Borderline Personality Disorder (BPD): What is it?

Borderline Personality Disorder (abbreviated as BPD

) is a rather rare mental destruction, characteristic of only 2-3% of people around the world. The pathogenesis of this type of psychopathy is usually accompanied by the presence of a complex of unfavorable factors.

It is quite difficult to recognize this type of disease in everyday life. Often, it is confused with narcissism or simply the bad character of an individual, since the behavior of “border guards” can be characterized by an extreme degree of unpredictability and hysteria, as well as a tendency to manipulation. For example, they confess their love to their partner, and after a couple of hours they leave “forever”; they can sincerely sympathize with someone, and then hit. It is also very common for patients of this type to constantly violate the boundaries of other people, shifting their problems onto them and avoiding responsibility. Let's look at the symptoms of borderline in more detail.

Symptoms of borderline personality disorder (BPD)

The main symptomatic difference of this type of disorder is the patient’s prolonged abnormal behavior

.

While in many other psychopathy periods of instability alternate with remission, in the case of BPD the patient behaves destructively over a long period of time. The field of psychological anomalies includes such manifestations as:

• aggressive behavior leading to relationship problems,
• unstable emotional background and inadequate self-image,
• high anxiety,
• total fear of loneliness and permanent feeling of boredom,
• dichotomous thinking and changeable moods, dividing the world only into “black and white” (today I love, and tomorrow I hate).

Also among the main symptoms can be noted: sociopathy and fear of society, associated with low self-esteem and, as a consequence, separation anxiety (an individual experiences it when separated from home or loved ones). Often, patients exhibit reckless, irresponsible “risky” behavior, the extreme form of which can be self-harm or suicide attempt.

Types of spontaneous actions accompanying mental borderline personality disorders

Due to difficulties in self-identification, lack of personal opinion, and a tendency toward polarity, BPD sufferers are prone to spontaneous destructive behavior.

A panicky fear of loneliness and the lack of an inner core pushes them into connections with sociopathic personalities who are characterized by destructive behavior: gambling, theft, vandalism, promiscuous relationships, drug addiction. This also includes self-harm, which was mentioned above.

One of the reasons for such uncontrolled behavior is the problem of maintaining internal impulse. The level of impulsivity is so high that a person is unable to control it.

How to recognize borderline personality disorder in yourself or a loved one

The diagnosis of “borderline personality disorder” can only be made by a psychotherapist, and only after a thorough examination. But if you or a loved one have certain problems, this is a reason to consult a specialist.

A small test will help you decide if you need help. Check all the statements with which you agree:

• I often feel emotionally drained;
• I have constant mood swings;
• I often feel sad, angry, anxious;
• I am constantly afraid that my “other half” will leave me;
• My romantic relationships are tumultuous but unstable;
• My attitude towards people and life is changing dramatically, and I don’t understand why;
• I often behave recklessly and understand that it is dangerous: casual sex, drugs, drinking, extreme driving, uncontrolled spending;
• I purposely harm myself - cuts, burns, etc. up to suicide attempts;
• When I feel threatened in a relationship, I resort to impulsive gestures to keep my partner.

If several statements describe your condition, it may well be borderline personality disorder and you should see a mental health professional. He will make a diagnosis and prescribe comprehensive treatment.

Pathogenesis of BPD

The pathogenesis of the disease lies in incorrect or incompletely formed intrapersonal awareness of oneself, in other words, “self-identification.” Borderlines have difficulty understanding how they relate to major areas of life. They have problems with the concept of their opinions, interests, hobbies and their character as well. This is where the more common definition of the disorder – “borderline” – came from. In this aspect, it means maneuvering on the line between psychopathy and a stable state. The word “borderline” in this particular case means a precarious state between the norm and deviation, as if a person lives on the border between “mental illness” (psychosis) and “mental health”. That is why the slang name for patients of this type is “borderliners” (from the English expression “border line”, which literally translates as “border”).

In classical psychiatry, borderline personality disorder is also classified as a type of ego-syntonic disorder. Ego-syntonicity implies that the patient does not evaluate his condition as painful, is not critical of it, and calmly accepts deviations in behavior, without considering that they harm him in any way. Moreover, the patient seems to “defend” his symptom, preventing his own healing due to the difficulty in identifying his own “I”.

How to help yourself or a loved one at home

What is borderline personality disorder Photo: Depositphotos
In short, the essence of home help comes down to three things:

• Calm down;
• Learn to control your impulse;
• To communicate with people.

Let's look at how to implement this in practice.

