Borderline Personality Disorder

Borderline Personality disorder as classified by the DSM IV, falls under the Dramatic Personality disorders; individuals who have intense, unstable emotions, distorted self perception and behavioural impulsiveness.

Borderline Personality Disorder (BPD) is still a controversial diagnosis and some researchers, like Judith Herman, believe that BPD is a label given to a particular manifestation of post-traumatic stress disorder, which, if it manifests in other ways, may be diagnosed as Dissociative Identity Disorder.

Researchers have identified four behaviour patterns they consider peculiar to BPD:

• Abandonment
• Engulfment
• Annihilation fears & neediness
• Ability to arouse inappropriately close or hostile treatment relationships

BPD usually begins by early adulthood and the diagnosis between the sexes is 4/1 women over men. It is also the diagnosed personality disorder with the highest risk of suicide and it is estimated that as many as 70% sufferers have a background of sexual abuse.

Symptoms:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships
• Persistent unstable self image or sense of self
• Impulsivity in at least 2 areas that are self damaging e.g. sex, excessive spending, substance abuse, reckless driving or binge eating
• Recurrent suicidal behaviour, threats or self mutilating behaviour
• Instability of moods e.g. intense anxiety, irritability or overwhelming sadness, lasting only a few hours or rarely more than a few days
• Chronic feelings of emptiness
• Inappropriate displays of temper, recurrent physical fights or difficulty controlling anger
• Transient stress related psychosis, everything becomes 'all good or all bad'

Perhaps the key word to describe individuals with this disorder is unstable. Their emotions and cognition are unstable, ranging from rational and clear to quite psychotic and their behaviour is unstable. It may be characterised by periods of excellent conduct, high efficiency and trustworthiness alternating with outbreaks of babyishness, unreliability, isolation and failure. Their self control is also unstable -- ranging from the extreme self denial of anorexia to being at the mercy of any impulses and their relationships are unstable. They may sacrifice themselves for others, only to suddenly fly into angry reproaches and tantrums.

Signs of BPD:

• Suicide threats and attempts
• Self-inflicted injuries or abuse
• Outbursts of rage and recrimination
• Impulsive marriages, divorces, pregnancies and abortions
• Repeated starting and stopping of jobs
• Anxiety, guilt and self-loathing for which short term relief is sought at any cost
• An appearance of being out of touch with reality for short periods

Treatment:

Patients showing the features of BPD are notoriously difficult to treat as they make considerable demands upon the therapist and are, indeed, difficult to even keep in therapy due to their unstable behaviours.

Some medication has proved to be useful in managing extreme mood swings but psychotherapy is the most effective treatment. Dialectical Behaviour Therapy (DBT), originally developed by Marsha Linehan (1993) specifically to treat BPD, has had considerable success. It requires a strong therapeutic relationship and commitment & co-operation by the patient to attend all therapy sessions.

BPD can cause intense distress not only to the individual but to all those associated with them. Living with someone with BPD may lead to the sufferer's family having a pervasive sense of just being unable to help and subsequently leading to estrangement from the family unit. Therapy is, therefore, often desirable for the whole family.

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