Borderline personality disorder

Borderline personality disorder is the most common personality disorder among the several
different types of personality disorders. The best way I have heard borderline personality disorder
described is having been born without an emotional skin, no barrier to ward off real or perceived
emotional assaults.
Borderline personality disorder (BPD) is a serious, long-lasting and complex mental health
problem. Though it has received less attention than other serious mental health problems, such as
Bipolar Disorder or Schizophrenia, the number of people diagnosed with BPD is similar or higher
than these disorders. People living with BPD have difficulty regulating or handling their emotions
or controlling their impulses. They are highly sensitive to what is going on around them and can
react with intense emotions to small changes in their environment. People with BPD have been
described as living with constant emotional pain and the symptoms of bpd are a result of their
efforts to cope with this pain. This difficulty with handling emotion is the core of BPD.

 The origins of the disorder :

The term ‘borderline personality’ was proposed in the United States by Adolph Stern in 1938
(most other personality disorders were first described in Europe). Stern described a group of
patients who ‘fit frankly neither into the psychotic nor into the psychoneurotic group’ and
introduced the term ‘borderline’ to describe what he observed because it ‘bordered’ on other
conditions.
The term ‘borderline personality organisation’ was introduced by Otto Kernberg (1975) to refer
to a consistent pattern of functioning and behaviour characterised by instability and reflecting a
disturbed psychological self-organisation. Whatever the purported underlying psychological
structures, the cluster of symptoms and behaviour associated with borderline personality were
becoming more widely recognised, and included striking fluctuations from periods of confidence to
times of absolute despair, markedly unstable self-image, rapid changes in mood, with fears of
abandonment and rejection, and a strong tendency towards suicidal thinking and self-harm.
Transient psychotic symptoms, including brief delusions and hallucinations, may also be present.
The characteristics that now define borderline personality disorder were described by Gunderson
and Kolb in 1978 and have since been incorporated into contemporary psychiatric classifications.
Either as a result of its position on the ‘border’ of other conditions, or as a result of conceptual
confusion, borderline personality disorder is often diagnostically comorbid with depression and
anxiety, eating disorders such as bulimia, post-traumatic stress disorder (PTSD), substance misuse
disorders and bipolar disorder (with which it is also sometimes clinically confused).
Because of this considerable overlap with other disorders, many have suggested that borderline
personality disorder should not be classified as a personality disorder; rather it should be classified
with the mood disorders or with disorders of identity. Its association with past trauma and the
manifest similarities with PTSD have led some to suggest that borderline personality disorder
should be regarded as a form of delayed PTSD (Yen & Shea, 2001). Despite these concerns,
borderline personality disorder is a more uniform category than other personality disorders and is
probably the most widely researched of the personality disorders. While some people with
borderline personality disorder come from stable and caring families, deprivation and instability in
relationships are likely to promote borderline personality development and should be the focus of
preventive strategies.
The course of borderline personality disorder is very variable. Most people show symptoms in
late adolescence or early adult life, although some may not come to the attention of psychiatric
services until much later. The outcome, at least in those who have received treatment or formal
psychiatric assessment, is much better than was originally thought, with at least 50% of people
improving sufficiently to not meet the criteria for borderline personality disorder 5 to 10 years after
first diagnosis (Zanarini, 2003). There is some controversy over the possible age of onset of
borderline personality disorder. Many believe that it cannot, or perhaps should not, be diagnosed in
people under 18 years of age while the personality is still forming (although diagnosis is possible in
the “Diagnostic and Statistical Manual of Mental Disorders”, 4th edition ,based on the same
criteria as adults with additional caveats). Nevertheless, borderline symptoms and characteristics are
often identifiable at a much earlier age, and sometimes early in adolescence.

 How BPD is diagnosed?

Diagnosis of borderline personality disorder is based on a clinical assessment by a mental
health professional. The best method is to present the criteria of the disorder to a person and to ask
them if they feel that these characteristics accurately describe them. Actively involving people with
BPD in determining their diagnosis can help them become more willing to accept it. Some
clinicians prefer not to tell people with BPD what their diagnosis is, either from concern about the
stigma attached to this condition or because BPD used to be considered untreatable; it is usually
helpful for the person with BPD to know their diagnosis.This helps them know that others have had
similar experiences and can point them toward effective treatments.
In general, the psychological evaluation includes asking the patient about the beginning and
severity of symptoms, as well as other questions about how symptoms impact the patient's quality
of life. Issues of particular note are suicidal ideations, experiences with self-harm, and thoughts
about harming others. Diagnosis is based both on the person's report of their symptoms and on the
clinician's own observations.Additional tests for BPD can include a physical exam and laboratory
tests to rule out other possible triggers for symptoms, such as thyroid conditions or substance abuse.
People with BPD may be misdiagnosed for a variety of reasons. One reason for misdiagnosis is
BPD has symptoms that coexist (comorbidity) with other disorders such as
depression, posttraumatic stress disorder (PTSD), and bipolar disorder. Borderline personality
disorder is one of the most contentious of all the personality disorder subtypes. The reliability and
validity of the diagnostic criteria have been criticised, and the utility of the construct itself has been
called into question (Tyrer, 1999). Moreover, it is unclear how satisfactorily clinical or research
diagnoses actually capture the experiences of people identified as personality disordered. There is a
large literature showing that borderline personality disorder overlaps considerably with other
categories of personality disorder, with ‘pure’ borderline personality disorder only occurring in 3 to
10% of cases). The extent of overlap in research studies is particularly great with other so-called
cluster B personality disorders (histrionic, narcissistic and antisocial). In addition, there is
considerable overlap between borderline personality disorder and mood and anxiety disorders.

