The Basis of Borderline personality Disorder

The illness known as borderline personality disorder (BPD) is characterized by problems with emotion control. Accordingly, those who have BPD feel emotions strongly and for a long time, and it is more difficult for them to restore to a stable baseline following an emotionally upsetting occurrence.
Impulsivity, a negative self-image, turbulent relationships, and strong emotional reactions to stimuli can all result from this issue. Self-regulation issues can make it difficult to manage day-to-day and lead to risky behaviors like self-harm.
Varied people have different BPD experiences. One could feel extremely strong, overpowering, or fluctuating emotions. Additionally, one can struggle with connections or an overall sense of self.

• Emotionally unstable personality disorder (EUPD)
• Emotional intensity disorder (EID)
• Borderline pattern personality disorder (borderline pattern PD)

Symptoms of Borderline Personality Disorder

There are nine indications and symptoms that define BPD. A person must satisfy a minimum of five of the requirements listed to be diagnosed:

• Frantic attempts to prevent desertion, whether real or imagined
• Splitting, which means volatile and turbulent interpersonal interactions that frequently alternate between extremes of idealization and depreciation.
• Clearly skewed self-image and sense of identity.
• Risky or rash actions
• Persistent suicidal thoughts or self-harm.
• Strong emotional dysregulation that changes quickly.
• Sensations of emptiness all the time.
• Powerful, inappropriate rage that might be hard to manage.
• Paranoia or strong dissociation symptoms, which are temporary and stress-related.

BPD is characterized by widespread trends of fragility in relationships and self-image, swinging between extremes of idealization and denigration of others, as well as a range of emotions and trouble controlling intense emotional reactions. Another association between the condition and risky or impulsive conduct is that. Depersonalization, experiencing paranoid ideas while under stress, feeling uncertain about one’s identity, morality, and values, and, in mild to severe cases, stress-related breakdowns with realism or psychotic episodes, are other symptoms that may be present.

Read our article: Know about BPD

Who is affected by borderline personality disorder?

The majority of personality disorders start in adolescence when your personality is still growing and developing. Because of this, practically everyone with a diagnosis of borderline personality disorder is older than 18.

Although anybody can acquire BPD, those who have a history of it in their families are more likely to do so. Additionally, those who suffer from other mental health issues including anxiety, depression, or eating disorders are more susceptible.

Approximately 75% of those with BPD diagnoses are born female (AFAB). According to research, those who were given the masculine gender at birth (AMAB) may also experience BPD, albeit they may receive the wrong diagnosis of post-traumatic stress disorder (PTSD) or depression.

What are the Risk Factors and Causes of Borderline Personality Disorder?

Researchers aren’t certain what triggers borderline personality disorder, but research suggests that biological, ecological, and cultural variables may all play a role. These elements may include:

• Genetic factors: Individuals who have a close relative with the condition are more likely to acquire borderline personality disorder.
• Brain structure and function: According to research, persons experiencing borderline personality disorder might also have structural and functional alterations in their brains, particularly in regions that govern impulses and emotion regulation.
• Environmental, societal, and cultural factors: Many persons with borderline personality disorder describe going through terrible life events including abuse, abandonment, or adversity as children. Others might have been subjected to tumultuous, demeaning partnerships or disputes.

Do Comorbid Conditions Exist Along with Borderline Personality Disorder?

Other mental diseases, such as post-traumatic stress disorder, depression, anxiety, and bipolar disorder frequently co-occur with a borderline personality disorder.

In particular, if symptoms of other diseases match with those of borderline personality disorder, these co-occurring disorders might make it more difficult to recognize and manage borderline personality disorder. Some of the co-occurring disorders are:

• Bipolar Disorder Bipolar illness is characterized by sharp swings between manic highs and depressing lows. Affected persons have difficulty controlling their emotions and are more likely to engage in dangerous or impulsive conduct. It exhibits typical BPD characteristics, making it challenging for those who suffer from either of these disorders to get the proper diagnosis.

