Borderline Personality Disorder: Diagnoses, Causes, Symptoms and Treatment

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental disorder that affects about 1.6% of adults in the United States and 20% of the psychiatric inpatient population (1). It is a mental health condition that affects how one thinks feels, and acts. It often leads to difficulties in effectively regulating emotions. This means those with BPD can have trouble feeling and expressing emotions, controlling their feelings, and knowing when it's appropriate to be emotional. People with BPD also have trouble maintaining relationships and staying on track with their goals.

Symptoms of Borderline Personality Disorder (BPD)

The symptoms of borderline personality disorder can vary from person to person, but common symptoms include (2):

1. Impulsive behavior like excessive spending or unsafe sex, binge eating, and substance abuse.

2. Difficulty controlling anger, especially when something bad happens.

3. Unstable relationships with family members or friends.

4. Fear of Abandonment. Desperate and frantic attempts to prevent actual or perceived abandonment by their loved ones.

5. Self-destructive behaviors, such as suicide attempts, thoughts of suicide, or engaging in self-harm, are commonly associated with Borderline Personality Disorder (BPD).

6. Identity Instability. An unstable sense of self and identity characterizes BPD. People with BPD have a vague or inconsistent understanding of who they are, their values, and their goals in life.

7. Chronic Feelings of Emptiness.  Those with BPD frequently experience a deep and persistent sense of emptiness and may feel a profound inner void or a lack of meaning and purpose.

8. Emotional Dysregulation. Rapid shifting of emotions like extreme sadness, anger, or anxiety, and having difficulty managing and regulating these emotions.

9. Temporary, stress-related paranoid ideation or severe dissociative symptoms.

How Is BPD Diagnosed?

An evaluation is conducted by a mental health professional, such as a psychiatrist or psychologist in diagnosing BPD. The diagnostic process involves a comprehensive assessment that includes several steps. Here is an overview of how BPD is diagnosed:

• Initial Evaluation. The process usually begins with an initial evaluation, where the mental health professional gathers information about the individual's symptoms, medical history, and family history.

• Diagnostic Criteria. The mental health professional will refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. BPD diagnosis requires the presence of specific criteria outlined in the DSM-5, including a pattern of unstable relationships, intense emotions, impulsivity, and identity disturbance, among others.

• Self-Report Measures. Self-reporting measures may be used to gain additional insight into the individual's experiences and symptoms. The individual completes questionnaires or assessments to provide more detailed information about their thoughts, feelings, and behaviors.

• Clinical Interviews.  In-depth clinical interviews are conducted to explore the individual's symptoms, emotions, relationships, and life experiences in more detail. The mental health professional may ask about specific BPD symptoms, such as fear of abandonment, self-harming behaviors, and identity struggles, to assess their presence and severity.

• Differential Diagnosis.  The mental health professional will also consider other possible diagnoses that share similarities with BPD, such as other personality disorders, mood disorders, or post-traumatic stress disorder (PTSD). They will carefully evaluate the symptoms and rule out other potential causes to ensure an accurate diagnosis.

• Duration and Patterns. BPD diagnosis typically requires the presence of symptoms for a sustained period, usually at least one year. The mental health professional will assess whether the symptoms are persistent and pervasive rather than episodic or isolated.

What are the Causes of Borderline Personality Disorder

The cause of BPD is not fully understood, but experts believe a combination of genetic, biological, and environmental factors may cause it. It affects all genders equally and typically begins in early adulthood. Here are some potential causes and contributing factors associated with BPD:

• Genetic Factors. Research suggests that Borderline Personality Disorder (BPD) may have a genetic component, as individuals with a family history of the disorder have an increased risk of developing it. (3)

• Brain abnormalities in brain structure and function have been observed in individuals with BPD. Dysregulation of neurotransmitters, including serotonin and dopamine, which have been linked to depression, aggression, and difficulty controlling destructive urges, may also play a role in the development of BPD. (4)

• Environmental Factors. Adverse childhood experiences, including trauma, abuse (physical, sexual, or emotional), neglect, or early loss or separation from caregivers, are commonly associated with the development of BPD. These experiences can significantly impact emotional development, attachment patterns, and the development of coping strategies (4).

