What are the other Names for this Condition? (Also known as/Synonyms)

• Ambulatory Personality Disorder
• Pseudoneurotic Schizophrenia
• Psychotic Character Disorder

What is Borderline Personality Disorder? (Definition/Background Information)

• Borderline Personality Disorder (BPD) describes the personality of an individual who stands on the border of mild mental, emotional, and psychotic disorder (disconnection from reality)
• It is a complex and severe mental illness that generally gets misdiagnosed with other mental illnesses such as bipolar disorder, major depressive disorder, or anxiety disorder. It is one of the widely studied personality disorders
• The condition is characterized by mood swings, impulsivity, odd and destructive behavior that include self-harm, low self-esteem, unstable relationships, instability, and feelings of emptiness
• The disorder usually begins during the teen years or early adulthood, but occasionally some symptoms are observed during childhood too
• Individuals with Borderline Personality Disorder often think about committing suicide. Around 80% of those with BPD often have thoughts of suicide. Around10% with BPD may attempt suicide
• First degree relatives of individuals with BPD have an increased risk for depression, alcohol abuse, and drug abuse. There may be additional associated conditions such as PTSD (post-traumatic stress disorder), eating disorder, depression, anxiety disorder, bipolar affective disorder, and alcohol/drug abuse disorders
• Mental health professionals find it difficult to treat individuals with Borderline Personality Disorder, because it is a poorly understood disorder. The current treatment options include psychiatric medication, psychotherapy, and if required, short-term inpatient psychiatric hospitalization

Who gets Borderline Personality Disorder? (Age and Sex Distribution)

• Around 1-2% of adult populations are thought to suffer from Borderline Personality Disorder
• The onset of the disorder may be during teenage or young adult stage; in some rare cases, children may also be affected
• There is a gender predilection; females are typically affected more than males
• 1 in 20-25 individuals may live with this condition and it may take many years for it to be diagnosed

What are the Risk Factors for Borderline Personality Disorder? (Predisposing Factors)

Following are the risk factors for Borderline Personality Disorder:

• The condition is twice as common in women as men
• Unstable family relationships
• First degree relative with Borderline Personality Disorder; a positive family history of the condition is a risk factor
• Those with stressful childhood or having experienced early childhood trauma such as sexual, emotional, or physical abuse, neglected and/or separated from parents/caregivers, etc. are at higher risk to develop BPD
• Personalities with anger issues, aggression, and impulsivity are at increased risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Borderline Personality Disorder? (Etiology)

 Two factors have a prominent role in causing Borderline Personality Disorder. They include:

• Environmental factors and
• Biological factors

Environmental factors:

• Early experiences in life such as unempathetic parental care or neglected/separated from parents or caregivers
• Traumatic life experiences during childhood or early stages of adulthood that includes physical, emotional, and sexual abuse
• Poor lifestyle choices
• Unstable family relationships

Biological factors:

• No specific genes have been identified or connected to Borderline Personality Disorder, but research has found many genes responsible for the development of BPD
• BPD has hereditary links and it is strongly inherited
• Genes that maintain emotions, temperament, and impulsivity are known to be associated with BPD
• Studies have shown that the mental illness is more commonly seen in 1st degree relatives affected by BPD
• Brain abnormalities have been associated with Borderline Personality Disorder. Studies, research, and MRI testing have shown some changes in the area of brain that handle emotions and judgment
• A genetic connection has been established between BPD and other mental disorders such as bipolar disorder, depression, ADHD, and schizophrenia
• Brain neurotransmitters or chemicals, such as serotonin that regulate mood, may not be functioning properly. Hormones, such as oxytocin, have also been shown to play a role in the development of the disorder

What are the Signs and Symptoms of Borderline Personality Disorder?

Individuals with the Borderline Personality Disorder may present the following signs and symptoms:

• Display mood swings with periods of intense depressed mood, irritability, or anxiety lasting from a few hours to a few days
• They may show highly unpredictable behavior, such as being argumentative at one moment and depressed the next moment
• Always appear to be in a state of crisis
• Have prolonged feelings of emptiness and boredom
• Suffer identity crisis, self-doubt, and low self-esteem
• Have rocky interpersonal relationships and demand extraordinary relationships from their loved ones
• They seem to be dependent on those who are close to them and always fear being alone or lonely
• May resort to unethical efforts to avoid abandonment
• Are Impulsive and aggressive when frustrated
• They blame others for life crises, which are more commonly used defense mechanisms
• Show stress related paranoid behavior
• Hold a perspective that things are either being ‘all good’ or ‘all bad’
• They worry about the negative effects of past unpleasant experiences and future negative possibilities
• They frequently change careers, relationships, life goals, or residences
• Indulge in repetitive self-destructive behavior, such as suicidal thinking or suicidal threats or manipulative suicide attempts, self-harming, to elicit help from others or to express anger, or even to relieve stress

How is Borderline Personality Disorder Diagnosed?

