A pervasive
pattern of instability of interpersonal relationships, self-image,
and affects, and marked impulsivity beginning by early adulthood
and present in a variety of contexts, as indicated by five (or
more) of the following:
Frantic efforts
to avoid real or imagined abandonment.
Apattern 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
Impulsivity in
at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance
abuse, reckless driving, binge
eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.
Affective instability
due to a marked reactivity of mood (e.g., intense episodic dysphoria,
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 (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
Transient, stress-related
paranoid ideation or severe dissociative symptoms.
DSM-IV Code: 301.83.
Associated
Features:
Depressed
Mood
Addiction
Dramatic or Erratic or Antisocial
Personality
Differential
Diagnosis
Some disorders
have similar or even the same symptom. The clinician, therefore,
in his diagnostic attempt has to differentiate against the following
disorders which he needs to rule out to establish a precise
diagnosis.
Mood
Disorders;
Histrionic
Personality Disorder
Schizotypal
Personality Disorder
Paranoid Personality
Disorder
Narcissistic
Personality Disorder
Antisocial
Personality Disorder
Dependent
Personality Disorder
Personality
Change Due to a General Medical Condition
Symptoms
that may develop in association with chronic substance use
Cause:
The roots
of Borderline Personality Disorder (BPD) have long been in question.
There is no across-the-board agreement in the mental health
profession when it comes to this question.
Treatment:
Counseling
and Psychotherapy [
See Therapy Section ]:
Like with
all personality disorders, psychotherapy is the treatment of
choice in helping people overcome this problem. While medications
can usually help some symptoms of the disorder, they cannot
help the patient learn new coping skills, emotion regulation,
or any of the other important changes in a person's life.
The most
successful and effective psychotherapeutic approach to date
has been Marsha Linehan's Dialectical Behavior Therapy. Research
conducted on this treatment have shown it to be more effective
than most other psychotherapeutic and medical approaches to
helping a person to better cope with this disorder. It seeks
to teach the client how to learn to better take control of their
lives, their emotions, and themselves through self-knowledge,
emotion regulation, and cognitive restructuring. It is a comprehensive
approach that is most often conducted within a group setting.
Because the skill set learned is new and complex, it is not
an appropriate therapy for those who may have difficulty learning
new concepts.
Like all
personality disorders, borderline personality disorder is intrinsically
difficult to treat. Personality disorders, by definition, are
long-standing ways of coping with the world, social and personal
relationships, handling stress and emotions, etc. that often
do not work, especially when a person is under increased stress
or performance demands in their lives. Treatment, therefore,
is also likely to be somewhat lengthy in duration, typically
lasting at least a year for most.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
Antidepressant
and anti-anxiety agents may be appropriate during particular
times in the patient's treatment, as appropriate. For example,
if a client presents with severe suicidal ideation and intent,
the clinician may want to seriously consider the prescription
of an appropriate antidepressant medication to help combat the
ideation. Medication of this type should be avoided for long-term
use, though, since most anxiety and depression is directly related
to short-term, situational factors that will quickly come and
go in the individual's life.
Self-Help
[ See Self-Help
Section ]
Self-help
methods for the treatment of this disorder are often overlooked
by the medical profession because very few professionals are
involved in them. Encouraging the individual with borderline
personality disorder to gain additional social support, however,
is an important aspect of treatment. Many support groups exist
within communities throughout the world which are devoted to
helping individuals with this disorder share their commons experiences
and feelings.
Patients
can be encouraged to try out new coping skills and emotion regulation
with people they meet within support groups. They can be an
important part of expanding the individual's skill set and develop
new, healthier social relationship
