OVERVIEW Environmental and Social Factors: People with BPD often

OVERVIEW

 

Borderline
personality disorder (BPD) is a serious mental illness that centers on the
inability of a person to manage emotions effectively. BPD affects relationships.
Sometimes all relationships are affected and sometimes only one. It is usually
diagnosed during adolescence or in early adulthood. People with BPD can be high
functioning in certain settings; their private lives are often chaotic.

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CAUSES

There’s no clarity on the cause of
BPD in some people. It can affect people of all genders and backgrounds but it
is observed that women are diagnosed with BPD more often than men are. However,
most researchers think that BPD is caused by a combination of different factors.
Genetic, brain, environmental and social factors are possibly involved.

Genetics: BPD is about five times more likely
to occur if a person has a close family member (first-degree biological
relatives) with the disorder. Studies involving twins suggest this illness
has strong hereditary links.

Environmental and Social Factors: People with BPD often report experiencing traumatic life
events, such as abuse or abandonment during childhood, or living with a parent
who is an alcoholic or who struggles to manage a mental health problem.  Others may have been exposed to unstable relationships,
loss of a parent and hostile conflicts. It is possible that a person who later
showed symptoms of BPD as a child could not learn how to regulate emotions due
to unstable environment he lived in. However, some people with BPD do not have
a history of trauma. And, many people with a history of traumatic life events
do not have BPD.

Brain Factors: The emotional
regulation system may be different in people with BPD, suggesting that there is
a neurological basis for some of the symptoms. The portions of the brain that
control emotions and decision-making/judgment may not communicate optimally
with one another. However, some people with similar changes in the brain do not
have BPD. More research is needed to understand the relationship between brain
structure and function and BPD.

 

DIAGNOSTIC CRITERIA

 

According to DSM-IV TR, five or more of the following symptoms should be
present in a person to be diagnosed with borderline personality disorder. Only
a certified psychiatrist can make the diagnosis.

Fear of abandonment: People with BPD are often terrified of being abandoned or left alone.
Even something as innocuous as a loved one getting home late from work or going
away for the weekend can trigger intense fear. This leads to frantic efforts to
keep the other person close. The person may beg, cling, start fights, jealously
track your loved one’s movements, or even physically block the other person
from leaving. Unfortunately, this behavior tends to have the opposite effect
driving others away.

Identity disturbance or unstable self-image: Their sense of self is typically
unstable. Sometimes they may feel good about their self, and other times hate
it, or even view themselves as evil. They probably don’t have a clear idea of
who they are or what they want in life. As a result, they may frequently change
jobs, friends, lovers, religion, values, goals, and even sexual identity.

Chronic feelings of emptiness: People with BPD often talk about feeling empty, as if there’s a hole or
a void inside them. At the extreme, you may feel as if you’re “nothing” or
“nobody.” This feeling is uncomfortable, so you may try to fill the hole with
things like drugs, food, or sex. But nothing feels truly satisfying.

Suicidal tendencies and self-harm: Suicidal behavior and deliberate self-harm is common in people with BPD. Suicidal
behavior includes thinking about suicide, making suicidal gestures or threats,
or actually carrying out a suicide attempt. Self-harm includes attempts to hurt yourself without suicidal intent. Common
forms of self-harm include cutting and burning.

Explosive anger: The person may struggle with intense anger and a short temper. He may also have trouble controlling himself
once he has the trigger he may start yelling, throwing things, or becoming
completely consumed by rage. It’s important to note that this anger isn’t
always directed outwards, one may spend a lot of time being angry at himself.

Intense mood swings: Unstable emotions and moods are common
with BPD. One moment, you may feel happy, and the next, hopeless. Little things
that other people brush off can send you into an emotional tailspin. These mood
swings are intense, but they tend to pass fairly quickly (unlike the emotional
swings of depression or bipolar disorder), usually lasting just a few minutes
or hours.

Instability in interpersonal relations: People with BPD tend to have relationships that are intense and
short-lived. Relationships either seem perfect or horrible, with nothing in
between. Their lovers, friends, or family members may feel like they have
emotional whiplash from their rapid swings between idealization and
devaluation, anger, and hate.

Severe dissociative symptoms: Feeling suspicious or out of touch with reality. People with BPD often
struggle with paranoia or suspicious thoughts about others’ motives. When under
stress, they may even lose touch with reality, an experience known as
dissociation. They may feel foggy, spaced out, or as if their outside their own
body.

Impulsive, self-destructive behaviors: If someone has BPD, he may engage in harmful, sensation-seeking
behaviors, especially when he is upset. He may impulsively spend money on
things he can’t afford, binge eat, drive recklessly, shoplift, engage in risky
sex, or overdo it with drugs or alcohol. These risky behaviors may help him
feel better in the moment, but they hurt him and those around him over the
long-term.

 

TREATMENT

 

THERAPY

The National Institute for Health and Care Excellence (NICE), an organization that produces guidelines on best
practice in health care suggests that the following kinds of talking
treatments could help treat BPD.

