Borderline personality disorder

Borderline personality disorder, what is it?

The following extracts about Borderline personality disorder are taken from Wikipedia, the free encyclopaedia,

Borderline personality disorder (BPD) is a personality disorder described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the disorder often manifests itself in idealization and devaluation episodes, as well as chaotic and unstable interpersonal relationships, self-image, identity, and behaviour; as well as a disturbance in the individual’s sense of self.

In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.

Borderline personality disorder (BPD) splitting includes a switch between idealizing and demonising others. This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. Borderline personality disorder disturbances also may include self-harm.Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.

There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline, and some have suggested that this disorder should be renamed. The ICD-10 manual has an alternative definition and terminology to this disorder, called Emotionally unstable personality disorder.

There is related concern that the diagnosis of Borderline personality disorder stigmatizes people and supports pejorative and discriminatory practices. It is common for those suffering from borderline personality disorder and their families to feel compounded by a lack of clear diagnoses, effective treatments, and accurate information. This is true especially because of evidence that this disorder originates in the families of those who suffer from it and has a lot to do with psychosocial and environmental factors (Axis IV), rather than belonging strictly in the personality disorders and mental retardation section (Axis II) of the DSM-IV construct. Conceptual, as well as therapeutic, relief may be obtained through evidence that Borderline personality disorder is closely related to traumatic events during childhood and to post-traumatic stress disorder (PTSD), about which much more is known.

Signs and symptoms

Borderline personality disorder is a diagnosis about which many articles and books have been written, yet about which very little is known based on empirical research.

Studies suggest that individuals with Borderline personality disorder tend to experience frequent, strong and long-lasting states of aversive tension, often triggered by perceived rejection, being alone or perceived failure. Individuals with Borderline personality disorder may show liability (changeability) between anger and anxiety or between depression and anxiety and temperamental sensitivity to emotive stimuli.

The negative emotional states specific to Borderline personality disorder may be grouped into four categories: destructive or self-destructive feelings; extreme feelings in general; feelings of fragmentation or lack of identity; and feelings of victimization.

Individuals with Borderline personality disorder can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviours are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.mental health professionals (and in the DSM-IV), as deliberately manipulative or difficult, but analysis and findings generally trace behaviours to inner pain and turmoil, powerlessness and defensive reactions, or limited coping and communication skills.There has been limited research on family members’ understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members. However the effect of expressed emotion by family members may actually be opposite (paradoxical) from the anticipated effect on individuals with such illnesses as depressive disorders and schizophrenia. For Borderline personality disorder such effect may be neutral or positive as opposed to negative, a counter-intuitive result.

Parents of individuals with Borderline personality disorder have been reported to show co-existing extremes of over-involvement and under-involvement. Borderline personality disorder has been linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.

Suicidal or self-harming behaviour is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging. The suicide rate is approximately 8 to 10 percent. Self-injury attempts are highly common among patients and may or may not be carried out with suicidal intent. Borderline personality disorder is often characterized by multiple low-lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high-lethality attempts that are attributed to impulsiveness or co-morbid major depression, with interpersonal stresses appearing to be particularly common triggers. Ongoing family interactions and associated vulnerabilities can lead to self-destructive behaviour. Stressful life events related to sexual abuse have been found to be a particular trigger for suicide attempts by adolescents with a Borderline personality disorder diagnosis.

Diagnosis

Diagnosis is based on a clinical assessment by a qualified mental health professional. The assessment incorporates the patient’s self-reported experiences as well as the clinician’s observations. The resulting profile may be supported or corroborated by long-term patterns of behaviour as reported by family members, friends or co-workers. The list of criteria that must be met for diagnosis is outlined in the DSM-IV-TR.

Borderline personality disorder was once classified as a subset of schizophrenia (describing patients with borderline schizophrenic tendencies). Today Borderline personality disorder is used more generally to describe individuals who display emotional dysregulation and instability, with paranoid schizophrenic ideation or delusions being only one criterion (criterion #9) of a total of 9 criteria, of which 5, or more, must be present for this diagnosis.

Individuals with Borderline personality disorder are at high risk of developing other psychological disorders such as anxiety and depression. Other symptoms of Borderline personality disorder, such as dissociation, are frequently linked to severely traumatic childhood experiences, which some put forth as one of the many root causes of the borderline personality.

Adolescence

Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time, with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms. While borderline personality disorder can manifest itself in children and teenagers, therapists are discouraged from diagnosing anyone before the age of 18, due to adolescence and a still-developing personality.

There are some instances when Borderline personality disorder can be evident and diagnosed before the age of 18. The DSM-IV states: "To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year." In other words, it is possible to diagnose the disorder in children and adolescents, but a more conservative approach should be taken.

There is some evidence that Borderline personality disorder diagnosed in adolescence is predictive of the disease continuing into adulthood. It is possible that the diagnosis, if applicable, would be helpful in creating a more effective treatment plan for the child or teen.

 Mail this post

Technorati Tags: borderline, BPD, Disorder, mental health, personality