Borderline Personality Disorder Treatment
Borderline personality disorder or BPD is a severe mental disorder typified by pervasive instability in interpersonal relationships, moods, and behavior. This instability frequently disrupts work life and family as well as long-term planning and the person’s sense of identity.
Persons with this disorder also have trouble with emotion regulation. Although it’s less known than bipolar disorder or schizophrenia, it’s estimated that BPD affects 2% of adults. Furthermore, it’s more common in females, with almost 75% of those diagnosed being women.
Persons with the disorder frequently require extensive mental health services and usually account for 20% of psychiatric hospitalizations. Nevertheless, with help, several show improvement over time and eventually lead productive lives.
What is Borderline Personality Disorder?
The mental illness is part of the group of mental disorders called personality disorders. Similar to other personality disorders, it’s marked by a constant pattern of feeling, thinking, and interrelating with others and with the world that typically leads to significant issues for the sufferer.
Specifically, it’s related to a pattern of unstable ways of perceiving oneself, behaving, feeling, and associating with other people that cause marked interference with the person’s capacity to function. Like other personality disorders, the individual is typically an adult or adolescent before an assessment establishes that the person has met full symptom criteria for the disorder.
Historically, it’s been perceived as a set of symptoms that comprises mood issues (neuroses) and reality distortions (psychosis) and was therefore considered to be on the borderline between schizophrenia and mood issues.
However, it’s currently understood that while BPD’s symptoms may overlap those symptom complexes, the disorder is more closely associated with other personality disorders in terms of how it might develop within families. Moreover, the frequency with which it occurs is believed to be considerably higher than formerly thought.
Which Disorders Frequently Occur with BPD?
Men with this disorder have a higher likelihood of having a substance-related disorder while women are more likely to have an eating disorder. In adolescents, the disorder usually co-occurs with disorders like passive aggressive and schizotypal personality disorder.
Adults with an antisocial personality disorder, colloquially termed sociopaths, might be more likely to have borderline personality disorder. Interestingly, even those with some BPD symptoms but don’t meet full diagnostic criteria for the disorder, could have BPD traits and narcissistic personality disorder.
Although some controversy exists as for whether BPD is actually its own disorder or a bipolar variation, research maintains the theory that BPD, like nearly all medical or mental health illness, can present in almost as many complex and unique ways as the individuals who have it. That is, some persons with BPD will only have the disorder while others will have it together with bipolar or another mental illness.
What are the Causes of BPD?
While the exact cause of the disorder is unknown, it’s understood to be the outcome of a mixture of biological predispositions, social stressors, and ways of understanding the world.
Biologically, persons with the disorder have a higher likelihood of exhibiting abnormalities in the hippocampus size, in the functioning and size of the amygdala, and in the working of the frontal lobes, which are the brain areas that regulate emotions and integrate emotions with thoughts.
While some research indicates that persons with BPD appear to have brain areas that are less and more active compared to persons who don’t have the illness, other research contradicts that. Although the disorder isn’t believed to be genetic, it can run in families to some extent.
In fact, the disorder is more common among persons whose close biological relatives have the illness. Studies also reveal that numerous persons with the disorder report a history of neglect, abuse, or separation as young kids.
Researchers believe that the disorder originates from a mixture of individual susceptibility to environmental stress and a series of occurrences that trigger its onset as young adults. Adults with the disorder also have a higher likelihood of being violence victims, including rape among other crimes.
Such incidents may arise from destructive settings as well as the person’s impulsivity and poor judgment in selecting lifestyles and partners.
Norepinephrine, serotonin, and acetylcholine are some of the messengers that play a role in regulating emotions, including anger, sadness, irritability, and anxiety.
Drugs that augment brain serotonin role may enhance emotional signs in BPD. Similarly, mood-stabilizing drugs known to enhance GABA activity-the principal inhibitory transmitter in the brain might help persons with BPD-like mood swings.
Symptoms of BPD
This manifests in numerous ways, but for diagnosis purposes, mental health experts group them into nine main categories. In order to obtain a diagnosis, you must exhibit at least five of these signs. Furthermore, they should be long-standing (typically starting in adolescence) and persistent across numerous areas of your life. The symptoms are:
Fear of desertion
Persons with this disorder are frequently terrified of being left alone or abandoned. Even something as harmless as a loved home returning home late or being away for the weekend could trigger intense fear. This results in frantic attempts to keep the other individual close.
The person might cling, beg, begin fights, track the loved one’s movements jealously, or even block the other individual from leaving physically. Unfortunately, such behavior usually has the opposite effect-it pushes others away.
People with this disorder typically have intense and short-lived relationships. They’re likely to fall in love fast, thinking every new person is the one who’ll make them feel whole only to be disappointed fast. Their relationships appear either horrible or perfect, with nothing in between. Family members or friends might feel as though they have emotional whiplash from their fast swings between devaluation and idealization, hate, and anger.
Impulsive and self-destructive behaviors
Persons with this disorder might engage in destructive, sensation-seeking behaviors, particularly when upset. They might spend money they can’t afford, drive recklessly, binge eat, or shoplift. While such risky behaviors might make you feel better temporarily, they harm you and those around you in the long-term.
