Borderline Personality Disorder

According to the DSM-TR-IV, psychology's diagnostic "bible," BPD is a type of psychological personality disorder that interferes with an individual's ability to regulate emotion. The characteristic emotional instability results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships.

People with this disorder are prone to unpredictable outbursts of anger, which sometimes manifest in self-injurious behavior. Borderlines are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such as suicide threats and attempts.

Borderline Behavior

Those suffering from BPD are also prone to other impulsive behaviors, such as excessive spending, binge eating, risky sex, and drug and alcohol abuse. They often exhibit additional psychiatric problems, particularly bipolar disorder, depression, anxiety, and other personality disorders. Symptoms typically begin in early adulthood, and once present, can interfere with relationships, work performance, long-term planning, and the individual's sense of self-identity.

BPD or Emotional Regulation Disorder?

The term "borderline" was originally used to describe mental health patients that appeared to be on the border between neurosis and psychosis. The diagnostic label has been long subject to misuse, and is occasionally used as a "catch-all" diagnosis for individuals who are difficult to diagnose (Friedel 2004). The disorder is also referred to as Emotional Regulation Disorder (ERD), which many feel more accurately describes the true nature of the illness.

Diagnosis of Borderline Personality Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, a patient must fit the following criteria in order to be diagnosed with BPD:

A pervasive pattern of instability of interpersonal relationships, self-image, and affect, marked b impulsivity beginning by early adulthood, as indicated by five (or more) of the following:

• frantic efforts to avoid real or imagined abandonment
• pattern of unstable and intense interpersonal relationships
• identity disturbance: markedly and persistently unstable self-image
• impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• affective instability due to a marked reactivity of mood (extreme changes in mood typically lasting a few hours and only rarely more than a few days).
• chronic feelings of emptiness
• inappropriate, intense anger or difficulty controlling anger
• transient, stress-related paranoid ideation or severe dissociative symptoms

Prevalence of BPD

Borderline Personality Disorder affects approximately 2% of the general population. About 10% of those seen in outpatient mental health clinics, and 20% of psychiatric inpatients are diagnosed borderline, with women being three times more likely to have the disorder than men. There appears to be a genetic component to the disease, as BPD is nearly five times more common among immediate family members of those with the disorder than in the general population (Oldham 2004).

Treatment of BPD

Those with BPD commonly utilize mental health resources, either through their own volition, or at the insistence of loved ones. Impairment from the disorder and risk of suicide are greatest during young-adulthood and gradually wane with advancing age. During their 30s and 40s, most attain greater stability in their emotions and their life.

There have been advancements in the treatments for BPD in recent years. Group and individual psychotherapy are at least partially effective for many patients. Dialectical Behavior Therapy (DBT) and Transference-Focused Psychotherapy (TFP) are two therapeutic approaches developed specifically to treat BPD (Clarkin 2007). Medication may also be helpful for relief of some aspects of the disorder. Brief hospitalization is sometimes required, especially in cases involving psychotic episodes or suicide threats or attempts.This Suite 101 article is a brief summary of BPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.

Sources

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychaiatry,164, 6.

Friedel, R. O. Hoffman, P. D., Penney, D. and Woodward, P. (2004) Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD. Marlowe & Co.

Oldham, J. (2004) Borderline Personality Disorder: An Overview. Psychiatric Times, 21, 8.

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).