Borderline personality disorder (BPD) is an abnormal personality type, characterized by fear of abandonment, emotional instability, and ambiguity about one’s self-worth. It often develops in people who have been abused, abandoned or orphaned at an early age.
What is borderline personality disorder?
Borderline Personality Disorder (BPD) is the most common form of personality disorder with an prevalence of about 2-5.9% of the world population. This personality disorder is characterized by extreme sensitivity in personal relationships, constant fear of abandonment, strong impulses, and large mood swings. In addition, people with borderline personality disorder are vague about their own values and have a black-and-white mindset.
Borderline personality disorder is only discovered when a patient develops other psychological or psychiatric problems such as depression, anxiety disorders, and bipolar disorder. Like other abnormal personality types, BPD is easily confused with the usual sensitive personality. It is classified as a group B personality disorder – a group characterized by exaggerated emotions, dramatic behavior, shallow thinking, and unstable moods.
The risk of developing this personality type did not differ between men and women. If left untreated, patients with borderline personality disorder are at high risk of suicide at rates similar to those of depression. Although it is a chronic and lifelong disease, borderline personality disorder can be managed through psychotherapy and medication.
Signs of borderline personality disorder
Typical symptoms of borderline personality disorder are instability (uncertainty) and fear of abandonment. In addition to the name borderline personality disorder, this disorder is also known as volatile personality disorder. This emphasizes instability in emotions, behaviors, and (cognitive) thoughts.
Signs of borderline personality disorder:
- Anxiety, fear, and extreme sensitivity about being abandoned. This feeling of fear persists and flares up when the other person has behaviors that are related to the end of the relationship (refuse to meet, make love, lack of interest, etc.)
- The patient becomes extremely angry when the other party proposes to end the relationship. Some people became panicked, scared, screaming, crying and smashing things.
- Attempts to hold on to the relationship by all means such as begging, begging, even threatening to harm themselves and commit suicide if the other party does not accept to continue the relationship.
- Sudden change of opinion about others (black and white thinking). Patients can idealize and flatter a person when the other person gives them care and pampering. However, the patient may hate the other person when he or she gives enough attention or engages in unsatisfactory behavior.
- The patient gets angry easily and cannot control his anger. The patient is harsh, critical, reproachful and even insults others just because the other party does not accept the continuation of the relationship or refuses or ignores the patient’s request.
- Ambiguous about self-image, often changing about goals, career trends and values that you pursue.
- There is a feeling of emptiness and anxiety from deep inside because you are not really aware of your own position and worth
- The patient still has the ability to empathize with others, but only if the patient believes that person will be there to take care of them.
- When angry, the patient expresses anger violently through facial expressions and harsh, lashing words. However, after the anger, the patient often has feelings of shame and torment.
- Tends to self-destruct, such as quitting a job while advancing well, actively terminating a relationship with potential long-term growth, dropping out of school right after graduation, etc.
- High impulses prompt self-injurious behaviors such as cutting hands, banging your head against the wall, causing burns with cigarettes, etc.
- In addition, the patient may engage in potentially risky behaviors during an impulse such as unsafe sex, substance abuse, reckless spending, racing, gambling, etc. This is usually triggered by being rejected and abandoned by the other party.
- Great emotional swings, which can be intense for a few days, followed by anxiety and restlessness for a few hours to a few days.
- During episodes of anger and panic attacks, patients may present with dissociative disorder (detached from reality) and delusions of being harmed. However, these symptoms are short-lived and do not meet the criteria for a diagnosis of psychosis, schizophrenia, or dissociative disorder.
Symptoms of borderline personality disorder can be discovered by a family or partner after a period of time together. Due to excessive sensitivity and emotional instability, it is difficult for patients to maintain a long-term relationship. People with this personality type can get married, but often divorce or separate because the other person can’t stand their unusual personality.
Causes of borderline personality disorder
Personality disorders in general and borderline personality disorders in particular are related to genetics, innate and environmental influences. However, experts have not been able to determine the exact cause.
Through the studies performed, the experts found the role of the following factors in the pathogenesis:
1. Brain damage during perinatal period
Experts believe that brain damage in the perinatal period such as trauma, encephalitis, etc. is related to borderline personality disorder – especially damage to the frontal lobe. Damage in this position is impaired ability to control emotions and judgement. In addition, regulatory dysfunction and dysregulation of the neuropeptide system have also been implicated in the development of abnormal personality forms.
2. Trauma from childhood
Most abnormal personality types develop as a result of childhood trauma. Borderline personality disorder can develop after traumatic events such as abandonment, physical abuse, sex, orphanage.
These traumas create an unconscious fear of abandonment. In addition, past negative experiences also make the brain sensitive and have trouble controlling emotions. Some experts have found that overprotective and indulgent upbringing can also promote the development of borderline personality disorder.
Borderline personality disorder can run in families. The risk is markedly increased in people with a mother with borderline personality disorder, a family history of substance abuse, and mood disorders. Studies also show that the risk of borderline personality disorder increases fivefold when a parent or sibling has this disorder.
Is borderline personality disorder dangerous?
All personality disorders interfere with life from study, career to relationships. In particular, borderline personality disorder profoundly affects all aspects due to the patient’s ambiguity about himself, a feeling of emptiness, excessive sensitivity in relationships, and a lack of sense of purpose. goals and values to pursue.
It is difficult for the patient to maintain a long-term relationship due to his sensitive and demanding personality. When a request or request is denied, the patient becomes angry, impatient and constantly scolds and criticizes the other person. In addition, constantly engaging in self-destructive behaviors and threatening suicide also makes the other person tired and want to end the relationship.
