Borderline Personality Disorder or BPD is a personality disorder specified under Cluster B of Personality disorders in DSM-5. People with this disorder show erratic and unpredictable behavior such as extreme mood fluctuations, unstable interpersonal relationships and impulsiveness. They experience troubles in emotional regulation say for instance controlling their anger or expressing it in a socially acceptable manner. They could express their anger with unjustified and unreasonable bitterness or angry tirades. They experience abrupt changes in how they feel about others and themselves and can often oscillate between extreme emotions like fear, anxiety, hatred, sadness and love. These swings can last anywhere between a few hours to a few days. Impulsivity and engaging in dangerous or risky behaviors, such as speedy driving or engaging in unsafe sexual activity is not uncommon for people with BPD. They have an intense fear of abandonment by their loved ones and may come across as too clingy and could even respond to perceived abandonment with extreme anger outbursts. They may repeatedly engage in self-harm or suicidal behavior or threaten to do so. These self-destructive acts could be the aftermath of a rejection or possible abandonment by a loved one or a romantic partner. To learn more about Borderline Personality Disorder, seek Online Counselling at TalktoAngel.
People with BPD tend to dramatically change their views of others quickly. For instance they can go from idealizing others to devaluing them quickly over a very short period of time. These behaviors make it difficult for them to hold long term meaningful relationships especially romantic and intimate relationships. People with BPD have an ill formed sense of self or an unclear self-image. Often, they look upon themselves as “bad” and feel guilty or ashamed for being the way they are. They can abruptly and dramatically alter their self-image, by suddenly changing their goals, career paths or social circle. They also knowingly impede their own progress at times. For instance, they may fail a test on purpose, call off a well going relationship without any substantial reason and frequently hop from one job to another without any aim. A lot of people with BPD feel gloomy, empty or unfulfilled. They tend to engage in self loathing or may feel as if their life is worthless. Quite often, paranoid thoughts with ill justified suspicions are exhibited by people with BPD. Dissociative episodes and hallucinations may be triggered by extreme stress, such as fear of abandonment.
In nearly all the cases BPD is diagnosed after the age of 18 years. Usually a person either does not know about his or her disorder or out rightly denies acknowledging it. A person may approach a clinician for help with other disorders such as a Depressive disorder or an Anxiety based disorder which is commonly diagnosed co morbid disorders with BPD. Childhood abuse and trauma in sexual, emotional or physical forms is known to be a contributing factor in later development of this disorder. Early maternal separation or poor maternal attachment, inappropriate family conditions and parental substance abuse are also associated with BPD. Studies have also shown that borderline personality disorder runs in families. If one has a family history of BPD, then they are more likely to develop the condition.
Psychoeducation of primary care taker or family members of people with this disorder can be helpful in improving their understanding and enabling them to mitigate problematic situations arising out of this condition. Psychotherapy has shown promising results in teaching necessary coping skills such as distress toleration and emotional regulation to clients with BPD. Key therapy modalities include Dialectical Behavioral Therapy or DBT, Metallization-based treatment (MBT) and Schema-focused therapy (SFT) which have been established as evidence based treatment protocols for BPD. Psychiatric medication in conjunction with therapy may be needed in cases where associated co morbid conditions are leading to functional or occupational impairment.
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