life such as intimate relationships, jobs, school, social activities and self-image, resulting in:

• Repeated loss of job or changes.
• Incomplete education 
• Multiple legal issues, such as jail time.
• Conflict-filled relationships, marital stress or divorce.
• Self-injury, such as cutting or burning, and frequent hospitalizations.
• Involvement in abusive relationships. 
• Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents and physical violence due to impulsive and risky behavior.
• Suicidal thoughts or attempted or completed suicide.

In addition, you may have other mental health disorders, such as:

• Depression
• Alcohol or other substance misuse
• Anxiety disorders
• Eating disorders
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Other personality disorders