Borderline personality disorder

Specialty of Psychiatry

What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental health disorder that affects the way someone thinks, feels and relates to others which can create problems in everyday life. BPD is thought to be the most common of personality disorders.

What are the symptoms?

The symptoms of borderline personality disorder generally start to show and emerge in adolescence and continue into adulthood.

Signs and symptoms of BPD are categorised into four main areas:

  • Impulsive behaviour
  • Emotional instability – this is known in psychiatry as affective dysregulation
  • Intense, unstable relationships with others
  • Cognitive or perceptual distortions – this describes warped, disturbed patterns of thinking or perception

What causes borderline personality disorder?

As with many mental health disorders, the exact causes of BPD are not clear cut, however, BPD is thought to result from a combination of environmental and genetic factors.

Genetics:

  • The genes inherited from your parents could make you more predisposed to BPD.
  • A study found that if one identical twin had BPD, then the chances of the second twin having BPD were very high.
  • However, there is still no evidence to fully support genetic influence on BPD.

Brain abnormalities:

  • Some research has indicated that parts of the brain involved in the regulation of emotion, aggression, impulsivity show changes in those suffering from BPD.

Environmental factors thought to be common among those with BPD:

  • Having a stressful childhood
  • Being neglected by one or both parents as a child
  • Being a victim of sexual, emotional or physical abuse
  • Being exposed to a family member with a serious mental illness or substance abuse problem as a child

How is borderline personality disorder diagnosed?

A diagnosis of BPD will be based on the following:

  • Medical history
  • A psychological evaluation, which can sometimes involve a series of questionnaires
  • A thorough interview with a specialist

There is a set of criteria used to diagnose BPD which are internationally recognised, which a specialist will use to guide their diagnosis.

What is the treatment?

Treatment for borderline personality disorder uses psychotherapy, and sometimes medication too. Generally, the purpose of BPD treatment is to show how you can cope with such a disorder and how to live a more stable and rewarding life.

Psychotherapy:

There are lots of different types of psychotherapy, but fundamentally each will take the time to understand how someone with BPD thinks and feels, and to work on how to cope and to help the patient better understand their own condition.

These are the forms of psychotherapy found to be effective when treating borderline personality disorder:

  • Dialectical behaviour therapy (DBT)
  • Mentalisation-based therapy (MBT)
  • Therapeutic communities (TCs)
  • Art therapies

Medication:

  • The use of medication in treating BPD is disputed, and generally won’t be recommended.
  • However, if someone presents other mental health conditions as well, such as depression, anxiety disorder or bipolar disorder, then mood stabilisers or antipsychotic medication might be prescribed to help reduce some of the mood swings and psychotic symptoms.
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