Dialectical Behavior Therapy (DBT): A treatment specifically developed for BPD. It first
focuses on the suicidal and other self-destructive behaviors of the person. When
the person is no more suicidal, cognitive behavioral therapy identifies then
tries to change the negative thinking patterns of the person and presses for
positive behavioral changes. It teaches patients the skills to cope with and
change unhealthy behaviors, control intense emotions, reduce self-destructive
behavior, manage distress, and improve relationships. It uses individual and group
therapy to help learn skills to manage emotions.

Metallization Based Therapy (MBT): A long-term talking treatment which aims to improve the
ability to recognize and understand your and other people’s mental states, and
helps examine  thoughts about yourself
and others to see if they’re valid.

Therapeutic communities (TCs): Therapeutic communities (TCs) are structured environments
designed to help people with long-standing emotional problems and a history of
self-harming. Here people with a range of complex psychological conditions and
needs come together to interact with each other and take part in therapy. The therapy
teaches them skills needed to interact socially with others. Most TCs are
residential where you stay for around one to five days a week.

 

MEDICATION

 

There is no specific medication to treat BPD. The National Institute for
Health and Care Excellence (NICE) does not recommend medication but it is seen
that it may be helpful for a person who has another mental health condition alongside
BPD like depression, anxiety disorder, bipolar disorder etc. These may include:

Anti-depressants: Antidepressants
are mood-boosters.  They extend the activity
of particular chemicals in the brain which are thought to be involved with
regulating mood such as nor-adrenaline and serotonin.

Mood
stabilizers: Mood stabilizers can be used to reduce anxiety, anger, depression, impulsivity,
or attempts at self-harm related with borderline
personality disorder.

Anti-psychotics:
Psychiatric drugs used to treat those mental health
problems whose symptoms consist of psychotic experiences. Although BPD is not a psychotic
disorder, it has been shown through research that antipsychotic medications may
be helpful in reducing a few of the symptoms of
BPD like anger and hostility, intense mood shifts, and
cognitive symptoms, like paranoid thinking. According to research antipsychotics
are not helpful in improving depressed mood, anxiety, and impulsivity
in BPD.

 

WORK ISSUES

Different borderline types such as discouraged, impulsive,
petulant and self destructive borderline face different issues in their work
environment affecting their colleagues, productivity, subordinates and
themselves while also increasing the turnover rate for these individuals,
decreasing the satisfaction and increasing the level of dissatisfaction. Overall,
the problems faced by BPD patients in their work environments include,

Difficulty
relating appropriately with co-workers and supervisors: They
might develop unstable relationships with their coworkers based on their
idealization and devaluation thinking patterns. They may be overly dependent on
their supervisors affecting their work and productivity. Fear of abandonment
many make the person cling to their colleagues.

 

Inappropriate
response to work/social situations: People with BPD
might act according to their own emotions and feelings even when the situation
does not demand that like being angry when they need to stay calm. Being sad
when they should be happy in a group setting which makes them look weird to
other people and they may end up alone feeling guilty and confirming to their
selves that they are unwanted, unworthy and useless.

Difficulty
concentrating on work activities: The symptoms of
feeling empty and dissociation from the self affects concentration levels.
Stress diverts their mind towards the problems that may not even exist thus no solution
can be found for them making the person feel guilty.

Impulsive
and angry behavior: Severe unstable and unpredictable
mood swings can cause people to get angry every now and then with or without
reason. The trigger is often reported to be relationship or social factors. It
may cause frustration and feelings of guilt once the anger subsides. Excessive
guilt heightens the BPD symptoms which affect their work.

Inability
to take decisions: Identity disturbances lead to
questions like “who am I?” and “why do I exist?” which clouds the mind and make
the person unaware of what he wants and what he should do, which makes him
unable to take effective decisions.

 

SUITABLE WORK ENVIRONMENT

People who
suffer from BPD face certain hardships in their work environment making it hard
for them to stay in a job and be satisfied. They should look for jobs that do
not trigger their symptoms as much and avoid those that trigger them to a
greater extent. The suitable work environment for them should have or be;

Organized:
Working in a clean,
neat and organized environment helps relieve stress and think clearer. A
cluttered office results in a cluttered mind. The mind distracts less
and the person can concentrate more on his work and encourages him to work.

Limited
work hours: Limited work hours give the person
time to relax and attend his therapy sessions on regular basis thus relieving
the symptoms.

Jobs
with less people interaction: As BPD symptoms are
intensified the more the person interacts with people, jobs that do not require
much social interaction unlike marketing and media jobs which demand social
exposure are good for BPD patients.

Not
or less competitive than other jobs: Competition in
work environment may increase stress levels in many BPD patients like working
as a salesperson might not be a good idea.

Expressive
and flexible: Jobs in which the person can put his
ideas into work such as being an artist or an author are good for BPD patients
as they also have flexible working time often adjusted according to the artist’s
desires.

Self-employment:
If a person cannot find a job he/she fits into,
self-employment is a choice for BPD patients too as they don’t have to work
under anyone. Working from home such as being a freelance programmer or a
graphics designer might keep the person in job for longer period.