Borderline Personality Disorder - BPD & Me!
Raising questions, finding answers
Borderline personality disorder (BPD) is a serious mental
illness characterized by pervasive instability in moods,
interpersonal relationships, self-image, and behavior. This
instability often disrupts...
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Borderline Personality Disorder
Borderline personality disorder (BPD) is a serious mental
illness characterized by pervasive instability in moods,
interpersonal relationships, self-image, and behavior. This
instability often disrupts family and work life, long-term
planning, and the individual's sense of self-identity.
Originally thought to be at the "borderline" of psychosis,
people with BPD suffer from a disorder of emotion regulation.
While less well known than schizophrenia or bipolar disorder
(manic-depressive illness), BPD is more common, affecting 2
percent of adults, mostly young women. There is a high rate of
self-injury without suicide intent, as well as a significant
rate of suicide attempts and completed suicide in severe cases.
Patients often need extensive mental health services, and
account for 20 percent of psychiatric hospitalizations. Yet,
with help, many improve over time and are eventually able to
lead productive lives.
Symptoms
While a person with depression or bipolar disorder typically
endures the same mood for weeks, a person with BPD may
experience intense bouts of anger, depression and anxiety that
may last only hours, or at most a day. These may be associated
with episodes of impulsive aggression, self-injury, and drug or
alcohol abuse. Distortions in cognition and sense of self can
lead to frequent changes in long-term goals, career plans, jobs,
friendships, gender identity, and values.
Sometimes people with BPD view themselves as fundamentally bad,
or unworthy. They may feel unfairly misunderstood or mistreated,
bored, empty, and have little idea who they are. Such symptoms
are most acute when people with BPD feel isolated and lacking in
social support, and may result in frantic efforts to avoid being
alone.
People with BPD often have highly unstable patterns of social
relationships. While they can develop intense but stormy
attachments, their attitudes towards family, friends, and loved
ones may suddenly shift from idealization (great admiration and
love) to devaluation (intense anger and dislike).
Thus, they may form an immediate attachment and idealize the
other person, but when a slight separation or conflict occurs,
they switch unexpectedly to the other extreme and angrily accuse
the other person of not caring for them at all.
Even with family members, individuals with BPD are highly
sensitive to rejection, reacting with anger and distress to such
mild separations as a vacation, a business trip, or a sudden
change in plans. These fears of abandonment seem to be related
to difficulties feeling emotionally connected to important
persons when they are physically absent, leaving the individual
with BPD feeling lost and perhaps worthlessness.
Suicide threats and attempts may occur along with anger at
perceived abandonment and disappointments.People with BPD
exhibit other impulsive behaviors, such as excessive spending,
binge eating and risky sex. BPD often occurs together with other
psychiatric problems, particularly bipolar disorder, depression,
anxiety disorders, substance abuse, and other personality
disorders.
Treatment
Treatments for BPD have improved in recent years. Group and
individual psychotherapy are at least partially effective for
many patients. Within the past 15 years, a new psychosocial
treatment termed dialectical behavior therapy (DBT) was
developed specifically to treat BPD, and this technique has
looked promising in treatment studies.
Pharmacological treatments are often prescribed based on
specific target symptoms shown by the individual patient.
Antidepressant drugs and mood stabilizers may be helpful for
depressed and/or labile mood. Antipsychotic drugs may also be
used when there are distortions in thinking.
Recent Research
Findings
Although the cause of BPD is unknown, both environmental and
genetic factors are thought to play a role in predisposing
patients to BPD symptoms and traits. Studies show that many, but
not all individuals with BPD report a history of abuse, neglect,
or separation as young children. Forty to 71 percent of BPD
patients report having been sexually abused, usually by a
non-caregiver.
Researchers believe that BPD results from a combination of
individual vulnerability to environmental stress, neglect or
abuse as young children, and a series of events that trigger the
onset of the disorder as young adults.
Adults with BPD are also considerably more likely to be the
victim of violence, including rape and other crimes. This may
result from both harmful environments as well as impulsivity and
poor judgement in choosing partners and lifestyles.
NIMH-funded neuroscience research is revealing brain mechanisms
underlying the impulsively, mood instability, aggression, anger,
and negative emotion seen in BPD. Studies suggest that people
predisposed to impulsive aggression have impaired regulation of
the neural circuits that modulate emotion. The amygdala, a small
almond-shaped structure deep inside the brain, is an important
component of the circuit that regulates negative emotion.
In response to signals from other brain centers indicating a
perceived threat, it marshals fear and arousal. This might be
more pronounced under the influence of drugs like alcohol, or
stress. Areas in the front of the brain (pre-frontal area) act
to dampen the activity of this circuit.
Recent brain imaging studies show that individual differences in
the ability to activate regions of the prefrontal cerebral
cortex thought to be involved in inhibitory activity predict the
ability to suppress negative emotion.
Serotonin, norepinephrine and acetylcholine are among the
chemical messengers in these circuits that play a role in the
regulation of emotions, including sadness, anger, anxiety and
irritability. Drugs that enhance brain serotonin function may
improve emotional symptoms in BPD.
Likewise, mood-stabilizing drugs that are known to enhance the
activity of GABA, the brain's major inhibitory neurotransmitter,
may help people who experience BPD-like mood swings. Such
brain-based vulnerabilities can be managed with help from
behavioral interventions and medications, much like people
manage susceptibility to diabetes or high blood pressure.
Future Progress
Studies that translate basic findings about the neural basis of
temperament, mood regulation and cognition into clinically
relevant insights--which bear directly on BPD--represent a
growing area of NIMH-supported research. Research is also
underway to test the efficacy of combining medications with
behavioral treatments like DBT, and gauging the effect of
childhood abuse and other stress in BPD on brain hormones.
Data from the first prospective, longitudinal study of BPD,
which began in the early 1990s, is expected to reveal how
treatment affects the course of the illness. It will also
pinpoint specific environmental factors and personality traits
that predict a more favorable outcome. The Institute is also
collaborating with a private foundation to help attract new
researchers to develop a better understanding and better
treatment for BPD.
About the author:
Listen to Arthur Buchanan on the Mike Litman Show!
http://freesuccessaudios.com/Artlive.mp3 THIS LINK WORKS, LISTEN
TODAY!
With Much Love, Arthur Buchanan
President/CEO Out of Darkness & Into the Light 43 Oakwood Ave.
Suite 1012 Huron Ohio, 44839 www.out-of-darkness.com
567-219-0994 (cell)
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