A majority of Borderline Personality Disorder cases are often underdiagnosed or misdiagnosed. There is no single diagnostic test that is specific to BPD; also, the diagnosis is not based on one sign or symptom.

• Mental health professionals, such as psychiatrists, psychologists, social workers, and psychiatric nurses, working together as a team, can help diagnose BPD following a comprehensive psychiatric interview and through medical exam.  They can help rule out possible causes of the symptoms
• Diabetes, high blood pressure, fibromyalgia, chronic back pain, and arthritis are often seen along with BPD
• Individuals with BPD are more likely to have other comorbid disorders such as major depressive disorders, anxiety disorders, substance abuse, or PTSD

To be diagnosed with Borderline Personality Disorder, individuals must have 5 of the 9 BPD symptoms listed below: (DSM V Criteria)

• Fear of abandonment resulting in frantic effort to avoid abandonment
• Pattern of unstable and intense relationship
• Uncertainty about self-image or has identity disturbance
• Impulsive behavior that are self-damaging
• Self-injurious behavior or suicidal behavior and threats
• Are emotionally instable or hyperactive
• Have feelings of emptiness or boredom
• Display difficulty in controlling anger or exhibit frequent displays of temper
• Prone to transient suspiciousness or stress-related paranoid ideation

It is important to know that every human can exhibit some of these personality traits. To meet the diagnostic criteria for Borderline Personality Disorder, these traits must be inflexible. Additionally, these traits must cause functional impairment and distress in society. These symptoms may cause problems in interpersonal relationships at work, school, or home.

Many clinical conditions may have similar signs and symptoms. Your mental health care provider may perform additional tests to rule out other psychiatric conditions to arrive at a definitive diagnosis

What are the possible Complications of Borderline Personality Disorder?

Borderline Personality Disorders can lead to the following complications:

• Impulsivity and poor judgment in making lifestyle choices that affect social, marital, and occupational field
• There is a higher chance of ending up as victim of violence (including rape or other crime)
• Engagement in dangerous, risky behavior such as unsafe sex leading to STD, binge eating, overspending, and alcohol or drug abuse
• There is a higher incidence of developing comorbid conditions such as major depressive disorder
• BPDs are more common in patients with conversion disorder (condition in which one experiences psychological stress in physical symptoms)
• Certain serious complications include self-injurious behavior: One who has BPD has a higher incidence of suicide attempts (nearly 1-10% of the individuals with BPD attempt suicide)
• Relatives and family members may become overwhelmed, depressed, and worry about their loved one’s safety

How is Borderline Personality Disorder Treated?

Individuals with Borderline Personality Disorders are often treated with a combination of psychotherapy, medications, and short term hospitalization (if necessary).

• Psychotherapy/talk therapy has been the treatment of choice to approach those with BPD. Various type of psychotherapies include dialectal behavioral therapy (DBT), cognitive behavioral therapy (CBT), metallization based therapy (MBT), transference- focused psychotherapy, cognitive analytic therapy (CAT), schema- focused therapy, individual psychotherapy, family, marital, and group therapy
• The medications used may include mood stabilizers, antipsychotics, anti-anxiety drugs, antidepressants, and other medications
• Short-term inpatient psychiatric hospitalization: If medication and therapy is ineffective then hospitalization can provide a place to deal with acute stress. This can also help provide a safe environment for those with self-harming or suicidal thoughts

How can Borderline Personality Disorder be Prevented?

Currently, there is no method to prevent an individual from developing Borderline Personality Disorder. However, the following factors may be considered:

• Psychotherapy and medications can reduce the signs and symptoms of BPD
• Lifestyle modifications may include encouraging a healthy childhood upbringing and providing safe environment and support for children and young adults
• Take good care by eating right and exercising regularly
• Families need to provide support to individuals with BPD and also encourage them to engage in correct treatment measures

What is the Prognosis of Borderline Personality Disorder? (Outcomes/Resolutions)

• Borderline Personality Disorder can be a life-long condition but, those with the disorder can get better
• With treatment options, individuals can experience significant symptom remission levels during their lifetime and will learn healthy coping skills
• With no treatment, those with BPD have a higher susceptibility to major depressive disorder
• A complete recovery is slow and rarely achieved; but with proper treatment availability, individuals with BPD may lead a good and healthy life

Additional and Relevant Useful Information for Borderline Personality Disorder:

Individuals with Borderline Personality Disorder can look for online emotional support groups and also try to connect with those who are suffering similarly, through social sites or chat rooms. Through such support groups, one can share their thoughts and support each other emotionally too.