 What causes BPD?

As with other mental health disorders, our current understanding of bpd is that a person’s
genetic inheritance, biology and environmental experiences all contribute to the development of
bpd. That is, a person is born with certain personality or temperamental characteristics because of
the way their brain is “wired,” and these characteristics are further shaped by their environmental
experiences as they grow up and possibly by their cultural experiences.
Researchers have found differences in certain areas of the brain that might explain impulsive
behaviour, emotional instability and the way people perceive events. As well, twin and family
history studies have shown a genetic influence, with higher rates of bpd and/or other related mental
health disorders among close family members.
Environmental factors that may contribute to the development of bpd in vulnerable
individuals include separation, neglect, abuse or other traumatic childhood events. However,
families that provide a nurturing and caring environment may still have children who develop bpd,
while children who experience appalling childhoods do not develop bpd. Though histories of
physical and sexual abuse are reported to be high among those with bpd, many other experiences
can play a role for a child who is already emotionally vulnerable.

 Common symptoms :
Some common symptoms displayed by a person with BPD include : intense but short-lived
bouts of anger, depression or anxiety ; emptiness associated with loneliness and neediness; paranoid
thoughts and dissociative states in which the mind or psyche “shuts off” painful thoughts or feelings
; self-image that can change depending on whom the person is with; this can make it difficult for the
affected person to pursue his or her own long-term goals; impulsive and harmful behaviours such
as substance abuse, overeating, gambling or high-risk sexual behaviours ; non-suicidal self-injury
such as cutting, burning with a cigarette or overdose that can bring relief from intense emotional
pain (onset usually in early adolescence); up to 75 per cent of people with bpd self-injure one or
more times ; suicide (about 10 per cent of people with bpd take their own lives) ; intense fear of
being alone or of being abandoned, agitation with even brief separation from family, friends or
therapist (because of difficulty to feel emotionally connected to someone who is not there) ;
impulsive and emotionally volatile behaviours that may lead to the very abandonment and
alienation that the person fears.
A client with BPD described what he feels : “I feel empty and lonely, sometimes like I don’t
exist at all, and saying my name feels like a lie because I know there’s nothing inside. I play roles,
try to be who I’m “supposed” to be, and I’m good at being anyone but me. I fill in the space with
what’s appropriate—my goals, careers, values, it’s all based on the situation. I want to feel
something, anything other than nothing. I go from okay to suicidal in an instant and don’t even
know why. But one constant is a sense of worthlessness that spills over into a desperate need for
self-destruction.”
Borderline personality disorder can have degrees of severity and intensity, but at its most
severe and intense the emotional vulnerability of a person with bpd has been described as akin to a
burn victim without skin. The tiniest change in a person’s environment, such as a car horn, a
perceived look, a light touch from another person, can set a person with bpd on fire emotionally.
Some of the extreme feelings associated with bpd have been identified and include intense grief,
terror, panic, abandonment, betrayal, agony, fury or humiliation.
Family members have feelings around bpd as well. They have described living with a person
affected by bpd as constantly “walking on egg shells,” never knowing what will trigger an
outpouring of emotion or anger .Family members may often feel manipulated by their loved one,
but any perceived manipulation is not deliberate. The person living with bpd is trying to manage
and deal with intense emotions that greatly affect his or her behaviour.

 How common is BPD?

Studies in personality disorders are at an early stage of development. Community surveys of
adults have indicated that the prevalence of BPD is close to one adult in 100, similar to that of
schizophrenia. The most recent community survey in the United States found a prevalence of BPD
of six per cent. At this time, we don’t have accurate rates for Canada. It is unclear whether bpd is
more common among women than men and some reports state that about 70 to 80 per cent
diagnosed are women. Other research suggests that although there are more women in a treatment
setting, there is no significant difference between the incidence of BPD in women and men.

