OVERVIEW Borderlinepersonality disorder (BPD) is a serious mental illness that centers on theinability of a person to manage emotions effectively. BPD affects relationships.Sometimes all relationships are affected and sometimes only one. It is usuallydiagnosed during adolescence or in early adulthood. People with BPD can be highfunctioning in certain settings; their private lives are often chaotic.
CAUSESThere’s no clarity on the cause ofBPD in some people. It can affect people of all genders and backgrounds but itis 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 likelyto occur if a person has a close family member (first-degree biologicalrelatives) with the disorder. Studies involving twins suggest this illnesshas strong hereditary links.Environmental and Social Factors: People with BPD often report experiencing traumatic lifeevents, such as abuse or abandonment during childhood, or living with a parentwho 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 latershowed symptoms of BPD as a child could not learn how to regulate emotions dueto unstable environment he lived in. However, some people with BPD do not havea history of trauma. And, many people with a history of traumatic life eventsdo not have BPD.Brain Factors: The emotionalregulation system may be different in people with BPD, suggesting that there isa neurological basis for some of the symptoms.
The portions of the brain thatcontrol emotions and decision-making/judgment may not communicate optimallywith one another. However, some people with similar changes in the brain do nothave BPD. More research is needed to understand the relationship between brainstructure and function and BPD. DIAGNOSTIC CRITERIA According to DSM-IV TR, five or more of the following symptoms should bepresent in a person to be diagnosed with borderline personality disorder. Onlya 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 goingaway for the weekend can trigger intense fear. This leads to frantic efforts tokeep the other person close. The person may beg, cling, start fights, jealouslytrack your loved one’s movements, or even physically block the other personfrom leaving. Unfortunately, this behavior tends to have the opposite effectdriving others away.Identity disturbance or unstable self-image: Their sense of self is typicallyunstable. Sometimes they may feel good about their self, and other times hateit, or even view themselves as evil.
They probably don’t have a clear idea ofwho they are or what they want in life. As a result, they may frequently changejobs, 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 ora 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 withthings 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. Suicidalbehavior 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.
Commonforms 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 himselfonce he has the trigger he may start yelling, throwing things, or becomingcompletely consumed by rage. It’s important to note that this anger isn’talways directed outwards, one may spend a lot of time being angry at himself.Intense mood swings: Unstable emotions and moods are commonwith BPD. One moment, you may feel happy, and the next, hopeless.
Little thingsthat other people brush off can send you into an emotional tailspin. These moodswings are intense, but they tend to pass fairly quickly (unlike the emotionalswings of depression or bipolar disorder), usually lasting just a few minutesor hours.Instability in interpersonal relations: People with BPD tend to have relationships that are intense andshort-lived.
Relationships either seem perfect or horrible, with nothing inbetween. Their lovers, friends, or family members may feel like they haveemotional whiplash from their rapid swings between idealization anddevaluation, anger, and hate.Severe dissociative symptoms: Feeling suspicious or out of touch with reality. People with BPD oftenstruggle with paranoia or suspicious thoughts about others’ motives.
When understress, they may even lose touch with reality, an experience known asdissociation. They may feel foggy, spaced out, or as if their outside their ownbody.Impulsive, self-destructive behaviors: If someone has BPD, he may engage in harmful, sensation-seekingbehaviors, especially when he is upset.
He may impulsively spend money onthings he can’t afford, binge eat, drive recklessly, shoplift, engage in riskysex, or overdo it with drugs or alcohol. These risky behaviors may help himfeel better in the moment, but they hurt him and those around him over thelong-term. TREATMENT THERAPYThe National Institute for Health and Care Excellence (NICE), an organization that produces guidelines on bestpractice in health care suggests that the following kinds of talkingtreatments could help treat BPD.Dialectical Behavior Therapy (DBT): A treatment specifically developed for BPD. It firstfocuses on the suicidal and other self-destructive behaviors of the person. Whenthe person is no more suicidal, cognitive behavioral therapy identifies thentries to change the negative thinking patterns of the person and presses forpositive behavioral changes.
