Overview of BPD

Borderline personality disorder (BPD) is a serious mental illness that centers on the difficulty or inability to manage emotions effectively. The disorder occurs in the context of relationships: sometimes all relationships are affected, sometimes only one. It usually begins during adolescence or early adulthood.

While some persons with BPD are high functioning in certain settings, their private lives may be in turmoil. Most people who have BPD suffer from problems regulating their emotions and thoughts, impulsive and sometimes reckless behavior, and unstable relationships

Other disorders, such as depression, anxiety disorders, eating disorders, substance abuse and other personality disorders can often exist along with BPD.

The diagnosis of BPD is frequently missed and a misdiagnosis of BPD has been shown to delay and/or prevent recovery. Bipolar disorder is one example of a misdiagnosis as it also includes mood instability. There are important differences between these conditions but both involve unstable moods. For the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and can even occur within the same day.

Officially recognized in 1980 by the psychiatric community, BPD is more than two decades behind in research, treatment options, and family psycho-education compared to other major psychiatric disorders. BPD has historically been met with widespread misunderstanding and blatant stigma. However, evidenced-based treatments have emerged over the past two decades- bringing hope to those diagnosed with the disorder and to their loved ones.

Incidence

• BPD affects 5.9% of adults (about 14 million Americans) at some time in their life
• BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%)
• BPD affects 20% of patients admitted to psychiatric hospitals
• BPD affects 10% of people in outpatient mental health treatment

Causes Of Borderline Personality Disorder

Research on the causes and risk factors for BPD is still in its early stages. However, scientists generally agree that genetic and environmental influences are likely to be involved.

Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.

According to the biosocial theory of BPD, this complex disorder is the result of certain biological predispositions which manifest themselves when met with a dysfunctional or invalidating environment. For example, temperamental traits such as impulsivity are inherited. If brought up in a supportive and empathetic home, an impulsive child will learn to control their behavior and keep tabs on their impulses. However, if the same child faces emotional abuse or neglect, or another invalidating environment, they are more likely to develop BPD later in life.

Prognosis

Research has shown that outcomes can be quite good for people with BPD, particularly if they are engaged in treatment. With specialized therapy, most people with borderline personality disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviors and suffering. Under stress, some symptoms may come back. When this happens, people with BPD should return to therapy and other kinds of support.

Many individuals with BPD experience a decrease in their impulsive behavior in their 40’s.

What Does “Borderline Personality Disorder” Mean?

Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful. The term “borderline” also has a history of misuse and prejudice—BPD is a clinical diagnosis, not a judgment.

Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image. Some people refer to BPD as “Emotion Dysregulation.”

How is BPD Treated?

BPD may be treated in a number of ways, including but not limited to Dialectical Behavior Therapy (DBT) and Schema Therapy. Cor Counseling specializes in DBT.

DBT is a type of cognitive behavioral therapy developed by Dr. Marsha Linehan. Its main goals are to teach people how to live in the moment, cope with stress in a healthier way, regulate emotions, and improve relationships with others. Though it was originally intended for those with BPD, it has since been adapted for use with other conditions such as eating disorders, substance abuse, and PTSD.