  Psychosocial factors :
Family studies have identified a number of factors that may be important in the development
of borderline personality disorder, for example a history of mood disorders and substance misuse in
other family members. Recent evidence also suggests that neglect, including supervision neglect,
and emotional under-involvement by caregivers are important. Prospective studies in children have
shown that parental emotional under-involvement contributes to a child’s difficulties in socialising
and perhaps to a risk for suicide attempts. People with borderline personality disorder (at least while
symptomatic), significantly more often than people without the disorder, see their mother as distant
or overprotective, and their relationship with her conflictual, while the father is perceived as less
involved and more distant. This suggests that problems with both parents are more likely to be the
common pathogenic influence in this group rather than problems with either parent alone. While
these findings should be replicated with those who have recovered from borderline personality
disorder, the general point about biparental difficulties being important in the genesis of borderline
personality disorder is given further support from studies of abuse.
Physical, sexual and emotional abuse can all occur in a family context and high rates are
reported in people with borderline personality disorder.
   Attachment process :
The literature on the relationship between attachment processes and the emergence of
borderline personality disorder is broad and varies. For example, some studies suggest that people
are made more vulnerable to the highly stressful psychosocial experiences discussed above by early
inadequate mirroring and disorganised attachment. This is likely to be associated with a more
general failure in families such as neglect, rejection, excessive control, unsupportive relationships,
incoherence and confusion. While the relationship of diagnosis of borderline personality disorder
and specific attachment category is not obvious, borderline personality disorder is strongly
associated with insecure attachment (6 to 8% of patients with borderline personality disorder are
coded as secure) and there are indications of disorganisation (unresolved attachment and inability to
classify category of attachment) in interviews, and fearful avoidant and preoccupied attachment in
questionnaire studies .

 Treatment :
Medication has a role in the treatment of many serious mental health problems. Though there is
no specific medication for BPD, medication may be prescribed to reduce the impact of specific
symptoms of the disorder. For example, medication may be prescribed to reduce depression or
psychotic-like symptoms such as paranoia. Medication can also be helpful to the person with bpd by
providing a period of time when their symptoms are reduced. This allows them to focus on learning
new skills to manage their behaviours with the goal of discontinuing medication when they are able
to self-manage. Though medication can reduce the severity of symptoms, medication does not cure
bpd and medication is not appropriate for everyone with this diagnosis.
Most mental health medications are used to help restore chemical balance in the brain. They
can help reduce the frequency and severity of symptoms. Medications are divided into four main
groups based on the problems that they were developed to treat:
• antidepressants
• mood stabilizers
• anti-anxiety drugs
• antipsychotics.

 Recovery process :
Despite its often devastating effects on the affected person and his or her family, treatment
outcome research has found that for many people, treatment does work. Many people with bpd
do learn to cope with their symptoms and do things differently, particularly as they reach middle
age. Because of the serious and complex nature of their symptoms, people affected by bpd often
require long-term treatment, often over several years. Treatment accelerates the natural process
of recovery. Studies have followed people affected by bpd for extended periods of time and
found that most improve with time. About 75 per cent will regain close to normal functioning by
age 35 to 40 and 90 per cent will recover by age 50.

 CONCLUSION :
In conclusion, Borderline personality disorder (BPD) is considered a fatal mental illness that
is characterized by unstable moods and behavior. The personality refers to a set of traits, behavior
styles, and patterns that make up who and how we are. How we portray the world and our attitudes,
thoughts and feelings are part of our personality. People with healthy personalities can cope with
everyday life. They have no problem dealing with stress and can form healthy relationships. People
who cannot do the above described often have a personality disorder such as the one described in
this essay -borderline personality disorder.
Patients with BPD tend to be inflexiblable, and are unable to deal to the demands of very day
life. Individuals with this disorder feel that their behavior is normal and okay. BPD patients have a
limited view of the world and have a hard time interacting in social activities. Many people with
BPD live a life of distress and insecure existences. Many have a difficult time maintaining
meaning relationship, making friends, and have difficulty with a sense of self identity. Although
BPD was introduced in the 1930’s, BPD is still hard to recognize due to many symptoms that
describe many other disorders. BPD is not recognized because it is often misdiagnosed for bipolar.
Many patients go undiagnosed due to the reputation of patients being manipulative and untreatable.
Due to the lack of education about BPD makes it hard for patients to be properly diagnosed.
In my opinion, families play a crucial role in supporting their affected family member’s
recovery, but families also need support and nurturing to recover from the impact of their family
member’s illness. Individuals constitutionally vulnerable and exposed to influences that
undermine the development of social cognitive capacities, such as neglect in early relationships,
develop with an impaired ability both to represent and to modulate affect and effortfully control
attentional capacity. These factors, with or without further trauma, exemplified by severe
neglect, abuse and other forms of maltreatment, may cause changes in the neural mechanisms of
arousal and lead to structural and functional changes in the developing brain. Unless adequate
remedial measures are taken, borderline personality may develop.
 REFERENCES :
 Williams, L. (1998). A classic case of Borderline Personality Disorder. Psychiatric
Services, 49 (29), pg. 173–174;
 Grant, B.F., Chou, S.P., Goldstein, R.B., Huang, B. et al. (2008). Prevalence, correlates,
disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2
National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry,
69, 533–45.
 https://books.google.ro/books?
hl=ro&lr=&id=PPgFB9oTptMC&oi=fnd&pg=PR9&dq=borderline+personality+disorder&ots=APcx
L7Edwm&sig=C7WKBxRarxfIRTQ9lW15Bk5u6jI&redir_esc=y#v=onepage&q=borderline
%20personality%20disorder&f=false
 https://en.wikipedia.org/wiki/Borderline_personality_disorder
 https://www.ncbi.nlm.nih.gov/books/NBK55415/