What You Should Know About Borderline Personality Disorder (BPD)

I read a NY Times article a while back ago Borderline Personality Disorder (BPD). The article mentioned the intricacies of the disorder and the difficulties to diagnose and treat it successfully. I started to write a blog post last month in response, but never finished it. But in lieu of WEGO Health member jolly's discussion post in the Depression Group, I thought I would revisit BPD and share information with anyone who is interested in learning more about the disorder and how it differs from depression and other mental health disorders. I believe very strongly in removing social stigmas about mental illness and I think one of the ways to do that is by spreading information.

You may recognize BPD if you've seen Girl Interrupted, the film based on the memoir of the same name. Winona Ryder's character was diagnosed with BPD - and the film tried to accurately portray a handful of common BPD symptoms (impulsive moods, reckless behavior and promiscuity, pervasive sense of emptiness, and relationships that often are intense and unstable). Not everyone in the health community agrees with the portrayal of mental illness in that particular film, though. But it's probably our best mainstream source for a glimpse into what BPD might be like.

According to the NY Times article, BPD affects a person's whole family and relationships. BPD patients have a hard time with relationships in general, often damaging them by creating intense but stormy attachments and having violent mood shifts (often from high admiration to intense dislike). Their strong reactions to rejection and sensitivity to sudden changes are often very aggressive and appear very irrational to others. As with many mental illnesses, a Borderline cannot see his/her actions or emotions as irrational - and everyone else can't quite understand what the emotions/actions mean or feel like. (As with other personality disorders and mental illnesses, the onset of symptoms does not allow patient to "snap out of it" and "just fix themselves" - and, though their behavior can seem very extreme and hurtful to those close to the patient, having compassion and seeking understanding while giving support are very important.)

BPD is the most researched personality disorder that affects nearly 2% of the population (twice that of schizophrenia - a disease that seems more popular). Criteria for diagnosis include:
- frantic efforts to avoid abandonment
- a pattern of unstable relationships that alternate between idealization and devaluation
- unstable self-image and sense of self
- impulsive behavior that is self-damaging (promiscuous sex, eating disorders, substance abuse, reckless driving)
- intense episodes of instability because of a mood (irritability, anxiety, etc)
- chronic feelings of emptiness/worthlessness
- inappropriate anger/difficulty controlling anger (lots of fights, harsh temper)
- stress-related delusions

Those diagnosed with BPD also had a high rate of
- anxiety disorders
- mood disorders (depression, bipolar)
- eating disorders
- somatoform disorders
- dissociative disorders (DID, formerly mult. personality disorder)

What is the difference between BPD and bipolar or depression? Mainly, the moods. While someone with bipolar or depression might feel that same mood for weeks - someone with BPD has intense bouts of emotion that can last a few hours or 1 day at most. These bouts can include aggression, self-harm, and drug/alcohol abuse. Something else is the pervasive boredom, feelings of emptiness, loss of identity, presumed unfair treatment, and incorrect perception of self. These traits are rarely associated with depression (though sometimes those with BPD also suffer from depression).

Treatments are improving. Group and individual therapy is at least partially effective for many Borderlines. A new psychological treatment called dialectical behavior therapy (DBT) was developed specifically to treat BPD and is looking to be quite positive. Often medication is prescribed to target specific symptoms of the particular patient (often mood stabilizers and antidepressants are used, while sometimes antipsychotic drugs are prescribed to combat distorted thinking.)

But what's the cause? Like many, if not all, mental illnesses - the cause of BPD is unknown. However, a combination of environmental and genetic factors are thought to predispose someone to BPD symptoms/traits. The combination of possible causes makes it both tricky to pinpoint and certainly difficult to predict. Around 40-70% BPD patients have reported sexual abuse that was usually committed by non-caregivers. Researchers point toward a combination of individual vulnerability to environmental stress, neglect or abuse in childhood, and a series of events that trigger the onset of this disorder. Adults with BPD are a lot more likely to become a victim of violence, rape, and other crimes. This may be due to harmful environments as well as impulsivity and poor judgment in selecting partners or lifestyles.

Studies show that there are probably brain mechanisms responsible for the underlying symptoms of BPD, including an impaired regulation of neural circuits that control emotion. The amygdala, is an important component to regulating negative emotion and is in change of causing fear and arousal when other brain signals perceive a threat. This part might be more pronounced under the influence of drugs/alcohol/stress. Parts of the pre-frontal area of the brain try to counteract the amygdala - and there are studies being done to predict its ability to suppress negative emotions.

Do you (or does someone you're close to) have BPD? What have you heard about BPD in the past? What more would you like to know about BPD? What mental illnesses do you think deserve more attention either in the media or in the health community?

Here are a bunch of great sources that you should check out that helped me write this post:
WEGO Health's Community-Rated Mental Health resources, Including BPD
The National Institute of Mental Health's BPD Page
New York Times BPD Main Page
BPD Sanctuary (a great listing of BPD articles, stories, and news)

Join the WEGO Health Mental Health Group
Respond to jolly's BPD discussion

(As always, you should see a doctor if you have questions about your mental health, are looking for a diagnosis, or would like to pursue treatment.)