Tip 1. How to reduce emotional intensity

A person with BPD has low self-esteem. He seems to feel guilty for what happened to him in childhood and is happening now. Therefore, he is afraid that others will find out who he really is. In such a situation, it is important not to suppress your feelings and emotions, but to experience them without judgment or evaluation:

• Observe the emotions, as if from the outside - imagine that these are waves that come and roll back;
• Focus on physical sensations during emotions;
• Accept all your sensations;
• Realize that as soon as you allow yourself these feelings, they will no longer be so acute.

The second exercise that will allow you to quickly calm down is to influence your senses. Use different strategies in different emotional states.

1. If you feel depressed, indifferent, lethargic, rinse your hands with cold or warm water, hold a piece of ice or squeeze any object, the edge of furniture, as tightly as possible.
2. If you need to calm down, take a hot bath or shower, hug your pet, or wrap yourself in a blanket.
3. If you feel empty, slowly eat a mint candy or a dish with an intense smell and taste - for example, something salty or spicy. If you need to calm down, drink hot mint tea or eat hot soup.
4. Aromatherapy effectively helps bring emotions back to normal. Use scented candles, your favorite perfume, citrus fruits, spices, incense. Smell the flowers.
5. Focus on a picture or photograph that catches your attention. Admire the beautiful landscape outside your window or simply imagine a place where you would like to be.
6. Sounds will help you get rid of depression. Turn on loud music and blow a whistle. If, on the contrary, you need to calm down, listen to the sounds of nature: the sea surf, the sound of the forest, the singing of birds - all this can be easily found on the Internet.

Not everyone responds to sensory sensations the same way. Therefore, you need to try different options and determine the most effective ones for yourself.

With borderline personality disorder, any situation can trigger negative emotions. To minimize negative factors, try to follow simple rules:

• Get enough sleep;
• Exercise;
• Balance your diet - your diet should contain complex carbohydrates, proteins and fats in the correct proportions. And as little sweets, fast food, sweet carbonated drinks and processed foods as possible;
• Learn to meditate to relax.

Tip 2. How to control your impulse

Impulsivity occurs when heavy thoughts take over. To escape from mental pain, a person causes himself physical pain or goes into extreme sports - dangerous driving, casual sex, drunkenness. He feels better for a short time, but does not solve the problem globally.

As an ambulance, we recommend several techniques that will help you quickly relieve stress - and this is the first step to learning to control your emotions.

1. Find a quiet, private place and sit comfortably. Focus on the sensations in your body - feel your arms, legs. Take a few deep breaths in and out. Watch your breathing carefully. After some time, the stress begins to release.
2. Take a deep breath, fill your lungs to capacity with air and exhale in a slow stream. Repeat ten times.
3. After inhaling and exhaling deeply, hold your breath. Count to twenty. After this, try to hold on for a few more seconds. And when you are already at the limit, start inhaling in a thin stream and imagine how the air gradually fills you. Repeat the exercise three to four times. Its essence is to switch the brain from emotional experiences to physiology - when there is not enough air, the body must save itself.
4. After breathing exercises, consolidate the result with sensory sensations: listen to your favorite music, smell soothing aromas, hug a cat or dog. An interesting movie, workout, or walk will help you calm down faster.

Tip 3. How to consolidate your results through communication

Communication is the third key to helping with borderline personality disorder. And it needs to be used in conjunction with the first two – reducing the intensity of emotions and controlling impulses.

It is important that a person with BPD communicates with those he trusts - talks about his old and new feelings. About what has changed after performing techniques and meditations. This method helps you quickly escape from difficult thoughts.

Causes of BPD

The underlying causes of borderline disorder are not clearly defined at this time, however, like most other disorders, BPD is caused by a group of factors.

Hereditary (genetic determination), physiological (impaired brain function) and social factors (low resistance to stress and psychological traumatic factors).

Unfavorable social environment

According to statistics, groups of people exposed to an unfavorable social environment, for example in the family, are more often susceptible to the disease. This may include:

• difficult childhood
• abuse,
• tyranny
• physical or emotional violence in the family,
• early loss of parents.

It is worth noting that among women “borderline” is 3 times more common than among men.

Post-traumatic stress disorder (PTSD)

, as a variation of an unfavorable social factor, can act not only as a cause, but also as a concomitant separate disease that is in a pathogenetic relationship with the diagnosis in question.

Chronic childhood emotional trauma may contribute to the development of BPD, but in rare cases it is the sole cause. Personal qualities responsible for the ability to cope with a stressful situation in this aspect also play a big role. It is worth noting here that, according to statistics, trauma received in childhood (especially before the age of 10) is much more likely to lead to subsequent disorder than that received in adulthood. Scientists also note that situations not associated with direct violence, such as natural disasters or catastrophes, are less likely to lead to the development of post-traumatic syndrome.

