Borderline Personality
Disorder

Alternative names: BPD, Emotionally Unstable Personality Disorder, Emotional Intensity Disorder

Borderline Personality Disorder is a serious mental illness involving highly variable moods, erratic behavior, unstable relationships, changing self-image, and repeating suicidal or self-harming tendencies.

Incidence; Causes and Development

It is estimated that roughly 1-6% of adults in the U.S. suffer from BPD in any given year.  Onset is usually during adolescence or early adulthood, with 75% of cases occurring in women.  BPD constitutes roughly 20% of all psychiatric hospitalizations, and is present in some 17% of the prison population.

The cause of Borderline Personality Disorder is unknown, but it is thought to be inherited (genetic) and dependent on the cultural environment that a person grows up in.  There appears to be a connection to Post-Traumatic Stress Disorder (PTSD) and a history of child trauma.

Signs and Symptoms

There are many signs of BPD, including:

• episodes of intense mood swings lasting from hours to days
• difficulty controlling emotions and thoughts
• impulsiveness, for example reckless spending or binge eating
• recklessness, for example unsafe sex, reckless driving, substance abuse (present in 38% of cases)
• unstable (intense, stormy, chaotic) interpersonal relationships with family, friends and colleagues, changing from extreme closeness to extreme dislike
• extreme reaction (panic, rage, depression, self-harm, etc.)  to separation from, or abandonment/rejection by, people who are close
• distorted, unstable self-image leading to sudden changes in opinions and plans for the future
• making poor choices in life
• paranoid thoughts
• repeated suicidal behavior, and/or threatening to do it
• repeated self-harm, such as cutting, burning, hitting, head banging, hair pulling
• chronic boredom
• chronic feelings of emptiness or being 'lost' – that one's life has no meaning or purpose
• irrational irritability
• feeling emotions longer and more easily and deeply than others do
• inappropriate emotional outbursts
• inappropriate anger – misinterpreting neutral facial expressions, being oversensitive to negative words or things not going to plan
• poor anger management – frequent rage and/or physical fights
• severe dissociative symptoms – 'zoning out', feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality

80% of sufferers exhibit suicidal behavior and about 5-10% commit suicide.

Diagnosis and Tests

There are no laboratory, blood or genetic tests that can be used to diagnose borderline personality disorder.  Other possible causes of the symptoms, such as thyroid disorder or substance abuse, should be ruled out first.

According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, it must be demonstrated that a person continuously exhibits at least 5 of 9 associated criteria in order to be diagnosed with borderline personality disorder.

Complication arises in cases where other mental illness(es) may be present at the same time.  85% of those with BPD also satisfy the diagnostic criteria for at least one other mental illness.  Women are more likely to have depression, anxiety or eating disorders; men are more likely to have substance abuse or antisocial personality disorder.

Treatment and Prevention

Some patients recover without treatment.

Long-term psychotherapy (talk therapy) is currently the treatment of choice.  However, one study showed that Dialectical Behavior Therapy (DBT) reduced suicide attempts in women much more than other types of psychotherapy.

There are currently no medications that cure BPD, but some may help to reduce anxiety, depression and aggression.

One study suggests that omega-3 fatty acids may help to reduce depression and aggression.

Patients with severe symptoms often require around-the-clock care.

Prognosis; Complications

With treatment, the majority of those with BPD can find relief from the worst symptoms and even achieve remission.  BPD usually decreases in severity with age.  Most patients stop experiencing the most serious symptoms by the time they are aged 40-50.

Those with borderline personality disorder are much more likely to be victims of violence, rape, and other crimes.

Medications that are used to treat BPD and other mental disorders can lead to obesity, which in turn can lead to diabetes, hypertension, chronic back pain, arthritis and fibromyalgia.