It's important to note that while these factors may contribute to the development of BPD, not everyone with these factors will develop the disorder. The interaction between genetic predisposition, biological factors, and environmental influences is complex and varies from person to person.

It's also worth mentioning that the causes of BPD are still being studied, and further research is needed to gain a deeper understanding of the underlying mechanisms.

Treatment

Treatment for Borderline Personality Disorder (BPD) typically involves a combination of psychotherapy, medication (in some cases), and supportive interventions. Here are some standard treatment options for BPD (5):

Psychotherapy:

Dialectical Behavior Therapy (DBT). DBT is the most well-known and evidence-based therapy for BPD. It focuses on developing skills for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. This may include individual therapy, participation in skills training groups, phone coaching for additional support, and collaboration with therapist consultation teams.

Cognitive Behavioral Therapy (CBT). CBT helps individuals identify and change negative patterns of thinking and behavior. It can help manage distressing emotions, improve problem-solving skills, and challenge self-defeating beliefs.

Mentalization-Based Therapy (MBT). MBT is a type of talk therapy that focuses on enhancing the individual's ability to understand their thoughts and feelings and those of others. It aims to improve mentalizing, which is the capacity to interpret and understand human behavior in terms of underlying mental states.

Schema-Focused Therapy. This therapy addresses deeply ingrained patterns of thinking, feeling, and behavior (schemas) that contribute to BPD symptoms. It helps individuals identify and modify maladaptive schemas and develop healthier coping strategies.

Medication

Medications may target symptoms of BPD, such as mood instability, depression, anxiety, or impulsivity. Commonly prescribed medications include antidepressants, mood stabilizers, antipsychotics, and anti-anxiety medications. A qualified psychiatrist or healthcare provider can conduct medication management if desired.

Group therapy or support groups

Group settings allow individuals to connect with others who have similar experiences, share insights, and learn from one another. Group therapy can provide community and support while developing interpersonal skills.

How to Help Someone with BPD?

It can be hard to know how to help someone with borderline personality disorder. If a loved one has been diagnosed with BPD, you may have many questions about how to interact with them and how they can be helped. Here are some ways in which you can help them (6):

1. Learn about BPD. Education about BPD helps individuals and their loved ones better understand the disorder, its symptoms, and treatment options

1. Set Clear Boundaries. Establish and maintain healthy boundaries in your relationship with the person to maintain a sense of stability.

2. Don’t judge them for their behavior.

3. Be a good listener when they talk about their feelings.

4. Remind them of their positive qualities and traits.

5. Be patient. Avoid getting involved in an argument because a person with BPD  finds it challenging to deal with their emotions.

6. Seek treatment and support. Join a support group or seek guidance from a therapist.

7. Practice self-care. Supporting someone with BPD can be emotionally demanding.

8. Be consistent and reliable. Being consistent and reliable in your interactions can help build trust and provide a sense of security.

Supporting a loved one with Borderline Personality Disorder (BPD) requires patience, empathy, and a willingness to expand your understanding. While it can be challenging, your support can make a significant difference in their journey toward managing their symptoms and improving their quality of life. It is a journey that requires ongoing understanding, flexibility, and compassion. By understanding and implementing the suggestions outlined in this article, you can create a nurturing environment that promotes healing, growth, and a stronger bond with your loved one. Together, you can navigate the challenges of BPD and work towards a brighter future.

 Resources:

1. Borderline Personality Disorder - StatPearls - NCBI Bookshelf. Ncbi. https://www.ncbi.nlm.nih.gov/books/NBK430883/

2. Borderline personality disorder | NAMI: National Alliance on Mental Illness. Nami. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder#:~:text=It's%20estimated%20that%201.4%25%20of,misdiagnosed%20with%20PTSD%20or%20depression.

3. Borderline personality disorder - Symptoms and causes - Mayo Clinic. Mayoclinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

4. Causes - Borderline personality disorder - NHS. Nhs. https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/causes/

5. Borderline personality disorder - Diagnosis and treatment - Mayo Clinic. Mayoclinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/diagnosis-treatment/drc-20370242

6. How to help someone with borderline personality disorder (BPD) - Mind. Mind. https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/for-friends-and-family/