Borderline personality disorder belongs to the cluster B category of personality disorders. It is classified by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a disorder that afflicts the individual with impaired personality functioning accompanied by pathological personality traits, per Psychology Today.
Updates to the disorder now include specific criteria that must be met for diagnosis, inclusive of:
- Either of two subsets of impaired self-functioning: identity or self-direction
- Either of two subsets of impaired interpersonal functioning: empathy or intimacy
- Negative affectivity: emotional lability, anxiety, separation insecurity, and depression
- Disinhibition marked by impulsivity and risk-taking
- Antagonism marked by hostile behavior
- Impairments to both personality functioning and trait expression must not waver across time or situations and cannot be better explained as being commonplace due to the person’s stage of development or sociocultural environment
- Impairments to personality functioning and trait expression cannot be explained by substance use (illicit or otherwise, inclusive of medical and non-medical use) or a medical condition
Who Is at Risk?
Risk factors for the development of BPD, per the Mayo Clinic, include a genetic predisposition whenever an immediate family member has the same disorder or a similar one, most commonly an anxiety-based or mood disorder; being the victim or childhood sexual or physical abuse; and experiencing neglect or being abandoned as a child. If you have a parent or sibling with BPD, your risk of developing it is five times greater than the average person, according to Psych Central.
The cause of BPD is still not fully understood. Research had led experts to believe the disorder develops from a combination of both inherited and environmental factors. It is thought that an unstable environment during a child’s upbringing can significantly contribute to the development of BPD, especially in situations where abuse is present. The National Institute of Mental Health notes several possible symptoms of borderline personality disorder. Some of the emotional effects are:
- An ongoing pattern of turbulent relationships with family, friends, peers, and coworkers
- Panicky, depressed, angered, or frantic reactions to being abandoned
- Extreme shifts in mood
- Restlessness and a general feeling of being bored with life
Likewise, borderline personality disorder inflicts physical effects on sufferers too. Psych Central notes impulsive behaviors like overspending, unprotected sex, drug or alcohol abuse, binge eating, and driving recklessly as being commonplace for the BPD patient. In addition, self-harming actions and attempts at or threats of suicide are all too common in the BPD-diagnosed. In fact, about 70 percent of BPD sufferers will have at least one suicide attempt in their lifetime, with 8 to 10 percent being successful.
BPD is not the same for every sufferer. In general, the depressive “lows” endured by borderline patients can be very emotionally taxing. Likewise, many will spend days on end in states of irritability and agitation that can sometimes mimic the manic-like symptoms of bipolar disorder. The crash that follows these periods of heightened emotion would wear out even the healthiest of individuals.
Victims of BPD often struggle to keep relationships and careers afloat due to their unstable behavior, poor attendance, and potentially violent mood swings. In a review of 11 studies regarding employment among the BPD population, follow-ups ranging from one to 27 years later reported results of 45 percent of the participants being unemployed, per an Innovations in Clinical Neuroscience publication.
NIMH reported on recent studies involving neuroimaging that showed vast differences in the brain structure of someone with BPD compared to someone without it. Some of the research points to emotional response mechanisms being overloaded in the BPD patient whenever they’re engaged in an activity they dislike. BPD patients also displayed less general activity in the regions of the brain responsible for the regulation of feelings and aggressive impulses. Other regions that may be hindered are those that help individuals to ascertain the context of a situation. Another neuroimaging study reported that BPD sufferers had increased activity in regions of the brain associated with reflexive actions and alertness whenever an emotionally negative stimulus was introduced — in the case of this study, photographs.
Borderline personality disorder has long been misunderstood. Those who suffer from it frequently complain of the stigma against it and the maltreatment and ridicule they endure. While the disorder was recognized centuries ago, modern research and treatment that have carried the diagnosis to where it is today didn’t officially start until around 1938 when Adolph Stern coined the term in reference to a group of patients that he found to be extremely difficult to treat with psychotherapeutic methods, according to the APA.
The behaviors exhibited by such patients would go on to be studied by Robert Knight in the 1950s and then termed as “borderline personality organization” by Otto Kernberg in 1975. Three years later, Gunderson and Kolb would change the face of the disorder forever, leading to a permanent implementation as a legitimate diagnosis in the psychiatric world, per the Royal College of Psychiatrists.
Known to be treatment-resistant, BPD patients present certain challenges for medical professionals and counselors alike. An American Medical Association publication on schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for the treatment of BPD produced impressive results with 45 percent of the schema patients and 24 percent of the TFP patients being in full recovery after three years of consistent treatment twice per week. At the four-year mark, the SFT recovery group increased to 52 percent, and the TFP group increased to 29 percent. Furthermore, dropout rates for the SFT group — at 27 percent — were nearly half as much as the TFP group’s 50 percent.
Perhaps the most prominent breakthrough in BPD research has been the use of dialectical behavior therapy (DBT) in the treatment of its patients. Among suicidal, drug-dependent female patients, Social Work Today reported a 36 percent dropout rate for those receiving DBT, compared to a 73 percent dropout rate for those not receiving it.
Medications used in the treatment of BPD include neuroleptics, atypical antipsychotics, and mood stabilizers, per Newsmax. Most often, the purpose of these medications is merely to decrease BPD symptoms so that psychotherapy is more effective during treatment. Likewise, a reduction in symptoms makes way for a more stable life with episodes of depression, suicidal ideation, anger, and violence.
BPD carries with it a very high rate of co-occurrence with other disorders. NAMI accounts for a 60 percent comorbidity of BPD with major depressive disorder, 70 percent with dysthymia, 25 percent with eating disorders, 35 percent with substance abuse, 15 percent with bipolar disorder, 25 percent with antisocial personality disorder, and 25 percent in conjunction with narcissistic personality disorder.
According to NAMI, half of all Americans who have a severe mental health disorder are also struggling with substance abuse. Psych Central accounts for substance abuse in about 50 to 70 percent of those afflicted with borderline personality disorder specifically. Psychiatric Times states a 20 percent estimated incidence of comorbidity with BPD in inpatient units, and 11 percent for outpatient.
A University of Missouri-Columbia review declared 14.3 percent of alcohol abusers or dependents qualified for a BPD diagnosis, in addition to 16.8 percent of cocaine-dependent users and 18.5 percent of opioid abusers. Substance abuse in the BPD patient can make treatment very difficult.
Get on the Road to Recovery Today
The best chance at successful treatment is rendered by a combination of medication, therapy, and educational and support groups, all of which you’ll find here at Axis. The presence of other mental health disorders can create complexities that only the best treatment professionals are skilled enough to remediate, like those on staff here. At Axis, you will find a temporary home where you’ll be surrounded by people who understand what you’re up against and want to help. Call us today for more information.