It teaches patients the skills to cope with andchange unhealthy behaviors, control intense emotions, reduce self-destructivebehavior, manage distress, and improve relationships. It uses individual and grouptherapy to help learn skills to manage emotions.Metallization Based Therapy (MBT): A long-term talking treatment which aims to improve theability to recognize and understand your and other people’s mental states, andhelps examine thoughts about yourselfand others to see if they’re valid. Therapeutic communities (TCs): Therapeutic communities (TCs) are structured environmentsdesigned to help people with long-standing emotional problems and a history ofself-harming. Here people with a range of complex psychological conditions andneeds come together to interact with each other and take part in therapy. The therapyteaches them skills needed to interact socially with others. Most TCs areresidential where you stay for around one to five days a week. MEDICATION There is no specific medication to treat BPD.
The National Institute forHealth and Care Excellence (NICE) does not recommend medication but it is seenthat it may be helpful for a person who has another mental health condition alongsideBPD like depression, anxiety disorder, bipolar disorder etc. These may include:Anti-depressants: Antidepressantsare mood-boosters. They extend the activityof particular chemicals in the brain which are thought to be involved withregulating mood such as nor-adrenaline and serotonin.
Moodstabilizers: Mood stabilizers can be used to reduce anxiety, anger, depression, impulsivity,or attempts at self-harm related with borderlinepersonality disorder.Anti-psychotics:Psychiatric drugs used to treat those mental healthproblems whose symptoms consist of psychotic experiences. Although BPD is not a psychoticdisorder, it has been shown through research that antipsychotic medications maybe helpful in reducing a few of the symptoms ofBPD like anger and hostility, intense mood shifts, andcognitive symptoms, like paranoid thinking.
According to research antipsychoticsare not helpful in improving depressed mood, anxiety, and impulsivityin BPD. WORK ISSUESDifferent borderline types such as discouraged, impulsive,petulant and self destructive borderline face different issues in their workenvironment affecting their colleagues, productivity, subordinates andthemselves 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,Difficultyrelating appropriately with co-workers and supervisors: Theymight develop unstable relationships with their coworkers based on theiridealization and devaluation thinking patterns. They may be overly dependent ontheir supervisors affecting their work and productivity. Fear of abandonmentmany make the person cling to their colleagues.
Inappropriateresponse to work/social situations: People with BPDmight act according to their own emotions and feelings even when the situationdoes not demand that like being angry when they need to stay calm. Being sadwhen they should be happy in a group setting which makes them look weird toother people and they may end up alone feeling guilty and confirming to theirselves that they are unwanted, unworthy and useless. Difficultyconcentrating on work activities: The symptoms offeeling empty and dissociation from the self affects concentration levels.Stress diverts their mind towards the problems that may not even exist thus no solutioncan be found for them making the person feel guilty. Impulsiveand angry behavior: Severe unstable and unpredictablemood swings can cause people to get angry every now and then with or withoutreason. The trigger is often reported to be relationship or social factors.
Itmay cause frustration and feelings of guilt once the anger subsides. Excessiveguilt heightens the BPD symptoms which affect their work.Inabilityto take decisions: Identity disturbances lead toquestions like “who am I?” and “why do I exist?” which clouds the mind and makethe person unaware of what he wants and what he should do, which makes himunable to take effective decisions. SUITABLE WORK ENVIRONMENTPeople whosuffer from BPD face certain hardships in their work environment making it hardfor them to stay in a job and be satisfied. They should look for jobs that donot trigger their symptoms as much and avoid those that trigger them to agreater 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. Acluttered office results in a cluttered mind. The mind distracts lessand the person can concentrate more on his work and encourages him to work.
Limitedwork hours: Limited work hours give the persontime to relax and attend his therapy sessions on regular basis thus relievingthe symptoms. Jobswith less people interaction: As BPD symptoms areintensified the more the person interacts with people, jobs that do not requiremuch social interaction unlike marketing and media jobs which demand socialexposure are good for BPD patients. Notor less competitive than other jobs: Competition inwork environment may increase stress levels in many BPD patients like workingas a salesperson might not be a good idea.Expressiveand flexible: Jobs in which the person can put hisideas into work such as being an artist or an author are good for BPD patientsas they also have flexible working time often adjusted according to the artist’sdesires.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 workunder anyone. Working from home such as being a freelance programmer or agraphics designer might keep the person in job for longer period.