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Borderline personality disorder

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What is borderline personality disorder?

The fourth edition of the Diagnostic and Statistical Manual, which is used to diagnose all mental disorders, describes borderline personality disorder as including at least five of the following:

  • Worry about abandonment and going to extremes to keep someone from leaving
  • Unstable, stormy relationships with major shifts in thinking about another person, such as believing someone is a loyal friend to believing the person is untrustworthy or hurtful
  • Unstable self-image, shifting from feeling confident about who you are to feeling like you are evil, or don't even exist
  • Self-damaging, impulsive behaviors, such as substance abuse, binge eating, reckless spending, or other behaviors that can lead to serious consequences
  • Frequent suicidal thoughts, threats, attempts, or self-hurting behaviors such as cutting
  • Rapidly changing, intense moods
  • Feelings of emptiness
  • Intense anger that may lead to physical fights or destruction of property
  • During times of stress, he or she may believe others are intentionally trying to make life difficult for them; at other times, they may feel like they are losing touch with reality

Another way to think about borderline personality disorder is that it is a disorder of emotional regulation. Those who suffer from this disorder experience very intense emotions and have difficulty regulating them. Some people have suggested that we call this disorder emotional intensity disorder (EID). This disorder is extremely painful for the persons who have it and for those who live with and care about them.

How common is borderline personality disorder?

Borderline personality disorder is estimated to affect 2 to 3 percent of the general population, but affects 11 percent of patients seen in outpatient clinics, and as many as 20 percent of hospitalized psychiatric patients. Those who suffer from borderline personality disorder are heavy users of mental health services because of frequent hospitalizations and emergency room visits due to suicidal thoughts and attempts. About 8 to 10 percent of people with this disorder die by suicide. The presence of this disorder complicates the treatment of other disorders such as major depression, bipolar (manic-depressive) disorder, eating disorders, and substance abuse.

What factors contribute to the development of borderline personality disorder?

As with other mental disorders, it is believed that borderline personality disorder may be the result of a combination of factors, including a biologic or genetic vulnerability that interacts with stressful events in the early family environment. There may be other family members who have borderline personality disorder, mood disorders such as major depression or bipolar disorder, or problems with substance abuse.

How is borderline personality disorder treated?

Medications may play a role in reducing the symptoms of depression, anxiety, irritability, and paranoid thoughts. Traditionally psychotherapy has been a very long-term process with uncertain results. Patients with borderline personality disorder and their therapist often become frustrated with the stress of maintaining a close working alliance long enough for the psychotherapy to work. Managed care programs have been reluctant to pay for services for this diagnosis. In the past few years, research studies have demonstrated the effectiveness of cognitive-behavorial therapies that teach emotion regulation skills and improved lifestyle behaviors to patients with this disorder. A combination of careful medication management and cognitive-behavioral therapy that includes emotion regulation skills training is viewed as a promising treatment which may allow the patient to see significant progress over a period of a few months. The value of education for family members and professional caregivers is being recognized.