• Major Depressive Disorder: A frequent comorbidity of BPD is the mood condition known as major depressive disorder (MDD). According to studies, between 38 and 71% of patients who have one of the diseases also suffer from the other. Long-lasting low moods, lack of interest, exhaustion, and sleep issues are all indicators of BPD as well as common signs of MDD. Low mood is among nine symptoms that people with BPD may or may not experience, although it often only lasts a few hours to a few days. People with BPD, as opposed to those with MDD, struggle to control their emotions and experience instability in a variety of contexts, including those not immediately connected to mood, such as interpersonal interactions.

• Eating Disorders: Persons with BPD may develop an eating disorder in an effort to help them better control their emotions, much as people with drug use disorders. Anorexia, bulimia, and binge eating disorder were found to be present in 90% of BPD patients, according to a 2010 research.

• Anxiety Disorders: A category of conditions known as anxiety disorders are characterized by persistent, overpowering, and seemingly uncontrolled intense dread and worry. People with BPD frequently experience emotional crisis states when they feel completely out of control and are unsure of how to control their behavior. They may consequently feel anxious and panicky.

• Substance Abuse Disorder: The DSM-5 states that a person has a substance use disorder when their repeated use of alcohol or drugs “results in impairment in everyday life or evident distress.” Substance use disorder is frequently comorbidity of BPD since volatility is among the symptoms. At a certain point in their lives, up to 72% of persons with BPD develop a drug use problem.

Is There an Overlap Between Bipolar Disorder and Borderline Personality Disorder?

Borderline personality disorder is not the same as bipolar disorder, which also exhibits significant mood and behavior changes. When under substantial stress, especially when dealing with others, emotions and behavior in BPD shift quickly, but in bipolar disorder, moods are more stable and less reactive. Contrary to people with BPD, persons with bipolar illness also experience considerable variations in energy and activity.

Impact of Borderline Personality Disorder on The Individual

In most cases, BPD symptoms progressively become better as people mature. In their 40s, some people’s symptoms go away.

Many BPD sufferers can learn to control their symptoms and promote quality of life with the correct care. Without therapy, BPD sufferers are more likely to experience the following:

• Alcoholism and substance abuse disorders.
• Depression.
• Self-harm.
• Suicide.

People with BPD have 40 times increased suicide risk. Suicide accounts for 8% to 10% of deaths among BPD patients. Untreated BPD frequently results in unstable or chaotic interpersonal relationships and difficulties maintaining employment. They are more likely to get divorced, drift away from friends and family, and have Financial and legal issues

Diagnosis of BPD

A clinical evaluation by a specialist in mental health is the basis for the diagnosis of BPD. The most effective approach is to show someone the criteria for the disease and ask them whether they believe that these traits truly describe them. People with BPD may be more receptive to accepting their diagnosis if they actively participate in its development.

It is normally beneficial for an individual to understand their diagnosis, however, some professionals do not like to inform patients with BPD exactly their identification, either out of concern for the stigma associated with this disorder or because BPD was once thought to be untreatable. They can benefit from knowing that others have gone through similar things, and it can direct them to cures that work.

Typically, the patient is questioned during the psychological examination regarding the onset and psychiatric symptoms as well as other topics such as how symptoms affect the patient’s overall well-being. Particularly important issues are thoughts of injuring others, self-harming behaviors, and suicidal ideations.

The clinician’s observations and the patient’s description of their symptoms are used to making the diagnosis. A physical examination and laboratory testing to exclude other potential reasons for symptoms like thyroid disorders or a drug use problem can be used as additional BPD diagnostic tools.

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What are the Different Criteria and Subtypes Usually Considered While Diagnosing an Individual with BPD

DSM-5

The multiaxial system was eliminated in DSM-5. As a result, Section II of the handbook contains a list of all diseases, including personality disorders. In order to be diagnosed with borderline personality disorder, a person must satisfy five out of nine requirements. It lists impulsive conduct and a widespread tendency of unpredictability in relationships, identity, and emotion as the condition’s key characteristics. Additionally, section III of the handbook, “Alternative DSM-5 Model for Personality Disorders,” suggests alternative diagnostic standards for BPD. Based on trait research, these alternative criteria call for mentioning a minimum of four of seven maladaptive features.

