Definition

Borderline personality disorder (BPD) is a complex and confusing illness. People with BPD may have unstable moods, interpersonal relationships, self-image, and behavior. They may often act impulsively. This behavior disrupts family and work life, long-term planning, and the individual’s sense of self. People with BPD also have difficulty controlling their moods (called affect regulation).

Most BPD sufferers have a very hard time coping with separations from loved ones and desperately try to avoid being alone. In severe cases, sufferers of BPD may seek relief from inner pain by cutting, burning, or scratching themselves.

Treatment options have improved as the causes and symptoms of BPD are better understood. Many BPD sufferers are helped by psychotherapy and medicines.

Causes

The causes of BPD are not fully understood. Brain chemistry, genetics, and environmental factors are thought to play a role. People who develop BPD are probably born vulnerable to the illness. When they are exposed to certain experiences and types of stress, their chances of developing the illness increase. BPD sufferers are often found to have experienced childhood abuse, neglect, separation, sexual abuse, or violence.

Central Nervous System - Brain

BPD is thought to develop from a combination of chemical imbalances in the brain and traumatic life experiences.

© 2009 Nucleus Medical Media, Inc.

Risk Factors

The following factors increase your chances of developing BPD:

• Sex: female
• A history of abuse, neglect, or abandonment as a child
• A history of sexual abuse or violence
• Inborn sensitivity to stress
• Poor self-image, not having a clear sense of who you are
• Mother, father, or sibling with BPD

Symptoms

The symptoms of BPD vary. People with BPD tend to be extremely sensitive to rejection. They may react with anger and upset at even mild separations from friends or family members. Symptoms often become more acute when people with BPD feel isolated and lonely or during times of particular stress.

Traits that are common to people with BPD include:

• Fears of being left alone, resulting in frantic behaviors aimed at avoiding it
• Extreme mood swings and difficulty managing emotions
• Difficulty in relationships, characterized by dramatic swings between idealizing and devaluing the relationship (viewing people as all good or all bad)
• Unstable self-image
• Impulsive behavior
  • Excessive spending
  • Promiscuity, risky sexual behavior
  • Gambling
  • Drug and alcohol abuse
  • Self-injury, suicide threats
  • Binge eating
• Repetitively injuring themselves through cutting, scratching, or burning
• Feeling misunderstood, bored, and empty
• Having deep-seated feelings of being flawed or bad in some way
• Using defense mechanisms to avoid taking responsibility for behavior, or to blame others
• Unpredictable mood and difficulty regulating mood
• Problems with anger management, manifested as periods of intense, uncontrollable and often unreasonable anger
• Episodes (usually precipitated by stress) of intense paranoia, dissociation, or thought patterns bordering on psychosis (hence the term “borderline”)

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam. This is to rule out other possible causes for mood and behavior problems. If BPD is suspected, you should get a thorough evaluation by a psychiatrist who specializes in personality disorders.

BPD can affect anyone but is usually diagnosed in adolescents and young adults. BPD seems to occur much more frequently among women than men. A diagnosis of BPD may be made if a person has a history of having unstable interpersonal relationships, poor self-image, and marked impulsivity along with some of the specific symptoms of BPD listed above. In addition, BPD patients almost always have other mental health problems, including:

• Depression
• Substance abuse
• Eating disorders
• Anxiety disorders
• Bipolar disorder
• Compulsive spending, gambling, or risky sexual behavior

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Prevention

There are no guidelines for preventing BPD. Research is underway to identify which treatment methods work most effectively to control and reverse the course of the illness.