Borderline Personality Disorder is a psychiatric disorder that didn’t come into clear focus until the last thirty five years or so, and was initially called “borderline” because psychiatrists thought that people who suffered from it were in between neurosis and psychosis. It was considered exceedingly difficult to treat and carried a grim prognosis.
Although it was listed in the DSM in 1980, more and more has been learned about the personality disorder that may affect up to two percent of the population, mostly women. And it’s also frequently underdiagnosed, or improperly diagnosed as clinical depression. In fact, it often occurs along with other psychiatric disorders — namely depression, bipolar disorder, or other personality disorders. The problem is, correct diagnosis is important because treatment may vary significantly from that of simple depression.
What are the symptoms of borderline personality disorder? Some are interchangeable or similar to that of clinical depression, so it is easy to see why it is easily misdiagnosed.
- Chronic feeling of emptiness or being alone
- Unreasonable fear that others will abandon you
- Reckless behavior — unsafe sex, eating disorders, money spending, drug use
- Suicidal ideation or attempts
- Difficulty in controlling anger, or anger at small things
- Feelings that fluctuate between depression, anxiety and irritability quickly
- Difficulty with relationships, keeping a job, staying in school
- Feelings of detachment to one’s self
- Frequently changing goals, career plans, or an unsure sense of self
Borderline Personality Disorder is characterized by a person’s inability to regulate their emotional, interpersonal, behavioral and cognitive domains. The four sentinel areas of dysregulation are: difficulty in maintaining healthy self-esteem, difficulty in regulating one’s feelings, difficulty in exercising self-care and difficulty in sustaining connection to others.
The causes of BPD are considered multi-factorial by most experts. Genetics, early childhood experiences that can include abuse, neglect, or having a parent with hostile or instability of mood may all play a part. Trauma also seems to be a key factor, as 70 percent of those diagnosed with BPD report a history of physical or sexual abuse. The frightening thing about BPD is it has a high suicide rate when not successfully treated — that’s why it’s important to differentiate it from other psychiatric disorders. It is believed that the suicide rate for those with BPD is around 10 percent.
While it is treated similarly to depression, sometimes using antidepressants and anti-anxiety meds, psychotherapy is much more important to the patient with BPD. This may include Cognitive Behavioral Therapy, support groups, addiction support, and a therapy that was invented specifically for those with BPD: Dialectical Behavior Therapy, which includes psychosocial skills training along with cognitive behavioral therapy, which is aimed at helping the individual recognize, modify and control their emotional reactions to situations and people.
Unfortunately, Borderline Personality Disorder carries a stigma of being untreatable, which is untrue. Imi Lo, a psychotherapist who specializes in treating those with Borderline Personality Disorder, says there are important things that loved ones can do to help their hurting family member, lover or friend.
“As a rule of thumb, always start by validating the other person’s feelings – you don’t have to agree with the behavior to do that, you can just empathize with the feelings, because there are no right or wrong feelings. Then, when they feel that you’re on their side, you can point out your version of the truth.”