Trillian's Depression Page

Borderline Personality Disorder (BPD)

Click here to read the criteria for Borderline Personality Disorder from the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV).

Click here to read the ICD-10 Classifications for , Borderline Personality Disorder from the World Health Organization

"The defining criteria of Borderline Personality Disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts, "as indicated by five (or more) of the following:

• frantic efforts to avoid real or imagined abandonment.
• a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
• identity disturbance: markedly and persistently unstable self-image or sense of self; or sense of long-term goals; or career choices, types of friends desired or values preferred.
• impulsivity in at least two areas that are potentially self-damaging: for example; spending, sex, substance abuse, and binge eating.
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
• affective instability: marked shifts from baseline mood to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days.
• chronic feelings of emptiness.
• inappropriate, intense anger or difficulty controlling anger; frequent displays of temper.
• transient, stress-related paranoid ideation or severe dissociative symptoms.

It should be noted that many of the traits associated as being BPD traits are commonly found in the general population as well. The line is drawn between the average and the Borderline Personality Disorder person by the number of characteristics listed above that effect them along with the severity or intensity of that affect.

In Borderline Personality Disorder, like DID (MPD), there is a likelihood of a trauma history: "Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder."'

How Does Borderline Personality Disorder Manifest?

Borderline personality disorder (BPD) individual's almost always appear to be in a state of crisis. Mood swings are common. These individuals can be argumentative at one moment and depressed at the next and then complain of having no feeling at all, at another time.

There may be short-lived psychotic episodes rather than full-blown episodes or psychotic breaks, and the psychotic symptoms of BPD are almost always circumscribed, fleeting, or in doubt. The behavior of a BPD individuals is highly unpredictable which makes it difficult for these individual's to achieve up to their potential in life. The repeated self-destructive acts which are "acted out" by Borderlines reflects the very painful nature of their lives. This self-destructive behavior often takes the form of self-mutilation to either elicit help from others, to express anger, or to numb themselves to overwhelming affect.(emotions).

Borderlines often feel both dependent and hostile which in most cases makes for tumultuous interpersonal relationships. They can be very dependent on those to whom they are close and they can express enormous anger at those close, around them in times of frustration. Borderlines have a very low frustration tolerance level as well.

Most Borderlines have a very difficult time being alone. Most frantically will do almost anything to avoid being alone. Borderlines do not have a stable sense of identity and often in spite of many overwhelming affects mention most often, depression.

Functionally, Borderlines are known to put people in either" all good, or all bad" categories. This is known as splitting. The good person is idealized and the bad person is devalued, there is no in between. It is the black and the white, there is no gray area in the world of the unrecovered Borderline.

The depth to which most Borderlines feel their pain is for the most part not understandable to non-borderline individuals. This deep intrapsychic pain is often the pain of a traumatic childhood. Borderlines live in constant fear, terror of having to deal with real or often imagined abandonment. Attachments and bonds are very difficult for borderlines to develop because there are many control and trust issues with which they do not cope well. They have a strong need to protect themselves from anymore pain which sees most borderlines basically being incapable of dealing with their own vulnerabilities or the vulnerabilities and emotions of others. Borderline individuals may not seem it to the outside world around them but they are very sensitive people in a great deal of pain. The very unfortunate reality of this personality disorder is that when they need and what they need to the most Borderlines often are compelled by impulse to push away, to sabotage in order to protect themselves from the agony increasing that is ever present inside.

Borderlines, not unlike anyone often project, to a greater degree, grant it than the average. It is this projection out onto others of all that is essentially reality inside of the borderline themselves that leads them to often be so abusive to those around them.

Borderlines struggle very much with image of self and identity and in so doing often have no clear definable understanding of where they end and the next person begins. This is a boundary issue that has its roots most often in the way in which these individuals were raised. The blurring of boundaries between self and other causes the borderline to act out what is often their own self-hatred and disdain for self onto others. At times it seems as though there is an "average collective reality" in the world and then there is the reality of the Borderline Disordered individual. Disorder is the basis of this lifestyle. It is a life that for any Borderline living it, is often entrenched in chaos and marred by virtually inescapable feelings of helplessness and victimization.

Etiology

It is a common disorder with estimates running as high as 10-14% of the general population. The frequency in women is two to three times greater than men.

This may be related to genetic or hormonal influences. An association between this disorder and severe cases of premenstrual tension has been postulated. Women commonly suffer from depression more often than men. The increased frequency of borderline disorders among women may also be a consequence of the greater incidence of incestuous experiences during their childhood. This is believed to occur ten times more often in women than in men, with estimates running to up to one-fourth of all women.

This chronic or periodic victimization and sometimes brutalization can later result in impaired relationships and mistrust of men and excessive preoccupation with sexuality, sexual promiscuity, inhibitions, deep-seated depression and a seriously damaged self-image. There may be an innate predisposition to this disorder in some people. Because of this there may ensue subsequent failures in development in the relationship between mother and infant particularly during the separation and identity-forming phases of childhood.

Treatment

Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgmental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways. Sometimes medications such as antidepressants, lithium carbonate, or antipsychotic medication are useful for certain patients or during certain times in the treatment of individual patients. Treatment of any alcohol or drug abuse problems is often mandatory if the therapy is to be able to continue. Brief hospitalization may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behavior threatens to erupt. Hospitalization may provide a temporary removal from external stress.

Outpatient treatment is usually difficult and long-term - sometimes over a number of years. The goals of treatment could include increased self-awareness with greater impulse control and increased stability of relationships. A positive result would be in one's increased tolerance of anxiety. Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle.

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