ICD-10

Emotionally unstable personality disorder is a disorder that the ICD-10 of the World Health Organization categorizes and which shares conceptual similarities with BPD. The next two subtypes of it are described below:

• Impulsive type (F60.30)

A minimum of three of the given should exist, including:

1. There must be a significant tendency to act impulsively and without thought of the consequences
2. A marked tendency to argue and clash with everyone, particularly when spontaneous acts are rejected or criticized
3. A propensity for explosive outbursts of rage or violence with a lack of control over the ensuing behavioral explosions
4. Inability to maintain any sequence of events that do not provide an immediate benefit.

• Ambiguous Type F60.31

At most two of the following conditions must also be present in addition to a minimum of three of the symptoms listed in F60.30

1. Impulsive type irregularities in and ambiguity about one’s self-image, goals, and internal preferences
2. Propensity to engage in emotionally draining and unstable relationships
3. Excessive efforts to prevent abandonment
4. Repeated risks or acts of self-harm
5. Persistent feelings of emptiness
6. Exhibits impulsive behavior, such as driving too fast or abusing drugs.

Subtypes of Millon

Theodore Millon, an American psychologist, has identified four BPD categories. According to him, a person with BPD may have none, one, or many of the below Subtype Features:

1. Discouraged ambiguous: Pliant, obedient, devoted, and humble; feels exposed and in danger all the time; and is helpless, unhappy, and despairing.
2. Petulant borderline: Negative, impatient, restless, belligerent, rebellious, sullen, gloomy, and spiteful; frequently feels “shortchanged” and rapidly loses hope.
3. Borderline impulsive: Captivating, capricious, shallow, flighty, distractable, frantic, and alluring; fearing loss, the person becomes aggravated; melancholy and irritable; and maybe suicidal.
4. Almost self-destructive: Self-punishing, furious, and introspective; conforming, submissive, and ingratiating habits have gotten worse; high-strung and gloomy; potential suicidal thoughts.

Read Blog: Effective tips to tackle borderline personality disorder

How to Take Control of Borderline Personality Disorder and Take a Step Towards Recovery?

The combination of certain therapies, medications, and self-help strategies works best for treating BPD

• The idea of mindfulness, or focusing on the current feeling, is central to dialectical behavior therapy (DBT). DBT imparts knowledge on how to manage discomfort, curb destructive behavior, and regulate strong emotions. It aims to strike a balance between behavior modification and acceptance. This proactive, problem-solving strategy was created especially for the treatment of BPD. Individual therapy sessions, group skill development, and where necessary, phone coaching are all included in the course of treatment. The BPD treatment that has been most extensively researched and demonstrated to be most successful is DBT.

Read Blog: Application and purpose of Dialectical Behavior Therapy (DBT) in counseling

• Talk therapy called mentalization-based therapy (MBT) aids individuals in recognizing and comprehending what others may be experiencing and thinking.

• Through the interaction between the patient and therapist, transference-focused therapy (TFP) aims to help patients comprehend their feelings, moods, and personal difficulties. Patients then apply what they have learned to new circumstances.

• Good Psychiatric Management (GPM) gives mental health workers a simple-to-use “toolbox” for dealing with patients who suffer from severe personality disorders.

• Although BPD cannot be cured, medications can help manage other illnesses including sadness, impulsivity, and anxiety that frequently coexist with BPD. Numerous drugs are frequently used to treat patients, although there is no proof that this strategy is helpful or even required. Individuals with BPD are urged to discuss the potential benefits and negative effects of each drug with the doctor who is giving it.

• The goal of cognitive behavioral therapy (CBT) is to fundamentally alter your beliefs about both yourself and other people. Similar to CBT, schema-focused therapy transforms unfavorable self-perceptions into favorable ones.

Read our blog: What is Schema Therapy?

• You could require inpatient care since BPD symptoms include self-harming behaviors like piercing and suicidal tendencies.

• Regular exercise, sound sleep patterns, a healthy diet, taking medicine, and stress management are all examples of self-care practices. Self-care can assist to lessen BPD’s typical symptoms.

• People with BPD may get individual or group arts or creative therapy as a part of their treatment regimen. Treatment options include dance movement therapy, art therapy, music therapy, and drama therapy. People who struggle to verbally communicate their feelings and thoughts might benefit from art treatments. The focus of the treatment is on using creative expression to convey your feelings. The classes are taught by licensed therapists who can assist you in considering your creation and how it ties to your ideas and past experiences.

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