Traumatic events (abandonment, rejection, etc.) can trigger impulses that lead to potentially dangerous behaviors such as binge eating, extravagant spending, unsafe sex, racing. vehicle, substance abuse, etc. These actions expose the patient to many consequences such as debt, injury, disability and possibly sexually transmitted diseases.
Patients with borderline personality disorder often engage in self-destructive behaviors to intimidate their partner into continuing the relationship or to release their emotions. Although this behavior is not done for the purpose of suicide, the patient can die from blood loss, septic shock.
People with borderline personality disorder are emotionally unstable and constantly face problems with finances, work, relationships, etc., leading to a high suicide rate. Statistics show that about 8-10% of patients commit suicide and the risk is 40 times higher than that of healthy people.
With treatment, borderline personality disorder goes into remission over time, and the recurrence rate is quite low. On the contrary, the condition can get worse when left untreated. In addition to the above effects, borderline personality disorder increases problems such as substance abuse, somatic disorders, psychosis, depression, and physical problems.
Diagnosis of borderline personality disorder
Borderline personality disorder is usually diagnosed before the age of 40. In particular, most patients only visit when experiencing physical and mental health problems such as body dysmorphic disorder, depression, psychosis, etc.
Similar to other personality disorders, borderline personality disorder is diagnosed based on clinical presentation. For an objective assessment, doctors often ask for the support of a loved one (especially a partner or lover).
Borderline personality disorder is characterized by many psychological and psychiatric problems such as psychosis, bipolar disorder, hysterical hysteria, etc. Therefore, laboratory tests and imaging tests will be performed. present to rule out these possibilities.
Borderline personality disorder will also be differentiated from other personality disorders – especially the abnormal group B personality types (characterized by the need for attention, attention, emotions, and dramatic behavior). , unstable). In addition, the doctor will also conduct a diagnosis of disease complications (if any).
Treatments for borderline personality disorder
Borderline personality disorder is often treated with psychotherapy and chemotherapy. Combining these two methods brings significant results, patients can reduce sensitivity, stabilize emotions and have goals and a clear sense of self-worth. Besides medical methods, support from family and society also plays an important role in the treatment process.
Treatments for people with borderline personality disorder:
Psychotherapy is the mainstay of treatment for borderline personality disorder. The goal of this approach is to control impulses and help the patient manage anger. It also reduces sensitivity and fear of abandonment and criticism.
Psychotherapy also helps patients develop social skills to increase adaptability. Patients with borderline personality disorder are often vague about their self-image, so they do not have clear goals. Therefore, in the process of therapy, the specialist will also help the patient to have a correct self-awareness, to have a clear goal and plan in life.
Psychotherapy is the first choice when treating borderline personality disorder. However, if the patient is panicking, agitated, and constantly engaging in self-destructive behavior, the doctor will prescribe inpatient treatment for a period of time to calm down before therapy. Psychotherapy is highly effective but takes a long time (about 20 weeks), so the family needs to encourage the patient to persevere in therapy.
Psychotherapy methods applied to patients with borderline personality disorder:
- Cognitive behavioral therapy
- Dialectical behavioral therapy
- Psychoanalytic therapy
- Schema Therapy
Psychotherapy can address or reduce abnormalities in emotions, thinking, and behavior of patients with borderline personality disorder. This will help the patient easily adapt and reduce problems and obstacles in life.
2. Drug use
There are no medications that are recommended for use in the treatment of borderline personality disorder. However, drugs can be used to relieve some of the symptoms caused by BPD such as emotional instability, psychosis, psychosis, stress, etc. Drugs are also indicated in most cases of comorbidities. such as depression, anxiety disorders, etc.
Medications used in the treatment of borderline personality disorder:
- Selective serotonin reuptake inhibitors (SSRIs) such as Sertraline, Fluoxetine, etc.
- Mood-modifying drugs such as Carbamazepine, Lithium, etc.
- Antipsychotics such as Olanzapine, Clozapine, etc.
- Benzodiazepine tranquilizers
- Sedative H1 antihistamines such as Promethazine
- Opioid antagonists such as Naltrexone, etc.
Drug therapy for patients with borderline personality disorder does not have a specific regimen that will be adjusted according to the patient’s symptoms. Although effective, using the drug has many potential risks, so the doctor will consider carefully before prescribing.
3. Care mode
People with borderline personality disorder have a hard time controlling their anger and stress due to their overly sensitive personalities. Therefore, patients need care to support medical methods. In addition, the family also needs to build a healthy living environment for the patient to change his personality in a positive direction.
Measures of care for patients with borderline personality disorder:
- Keeping a happy, warm family atmosphere, showing empathy and understanding to the patient. However, excessive indulgence and concern should not be shown.
- Minimize conflicts and conflicts in life.
- Interfere with some supportive therapies such as meditation, yoga, music therapy, aromatherapy, etc. to learn how to control anger and reduce self-destructive behaviors.
- Maintain a healthy lifestyle, stay away from alcohol, tobacco and stimulants.
- Limit caffeinated beverages as caffeine can increase stress and anxiety levels.
- Increase the patient’s awareness of the consequences of impulsive behaviors such as unsafe sex, racing, extravagant spending, gambling, etc.
- Direct the patient to develop clear goals and plans to stay motivated in life.
- Volunteering can help inspire compassion, learn to empathize with other people’s feelings, and better understand your own.
Borderline personality disorder accounts for about 30-60% of all patients with personality disorder. Although the prevalence is quite high, the community’s understanding of this disease is still limited. This leads to patients not being detected early and facing many impacts on health and quality of life.