Borderline Personality Disorder

Hannah is a 33 year old wife and mother. She experiences chronic frustration in her relationships. She is fed up with being depressed and feeling as if she has been on an “emotional roller coaster” since her teenage years. While she has been married for 9 years, the marriage has been very rocky at times. She vacillates between feeling intense love toward her husband and rage toward him. She struggles with mood swings in her marriage and close relationships. She has started feeling frustration toward her children, and specifically feels her “buttons are pushed” by her oldest child.  She has tried various therapists in the past, but had varying results. She still feels like she doesn’t have the ability to cope in a crisis and has a gnawing feeling of emptiness.

When she was growing up, she never felt her parents understood her. There were certainly some fun highlights (amusement parks, trips to grandparents house) during her childhood, but she remembers more moments in which she just cried and felt lonely. She feels as though her father chose to “do his own thing”. Hannah remembers her mother being frustrated with her and often throwing her hands in the air stating, “I don’t know what to do with you!” While Hannah reports having many friendships through the years, she has not had any lasting friendships. For several past relationships with friends and former boyfriends, she describes a pattern of intense closeness followed by a “crash and burn” disaster. Hannah just doesn’t feel understood by her family, boss,or friends. She has periods of being overwhelmed with her emotions and wants desperately to feel happy.

If you can relate to Hannah’s story, you many be experiencing symptoms of Borderline Personality Disorder (BPD).

The following is a checklist of BPD symptoms:

  • Extreme mood shifts and feeling uncertain of who I truly am
  • Rapidly changing interests and lack of clarity in what I really value
  • Fear of abandonment (feeling distressed if my spouse announces a sudden business trip, or my friend fails to show up for lunch)
  • Patterns of intense and unstable relationships with loved ones
  • Impulsive or reckless behaviors, such as spending sprees, unsafe sex, substance abuse, and binge eating
  • Recurring suicidal or self-harming thoughts/behaviors (for example, cutting)
  • Intense and highly changeable moods
  • Chronic feelings of emptiness
  • Periods of inappropriate, intense anger
  • Taking things personally or stress-related paranoid thoughts (e.g., “she must not like me anymore”)

If you or a loved one experiences any of the above signs, please call Genesis Counseling Center today at 757-827-7707.  Genesis Counseling Center therapists provide effective assessment and treatment for Borderline Personality Disorder (BPD) and BPD symptoms. There is hope!  Genesis provides Dialectical Behavior Therapy in both individual and group counseling settings. Research shows Dialectical Behavior Therapy is effective in treating BPD.

Definition

Borderline personality disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. These experiences often result in impulsive actions and unstable relationships. A person with BPD may experience intense episodes of anger, depression, and anxiety that may last from only a few hours to days. Some people with BPD also have high rates of co-occurring mental disorders, such as mood disorders, anxiety disorders, and eating disorders, along with substance abuse, self-harm, suicidal thinking and behaviors, and suicide. While mental health experts now generally agree that the label “borderline personality disorder” is very misleading, a more accurate term does not exist yet.

Signs and Symptoms

People with BPD may experience extreme mood swings and can display uncertainty about who they are. As a result, their interests and values can change rapidly.  Other symptoms include:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts
  • Having severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality

Seemingly ordinary events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.  Some of these signs and symptoms may be experienced by people with other mental health problems—and even by people without mental illness—and do not necessarily mean that they have BPD.  It is important that a qualified and licensed mental health professional conduct a thorough assessment to determine whether or not a diagnosis of BPD or other mental disorder is warranted, and to help guide treatment options when appropriate.

Tests and Diagnosis

Unfortunately, BPD is often under-diagnosed or misdiagnosed.  A licensed mental health professional experienced in diagnosing and treating mental disorders—such as a Psychologist, Licensed Professional Counselor (LPC), Licensed Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT)—can diagnose BPD based on a thorough interview and a comprehensive psychological assessment, which can help rule out other possible causes of symptoms.  The licensed mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illness. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish BPD from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

Research funded by NIMH is underway to look for ways to improve diagnosis of and treatments for BPD, and to understand the various components of BPD and other personality disorders such as impulsivity, relationship problems, and emotional instability.

Risk Factors

The causes of BPD are not yet clear, but research suggests that genetic, brain, environmental and social factors are likely to be involved.

  • Genetics: BPD is about five times more likely to occur if a person has a close family member (first-degree biological relatives) with the disorder.
  • Environmental and Social Factors: Many people with BPD report experiencing traumatic life events, such as abuse or abandonment during childhood. Others may have been exposed to unstable relationships and hostile conflicts. However, some people with BPD do not have a history of trauma. Many people with a history of traumatic life events do not have BPD.
  • Brain Factors: Studies show that people with BPD have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation. However, some people with similar changes in the brain do not have BPD. More research is needed to understand the relationship between brain structure and function and BPD.

Research on BPD is focused on examining biological and environmental risk factors, with special attention to whether early symptoms may emerge at a younger age than previously thought. Scientists are also studying ways to identify the disorder earlier in adolescents.

Treatments and Therapies

BPD has historically been viewed as difficult to treat. However, with newer and proper treatment, many people with BPD experience fewer or less severe symptoms and an improved quality of life. Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with BPD and their loved ones to be patient and to receive appropriate support during treatment. People with BPD can recover.  If you think you have BPD, it is important to seek treatment.  NIMH-funded studies indicate that BPD patients who never recovered may be more likely to develop other chronic medical conditions and are less likely to make healthy lifestyle choices. BPD is also associated with a high rate of self-harm and suicidal behavior.

If you are thinking about harming yourself or attempting suicide, tell someone who can help right away.  Call your licensed mental health professional if you are already working with one. If you are not already working with a licensed mental health professional, go to the nearest hospital emergency room.  If a loved one is considering suicide, do not leave him or her alone. Try to get your loved one to seek immediate help from his or her doctor or the nearest hospital emergency room, or call 911. Remove any access he or she may have to firearms or other potential tools for suicide, including medications, sharp edges such as knives, ropes, or belts.

If you or a loved one are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.  You can also call Genesis Counseling Center at 757-827-7707 to schedule a confidential appointment today.

Article By:  Dr. Trina Young Greer, Licensed Clinical Psychologist