Unstable or unclear self-image
When you have this disorder, your sense of self is usually unstable. At times, you might feel good about yourself but loathe yourself at other times. You might even perceive yourself as evil. It’s probable that you don’t have a clear idea of what you desire in life or who you are. Consequently, you might change jobs, religion, friends, and goals frequently.
Intense emotional swings
Unstable moods and emotions are common with this disorder. One moment, you might be happy and despondent the next. Trivial things that other individuals brush off could send you into an emotional breakdown. While they’re intense, the mood swings usually pass rather fast (unlike in bipolar disorder or depression), typically lasting a few hours or minutes.
Intentional self-harm and suicidal behaviors are common in persons with BPD. Suicidal behavior includes suicidal thoughts, making suicidal threats or gestures, or actually carrying out an attempt. On the other hand, self-harm comprises other efforts to harm yourself without suicidal intention. Common forms include burning and cutting.
Persistent feelings of emptiness
Persons with this illness frequently talk about feelings of emptiness, as if they have a void or hole inside them. At the extreme, they might feel as if they’re nothing. The feeling is uncomfortable, so they might try to fill the void with stuff like food or drugs but nothing feels actually satisfying.
If you have this mental illness, you might struggle with a short temper and intense anger. You might even have difficulty controlling yourself; you end up throwing things, yelling, or rage totally consumes you.
It’s important to keep in mind that the anger isn’t constantly directed externally. Instead, you might spend considerable time being annoyed at yourself.
Feeling distrustful or out of touch with reality
Persons with this mental illness frequently struggle with suspicious thoughts regarding others’ motives or paranoia. You might even lose touch with reality when stressed-an experience called dissociation. You might feel spaced out, foggy, or as though you’re outside your body.
Diagnosis of BPD
There isn’t a particular definitive test, for instance, a blood test that can accurately determine that you have the disorder. Persons who are concerned that they might be suffering from the illness might consider that likelihood by taking an online or printable self-test.
To establish the existence of this illness, practitioners perform a mental health interview that looks for the existence of the symptoms or diagnostic criteria. Like any mental health evaluation, the practitioner will typically work toward excluding other mental illnesses, including depression, mood issues, anxiety disorders, eating disorders, and other personality disorders.
Besides establishing if you suffer from BPD, the medical professional might determine that while some of the disorder’s symptoms are present, you don’t qualify fully for the condition. The professional will also try to ensure you aren’t suffering from a health problem that might produce emotional symptoms.
For this reason, the medical practitioner will frequently inquire about when you had a recent physical examination, blood testing, and other tests that a medical expert considers necessary to ensure you’re not suffering from a health condition rather than or in addition to emotional signs.
Since this disorder can be rather treatment resistant, it’s very important that the practitioner perform a comprehensive assessment and interview family members when suitable with the patient’s consent. This will ensure that you don’t obtain an incorrect diagnosis.
What is the Best Treatment for BPD?
Historically, the disorder has been perceived as hard to treat. However, newer, evidence-based treatment has led many to experience less or fewer symptoms as well as an enhanced quality of life. It’s also important that you obtain specialized treatment from a suitably trained provider.
Other kinds of treatment or treatment offered by a therapist or doctor who isn’t suitably trained, might not benefit the individual. Remember, numerous factors influence the duration it takes for symptom alleviation once treatment starts. Therefore, it’s important that persons with the illness and their loved ones exercise patience and obtain suitable support throughout treatment.
It’s important that you don’t diagnose the disorder on your own. Instead, seek professional help if you or a loved one is suffering from the illness. Beware that the disorder frequently overlaps with or is confused with other conditions. Therefore, you require a mental health expert to assess you and make a precise diagnosis.
Finding a Suitable Therapist For BPD
The guidance and support of a skilled therapist could make a big difference in BPD recovery and treatment. Therapy can potentially be a safe space where you can begin working through your trust issues, relationship, and try new coping methods.
A qualified expert will also be familiar with associated therapies, for instance, schema-focused and dialectical behavior therapy (DBT). It’s imperative you take the time to locate a therapist you’re safe with; it should be somebody who understands you and makes you feel accepted.
Once you locate the right person, commit to the treatment plan. You might start out believing the therapist will save you only to end up disappointed and feeling that he or she can’t help you.
Remember, the erratic swings are symptoms of BPD. Try sticking with the therapist and permit the relationship to grow and keep in mind that change is naturally uncomfortable.
This is the first treatment line for persons with BPD. A therapist can offer one-on-one treatment or it can take place in a group setting. Therapist-led sessions may help teach you how to interrelate with others and how to express yourself effectively.
It’s also important you cope with and trust your therapist. Unfortunately, the nature of this illness can make it hard for sufferers to maintain a trusting and comfortable bond with their therapist. The kinds of psychotherapies that treat this illness include:
Dialectical Behavior Therapy
This kind of therapy was designed purposely for persons with BPD. It adopts concepts of acceptance and mindfulness or being attentive and aware of the emotional state and current situation. This approach also teaches skills that help:
- Control extreme emotions
- Decrease self-destructive behaviors
- Enhance relationships
This form of cognitive behavior therapy works with the thought that unmet childhood needs can result in unhealthy ways of thinking about your world. It focuses on tackling the maladaptive behaviors and beliefs and emphasizes on healthy ways of coping and thinking.
