Most of us feel comfortable within our own skin. We have a natural tendency to reject notions that challenge the way we think. Many of us exhibit rash and unjustified behaviour at occasions but certain individuals have a tendency to let their personalities stagger along the borders of impulsiveness and aggression.

For the person suffering with borderline personality disorder, these characteristics can be the norm. Impulsiveness, agresssion, rigid black and white thoughts and feelings (e.g. all good or all bad), enduring feelings of emptiness, deep suicidal depressions and sometimes self-harming behaviours can all indicate the possibility of a borderline personality style.

It can be one of the most challenging tasks for a psychiatrist to diagnose somebody with a borderline personality disorder (BPD). Therefore it becomes imperative to thoroughly question and examine the sufferer’s behaviour to establish a confirmed diagnosis. Previous misconceptions about BPD being associated with neurosis, psychosis or schizophrenia need to be shunned before a familiarity with this disorder is established.

Understanding personality disorder

Personality disorders are a life-long mental illness which includes a specific diagnostic category of psychiatric disorders characterised by a chronic, rigid and maladaptive pattern of relating to the worldly affairs. This may evidently exhibit in the way the individual thinks, feels and responds and is most noticeable in the negative direction they tend to steer their personal relationships in.

To be diagnosed with a personality disorder, should not be viewed as possessing a flawed personality or being socially disabling. In fact 10% of adults around the world currently suffer from this condition which may prove painful to the sufferer who is ignorant about his illness.

What is borderline personality disorder?

Borderline personality disorder is a type of a chronic mental illness that is exhibited as patterns of turbulent and unstable emotions within the individual regarding himself or towards others. The main highlights of this disorder are a pervasive pattern of chaos in personal relationships, impulsive behaviour, labile mood and instability in the individual’s self-image. The person has generally passed into early adulthood by the time the complete spectrum of symptoms is established and diagnosed. The person suffers from a characteristic lability in the person’s feelings in a variety of settings e.g. home or workplace.

What causes BPD?

This disorder seems to be more prevalent amongst females (2-3% more common than men) especially those in an institutionalized setting. It is hypothesised to have a genetic component and has been observed to share an intimate relationship with social and family factors.

According to the biopsychosocial model, it is considered to be interplay of biological vulnerability, thinking patterns and social stressors. Recent research has even shown a change in the size of the hippocampus, amygdala and frontal lobes amongst the sufferers, displaying the role of these parts governing the emotional instability. Despite all this, a precise underlying cause is still unknown, although a variety of risk factors are considered to reinforce this condition:

·       Abandonment problems during childhood or adolescence.

·       Disturbed family life.

·       Lack of healthy communication within the family.

·       Neglectful parenting.

·       Sexual abuse.

·       Hormonal influences like premenstrual tension.

·       Adolescents with alcohol abuse.

·       Children dealing with their learning problems.

Signs and symptoms

People with BPD have a pattern of rather obvious impulsive and unstable behaviour. According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV), in order to be diagnosed with this condition the person must present with at least five out of the following symptoms:

1. Unstable self-image: they may exhibit a drastic and rapid change in their likes, dislikes, strengths, weaknesses and goals in life.
2.  Unstable interpersonal relationships: These individuals may display a rapid and drastic shift from viewing a certain person as ideal to devalued and useless.
3. Unstable Affect (outward display of emotions): The sufferer may exhibit marked and drastic changes in emotions ranging from euphoria, ecstasy, joy, anger, anxiety, depression or panic. These are generally in response to stressors that are viewed as minor by others.
4. Desperate efforts to avoid abandonment: whether in reality or imagined.
5. Impulsive conduct: The sufferer tends to perform drastic acts without thinking that may inflict self harm, for instance, sexual behaviour, spending, eating or driving habits or substance abuse.
6. Recurrent suicidal or self harming thoughts, threats or behaviour.
7. Long-term feelings of emptiness
8. Inappropriate and intense anger and difficulty managing it.
9. Transient or stress related paranoia or disassociation.

Treating BPD

This disorder like many other psychiatric problems can be successfully treated in its entirety with rigorous and dedicated psychotherapy performed by a reputed therapist. For those exhibiting even more severe symptoms solace can be provided by prescribed anti-depressants, but they only address selective aspects of the illness. The approaches recommended by therapists are:

1. Dialectical behavioural therapy: is one of the popular approaches for treatment and seeks to tackle four arenas that mat prove problematic in BPD. These are tarnished self-image, impulsive reactions, labile mood and problems in dealing with others. While dealing with these four issues, four major behavioural skills need to be worked upon namely mindfulness, distress tolerance, regulating emotions and interpersonal efficiency.
2. Cognitive behavioural therapy: Some other forms of therapies have also been successfully implemented during treatment strategies. Of these, the most notable one being talk therapy which uses cognitive behavioural therapy (CBT) to help manage BPD by understanding their thoughts and behaviours.
3. Interpersonal therapy:  This aims at understanding how the individual’s symptoms have a relationship to how he interacts with others.
4. Psychoanalytical therapy:  This therapy targets to teach the individual healthy ways of coping with their negative emotions. It is more successful is the therapist deals with current relationships rather than focusing solely with those in the past.
5. Medications: Anti-depressants like fluoxetine, sertraline, citalopram, escitalopram can be used if your doctor or psychiatrist recommends an additional treatment to alleviate certain symptoms. However in certain individuals, suicidal tendencies have been reported after this treatment hence it is essential to monitor the person’s thoughts and ideas when opting for this therapy.

The most troubling aspect of borderline personality disorder lies in the fact that the patient is unaware that his behaviour defies social and emotional norms. Broken relationships and lost opportunities at the hands of a certain impulsive or uncontrollable behaviour may leave him scarred for a long period while battling with this mental illness. Hence counselling loved ones should be a part of the therapy to enable undesired losses and emotional support during recovery.

If you or someone you know may be suffering from borderline personality disorder, Australia Counselling can link you with registered counsellors, psychologists and therapists who work with this condition in Sydney, Melbourne, Adelaide, Perth, Brisbane and country areas of Australia. Visit our Borderline Personality Disorder page to see therapists, psychologists and counsellors that work with this issue.

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