Borderline Personality Disorder: What is it?

Borderline personality disorder is a serious mental illness that is characterized by an enduring pattern of changing moods, self-image, and behavior. The distinguishing characteristics include unstable relationships, impulsive behaviors, and self-image issues. BPD can be trying for the patient and the family, but it can be treated with the right intervention if started on time. As a psychiatrist for depression patients, I find that some patients have accompanying depression alongside BPD: hence, there is a need to understand its symptoms to seek treatment early.

What is Borderline Personality Disorder?

Borderline personality disorder represents a serious mental illness normally beginning in late adolescence or early adulthood. It affects people's feelings about themselves as well as their feelings about others; as such, it brings mood swings, terror at being abandoned, and impulsive actions. Typically, huge episodes of anger, anxiety, or depression are characteristic of BPD, and they may be sustained for only several hours or even for several days. Such emotional shifts can severely impair a person's ability to maintain relationships and function effectively in daily life.

Symptoms of BPD may include one or more of the following features:

Emotional ability: They cannot maintain a stable and even mood; they can change from elated to desperate in a matter of seconds with no apparent provocation.

Unstable relationship. They are also unable to form stable, nurturing relationships due to a pathological fear of abandonment or rejection.

Impulsivity: He or she engages in activities that could pose danger or cause harm to people around them, such as speeding, substance abuse, or self-mutilation.

Fear of abandonment: That is, a heightened fear of abandonment. The patient would be in a way desperate in his or her endeavors to avoid real or imaginary abandonment.

Distorted self-image: In other words, unstable sense of identity with rapid changes in goals, values, or identity.

The disorder is not very well understood or recognized; however, if given appropriate professional treatment by a psychiatrist for depression or other mental health professionals, patients with the diagnosis of BPD can live meaningful and stable lives.

Signs that Call for Borderline Personality Disorder Treatment

Borderline Personality Disorder symptoms can only be faced appropriately with treatment. If you or someone you know displays some or all the following symptoms, then it's high time to seek help from a mental health professional:

1. Extreme Fear of Abandonment

Fear of Abandonment- This is the most characteristic symptom of BPD. It may also be manifest in extreme reactions to what may be, or at least are perceived as, abandonment or rejection signals. For example, a partner with BPD may become panicked, irritated, or even angry with his partner if the latter is late, fails to show up as scheduled, cancels plans, and so on. Such fear can make them clingy or controlling, which may seriously interfere with relationships.

2. Unstable Relationships

People with BPD generally have difficulties in staying together and stable for long periods of time. Their relationships usually become too intense and are very short in their period. Idealization patterns may thus quickly shift into devaluation patterns. This pattern of extremes makes family, friendship, and romantic relationships so turbulent.

3. Impulsivity

Impulsivity is one of the key features of BPD. People can start dangerous activities without thinking about the consequences. Such activities can be bingeing, excessive spending, reckless driving, substance abuse, or unsafe sexual practice. Such behaviors may deliver temporary relief from pain but bring regret or guilt later.

4. Self-Harming or Suicidal Behavior

A very common behavior in the case of BPD is self-harm through cutting or burning. This often acts as a form of coping with emotional pain. Suicidal ideation and even attempts are also very common, so these symptoms need to be sought help at once.

5. Persistent Emptiness

Most patients with BPD complain of emptiness inside as if lives lacked something and an identity. This chronic emptiness drives patients to be into a frenzied quest for meaning, or in order to fulfill something in life usually by impulsive behaviors or changing personal goals and values.

6. Extreme Mood Swings

BPD has highly extreme mood changes that may take hours up to days to occur. One might experience the typical temperament swings of happiness, anger, shame, or anxiety. As opposed to bipolar disorder, mood shifts persist for weeks or even months, the mood swings tend to be shorter in length and more reaction-based than bipolar disorder.

How Therapy for BPD Works

Borderline Personality Disorder is treatable; most affected individuals can improve significantly with the right treatment. In my practice as an attending psychiatrist for depression, many of my patients present with co-occurring depression and BPD, which I treat through a comprehensive amalgamation of therapeutic approaches and medications.

1. Dialectical Behavior Therapy

The most effective treatment for BPD is Dialectical Behavior Therapy, DBT. It is, essentially, a form of Cognitive Behavioral Therapy specific to those suffering from BPD. It imparts patients with skills that can functionally regulate their behavior so that they could effectively manage their emotions, develop better relations with others, and reduce self-destructive behavior.

DBT focuses on four areas:

Mindfulness: Patients are taught to remain in the here and now while paying attention to their emotions without being overtaken by the latter.

Distress tolerance: Develop coping skills to tolerate emotional crises without the person acting in detrimental ways.

Emotional regulation: Understand and practice ways to identify and regulate high emotion.

Interpersonal effectiveness: Learn how to build a healthy relationship through communication and assertiveness.

DBT is a treatment of long duration. Typically, it includes individual therapy, group therapy, and skills training. With regular attendance, most BPD patients could develop healthier ways of coping with their lives and the quality of lives improves.

2. Medication Management

No medicine is there for BPD, but some medications can be used to treat the symptoms of anxiety, depression, and mood swings in BPD patients. Different groups of medications, such as antidepressants, mood stabilizers, and antipsychotic drugs, are usually used for medication treatment for controlling emotions and diminishing impulsive behavior. The psychiatrist like me treating depression mostly uses both medicine and therapy.

3. Cognitive Behavioral Therapy (CBT)

Apart from DBT, other therapies such as CBT can help BPD patients face negative thinking patterns and behavior. CBT is founded on identification of dangerous thought patterns and replacing these with the healthiest and more adaptive ways of thinking.

4. Family Therapy

Family therapy will generally be of benefit to patients having BPD in that it helps loved ones deal with the disorder and learn how to provide suitable support. It plays an important role in enhancing family communication patterns and reducing conflict.

Borderline Personality Disorder is one of those conditions diagnosed in patients that makes treatment hard. On the other hand, it is treatable, just like depression, where one should first seek psychiatric help for depression. The right amount of therapy and medication with support can lead someone living with BPD to have an enjoyable and stable life.

So if you or someone close to you is showing the symptoms of Borderline Personality Disorder, do not wait for a moment to seek some professional help. Early intervention can be considered as the determinant between control and lack of control over the condition and overall mental health.