Cognitive Behavioral Therapy
This kind of therapy can help sufferers alter core behaviors and beliefs that underlie imprecise views of themselves and others, and issues interrelating with others. It may also help decrease a range of anxiety and mood symptoms and the number of self-harming and suicidal behaviors.
Mentalization Based Therapy
Researchers have studied this therapy to some degree for sufferers. It may help with depression and anxiety along with social functioning. The therapy concentrates on helping you recognize mental states-your feelings and thoughts along with the feelings and thoughts of others. Through recognition, you’ll be able to establish how the thoughts contribute to your behavior or that of others.
The therapy adopts the notion of transference-transferring emotions from one individual to another, which is a major notion in psychodynamic therapies. This approach uses the relationship between the therapist and client, allowing the therapist to see how you relate to others. In turn, the therapist can use the awareness to help you respond more efficiently in other relationships.
Interpersonal Psychotherapy Therapy (IPT) and Psychoanalytic Therapy
IPT is a treatment approach that addresses how your symptoms are associated with the problems you have in interacting with others. On the other hand, psychoanalytic therapy seeks to help you understand and better manage your ways of guarding against negative emotions.
What Medications can be taken for BPD?
Although the FDA hasn’t approved any drugs specifically for treating BPD, certain medications might help with symptoms or co-occurring issues such as impulsiveness, depression, anxiety, or aggression.
Since anxiety and depression can be a huge part of the disorder, anti-anxiety and anti-depressant medications can be beneficial. In the event that you experience periods of distorted thinking, your practitioner may recommend an anti-psychotic medication. Some of the commonly prescribed BP medications include:
While these may be helpful with feelings such as sadness, they don’t seem to be useful for symptoms such as anger.
Anxiety can occur with BPD, making some of these medicines beneficial though some of them are potentially addictive
These were some of the first medications for treating BPD and may be especially beneficial for some of the more difficult symptoms such as impulsivity, anger, and paranoid thinking.
- Mood stabilizers
These may help with impulsive thinking, which is common among sufferers.
BPD is associated with extreme emotional experiences. Consequently, persons with the disorder may require intensive treatment. At times, persons with the illness undergo admission into a psychiatric facility for inpatient treatment, which requires overnight stay in the hospital.
Another treatment choice is partial hospitalization. These programs are more intensive than conventional outpatient psychotherapy but don’t require an overnight stay. This program is suitable if you’re headed for a crisis or have been discharged from an inpatient facility. It’s also suitable if you require more intense treatment to ensure the crisis doesn’t reemerge.
Self-help strategies are an important part of any treatment plan. Of course, you should use these to supplement care from a competent therapist and not on your own. An ideal plan involves learning as much as possible as you can about BPD by learning coping skills and finding ways of helping you manage and express your emotions.
You can also access important self-help resources for BPD that can work in conjunction with more conventional treatment forms. You can also use online resources and books that provide information and recommend ways of coping with the symptoms.
Which Complications can arise from BPD?
The existence of this disorder frequently exacerbates the course of another co-occurring mental disorder. For instance, it usually changes the symptoms of PTSD and worsens depression. Persons with this illness exhibit the risk of self-destructive behaviors such as self-mutilation, completing or attempting suicide.
Although most persons with a mental illness don’t engage in violent behavior, BPD sufferers somewhat have an increased likelihood of such behaviors. BPD complications also frequently involve families of the sufferer of the disorder. For instance, a parent with this illness is susceptible to having children with depressive symptoms.
What is the Prognosis for BPD?
When it comes to any personal disorder, improvement isn’t similar to a cure. That is, while some BPD symptoms diminish over time, some frequently remain. Consequently, full recovery can be hard to attain.
How well or poorly persons with the disorder progress over time appears to depend on the severity of the disorder at the start of treatment, the state of the person’s existing personal relationships, whether the person has a history of child abuse, whether the person obtains appropriate treatment, and the duration it takes for that to take place.
Simultaneously, depression or other emotional issues are associated with a higher likelihood of relapse. Conversely, having a steady job or school standing once symptoms subside can protect sufferers against a relapse.
Persons with this mental illness also face a higher likelihood of long-term substance abuse. Other complications related to this disorder include social isolation, unemployment, legal problems, and reckless driving.
The Measures to Take in an Emergency
If you or a loved one is having a mental emergency, it’s crucial you obtain immediate help. Contact 911 or visit the nearest ER room. If there’s proof that you are a danger to others or yourself, admission might be necessary for a short hospital stay on an inpatient psychiatric facility until the crisis passes.
It’s advisable that anybody living with this disorder put together a BPD safety plan. The plan will inform you how you’ll address your feelings before they turn into an emergency.
While BPD can be hard to acknowledge, treat, and diagnose, there’s hope if you’re living with the disorder.