Borderline Personality Disorder (BPD); Introduction, symptoms, causes, treatment, DSM-5

INTRODUCTION : BPD

Borderline personality disorder (BPD) is a mental health disorder which is usually characterized by emotional instability, issues with self-image, difficulties in handling emotions or experiencing strong emotions. According to Diagnostic and statistical manual of mental disorders, 5th edition also known as DSM-5 has considered Borderline personality disorder (BPD) as a personality disorder.

It states that the essential features of a personality disorder are impairments (loss or abnormality) in personality including self and interpersonal functioning (interaction of an individual with other people and their surroundings effect on that individual) and the presence of pathological personality traits.

SYMPTOMS AND SIGNS

DISTORTED IDENTITY

People suffering from Borderline Personality Disorder have an unstable self-image, poorly developed self-identity and experience of chronic feeling of emptiness.

IMPAIRED INTIMACY

Unstable Relationship- people suffering from BPD experience interpersonal hypersensitivity. They have an unstable, intense, twisted and conflicted relationship with their close family members, friends, relatives, peer etc., especially with their loved ones. According to DSM-5, close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.
Fear of Abandonment- One of the indicators of BPD. It can be considered as an early insecure attachment. People suffering from BPD have extreme fear of abandonment and need frequent reassurance. At times they imagine themselves getting abandoned by their loved ones or close ones which makes them feel anxious. This severe fear of abandonment can drive them to take extreme steps. This may lead or may turn an understanding and cooperative relationship into dysfunctional and toxic relationship.
Paranoia- Person suffering from BPD experience paranoia which include mistrust under stressful condition.
Neediness- People suffering from BPD can be clingy, needy and passive.
Dysfunctional of Empathy: People suffering from BPD, have poor or lack of cognitive empathy. New research from University of Georgia show that it may be due to lowered activity in brain in those regions which facilitates empathy.

“We found that for those with more BPD traits, these empathetic processes aren’t as easily activated,” said Miller, a psychology professor and director of the Clinical Training Program. Haas found a link between those with high borderline personality traits and a decreased use of neural activity in two parts of the brain i.e. the temporoparietal junction and the superior temporal sulcus, two brain regions implicated to be critically important during empathic processing.

Poor Self direction: They have instability in establishing their goals, hard time in determining their own self values and aspiration
Extreme Mood Swings: People suffering from BPD undergo intense, rapid and severe mood swings over short period of time. They also undergo unstable emotional experiences. According to DSM-5, they experience emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. These can overwhelm someone suffering from BPD in such a way that they start engaging in substance abuse, self-harm etc.
Anxiety: They suffer from anxiety and panic as a reaction due to stressful experience in relationship with their friends, lover and family members. According to DSM-5, they worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

SEPARATION INSECURITY

Fear of Rejection: People suffering from BPD are sensitive to rejection. They experience intense fear of rejection within their intimate relationship. This may trigger rage, intense anger and impulsiveness. From a physiological perspective, people with BPD who are sensitive to rejection may have lower plasma levels of oxytocin (also known as love hormone); altered oxytocin may interact with attachment style (different ways of interacting in a relationship ) to cause interpersonal dysregulation (poor ability to manage relationship with people).
Fear of Separation: People suffering from BDP experience or imagine fear of separation from their loved ones. It is associated with the fear of overdependency over others and sense of loss of autonomy.
Depressiveness- The depressive symptoms which are part of Bpd are mainly to due interpersonal stress (eg fear of abandonment). It includes feeling of inferiority in self-worth, hopelessness, pessimistic future and suicidal thoughts is common.

DISINHIBITION

Impulsivity- Impulsiveness is one of the common symptoms of BPD. People suffering from BPD can act according to their intermediate stimuli. Acting in momentary basis can lead to self-harm tendencies in case of emotional distress.
Engaging in Risky behavior- People suffering from BPD are more likely to engage in dangerous and risky behavior and self-harming activities such as gambling, unprotected sex, sex with strangers, abusing alcohol or drugs, shoplifting etc. They have a sense of denial towards personal dangers caused by their action to themselves and others. They act without considering consequences of their action.
Hostility- People experiencing BPD frequently undergo emotions such as Anger and rage which may last for long period of time.

RISK FACTORS

High risk when a member of family or a close relative has same or similar disorder.
Experienced any kind of sexual or physical abuse
Faced neglect during childhood
Lived with parents, caregivers, guardians and foster parents with substance abuse or other mental health issues.
Been separated from parent, caregiver, foster parents and guardians.
Exposed to conflicted, unstable and hostile family relationship.

TREATMENT

Living with or your partner suffering from Borderline Personality can be quite challenging as it affects one self and those people in their surroundings. Borderline personality disorder cannot be cured. However, it can be treatable. Its treatment is a long-term process and with right therapy and treatment its symptoms are controllable.

Treatment includes a single or group of psychotherapeutic process and medications (only if any other mental health disorder associated) which is done under surveillance of certified mental health professional. It depends upon severity of the disorder.

Different Treatment Approaches are:

Psychotherapy: It is a term used by mental health professional for treating a mental health disorder through talking.
Dialectical behavior therapy (DBT): is a type of cognitive behavioural therapy which is specially designed for people suffering from Borderline Personality Disorder. It is helpful for treating difficulties in emotion regulation. The main purpose of this therapy is to teach how to manage one’s emotions and focuses on improvising relationships.
Medications: Food and Drug Administration haven’t specifically recommended any drug to treat Borderline Personality Disorder. However, there are drugs available to maintain and control certain specific symptoms and issues such as aggression, depression, anxiety etc. Medication should always be taken under prescription of certified mental health profession and psychiatrist. Discussing with them about side effects and benefits can be helpful.

REFERENCE:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990070/
https://journals.sagepub.com/doi/full/10.1177/1039856218810154
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357542/
https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

DSM-5

https://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf