Borderline Personality Disorder

What is BPD?

Borderline personality disorder (BPD) is a serious, long-lasting and complex mental health problem.

People with BPD have difficulty regulating or handling their emotions or controlling their impulses. They are highly sensitive to what is going on around them and can react with intense emotions to small changes in their environment.

How is BPD diagnosed?

A physician, a psychiatrist or a registered psychologist can make a formal diagnosis of BPD. The first step toward diagnosis is often with a family physician or the emergency department of a hospital. If there is enough reason to be concerned about someone’s mental health. the family physician can make a referral for further assessment.

What causes BPD?

As with other mental health disorders, our current understanding of BPD is that a person’s genetic inheritance, biology and environmental experiences all contribute to the development of BPD.

Signs and Symptoms

The types and severity of BPD symptoms may differ from person to person and symptoms can fluctuate overtime.

Criteria of Borderline Personality Disorder (DSM-V)

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  • Identity disturbance: markedly and persistently unstable self-image or sense of self.
  • 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, of self-mutilating behavior.
  • Affective instability due to a marked reactivity of mood (e.g.. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or difficulty controlling anger (e.g.. frequent displays of temper, constant anger, recurrent physical fights).
  • Transient, stress-related paranoid ideation or severe dissociative symptoms.
Treatment

Treatment for BPD will usually involve:

  • Education with discussions on what is known about BPD and its causes, what kinds of treatments are available, how to self-manage BPD and how to prevent relapse
  • Psychotherapy or counselling on an individual and group basis.
  • Evidence-based treatment with the most research data is Dialectical Behavioural Therapy
  • Prescribed medication for specific symptoms of BPD such as mood swings or anxiety.

“I want to feel something, anything other than nothing. I go from okay to suicidal in an instant and I don’t even know why.”

What to do if you think you may have BPD
  • Personality disorders are really difficult to deal with on your own, so if you’re worried about having a personality disorder it’s a good idea to visit your GP. It will make the process of diagnosing and managing the disorder much easier and quicker if you seek professional help.
  • Alongside a professional treatment plan, people with personality disorders also develop strategies to manage their symptoms in everyday life, including developing positive coping skills.
  • Attend the emergency room if you have thoughts of harming yourself or others
How to support a family member or friend with BPD
  • Validate their experience and listen without judgment
  • Educate yourself about BPD
  • Support their efforts to seek professional help
  • Do not ignore threats of harm and get in touch with emergency services
  • Remember to take care of yourself!

“I feel empty and lonely, sometimes like I don’t exist at all, and saying my name feels like a lie because I know there’s nothing inside. I play roles, try to be who I’m “supposed” to be, and I’m good at being anyone but me.”

THE GOOD NEWS: BPD IS VERY TREATABLE

With appropriate therapy most patients can recover and live a full productive life.

Dialectical Behavioural Therapy (DBT) is highly effective in treating BPD. DBT combines standard techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness.

DBT has also proven effective in the treatment of other mental health issues such as bipolar disorder and eating disorders. By providing an effective skills base for overall emotional stability, practicing DBT skills helps in regulating emotions; relating better with others and handling distress. See Family Connections for an evidence-based program developed to help families and friends with loved ones living with emotional dysregulation.

 

When we teach DBT skills to general populations, we help ensure that non-inherent life skills become more widely utilized. We believe this could result in fewer people exhibiting BPD traits, thus reducing the strain on medical resources. This could also help improve relationships within educational institutions, families and workplace through the creation of a more validating environment for everyone.

How Does the Future Look?

Research has shown that people can recover from BPD and that their recovery is often long-lasting. Everyone’s path to recovery is different, whether you are an individual with BPD or a family member or a friend. Recovery involves the development of new meaning and purpose in life as people grow beyond the impact of BPD. O’Grady and Skinner (2007) say it best: “Recovery has also been described as a process by which people recover their self-esteem, dreams, self-worth, empowerment, pride, dignity and meaning.”

Some of the above information was compiled from CAMH.ca. For more information visit CAMH.ca