Physiology

Another group of factors considers a possible cause of the development of the disease - disturbances in the functioning of neural brain connections, namely the destruction of the functioning of frontal-limbic neurons

Heredity

The third significant cause of BPD is genetic predisposition, which accounts for up to 40% of cases of this diagnosis. It is quite difficult to achieve clear indicators in this regard, however, according to European studies, BPD is ranked 3rd out of 10 in terms of genetic determinants among personality disorders. It is logical to note that deviations in the functioning of certain lobes of the brain can be inherited and lead to a number of psychological problems, the development of which is aggravated by social factors. Most studies show that borderline personality is most often inherited from the mother.

Borderline Personality Disorder: What is it? And why is it now diagnosed and treated in teenagers?

What is borderline personality disorder? And why is it now diagnosed and treated in teenagers?

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful combination of emotional turmoil, unstable relationships and self-destructive behavior, including suicide attempts.

But new understanding of the disorder, leading to new, more effective treatments, has made the prognosis for people with BPD much more hopeful. With the right support, most people with BPD can successfully learn to control their emotions, stop self-destructive behavior, and improve their lives.

“It used to be that receiving a diagnosis of BPD was like being sentenced to a life of suffering,” said Dr. Alec Miller, an expert in treating teens with BPD. “But research now shows that the chances of improving performance and even eliminating diagnostic labeling are very high.”

Another important change is that BPD is now diagnosed and treated in adolescents. Until recently, mental health professionals were reluctant to provide diagnoses to people under 18, even though symptoms began in adolescence or even earlier. Experts now emphasize that treating BPD as early as possible leads to better long-term outcomes and also reduces the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it begins with a biological (or temperamental) tendency that is exacerbated by the social environment. People who develop BPD are temperamentally very emotionally sensitive and reactive, feeling things faster and more strongly than most people. And once a strong emotion arises, it takes them longer to return to their emotional stability.

BPD develops when one of these emotionally vulnerable people encounters an environment that does not validate her feelings, that is, acknowledge them, make her feel understood, and help her cope with them. In many cases, children who develop BPD have been abused or neglected. But the disorder can also occur in children whose loving and supportive parents downplay or underestimate their emotional reactions because they seem exaggerated or inappropriate.

Rejecting what seems like an overreaction is a fairly typical parental reaction. But for highly reactive children, chronic feelings of not being understood or supported lead to painful feelings of loneliness and disconnection. Friends and family don't understand why people with BPD react so strongly to little things. BPD is something like a peanut allergy, a reaction that may not be typical for most people, but is no less real.

Emotional dysregulation

When a child's strong feelings are not validated by the adults in her life, it becomes difficult for her to learn to manage them in a healthy way. Adults help us name and identify what we feel; by calming us, they teach us to calm and calm ourselves.

Take a person with extremely strong, intense emotions, who is constantly told that he is overreacting, he should not feel what he feels. As a result, he does not learn to regulate and modulate his emotions.

People with BPD are often filled with intense anger and feelings of abandonment, emptiness, shame, and self-hatred.

These feelings tend to destabilize relationships in people with BPD, who are hypersensitive to social cues from others and are more likely than others to interpret things negatively. Minor slights—or things misinterpreted as slights—are seen as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in the blink of an eye. Or they become so frantic, asking for reassurance that they are loved—incessantly texting, calling, begging, clinging—that they push their partners away.

He notes that disagreements with friends or separation from partners often lead to self-harm or suicide attempts.

Why does BPD lead to self-destructive behavior?

Without skills to more effectively manage painful feelings, people with BPD often find unhealthy alternatives, including substance abuse, risky sex, and reckless sensation seeking.

Self-harm is very often one of these behaviors, with teenagers using things like cutting, scratching and picking to relieve emotions they find unbearable. In fact, it may work as an emotional regulation strategy. The problem is that if it works, they will likely use it again to cope with negative emotions. To reduce self-harm, we need to acknowledge what it does to them and try to offer them safer replacement strategies.

One dangerous misconception about BPD is that emotional drama and self-destructive behavior, including suicide attempts, are manipulative cries for attention.

Historically, people with BPD have been viewed as deliberately manipulative, resorting to extreme measures to obtain things by deceiving the people around them. But this is not at all the same. These people are in a lot of pain and feel like they can't get what they need.

In fact, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.

Diagnosis criteria for BPD

Here are the criteria that mental health professionals use to diagnose borderline personality disorder: 1. Frantic attempts to avoid rejection, real or imagined 2. A pattern of unstable and tense relationships 3. An unstable self-image or sense of self 4. Dangerous impulsivity, such as unsafe sex contacts, substance abuse. 5. Repeated suicidal behavior, gestures, threats or self-harm. 6. Emotional instability due to high reactivity 7. Chronic feeling of emptiness 8. Inappropriate, intense anger or difficulty controlling anger 9. Transient stress-related paranoia or severe dissociative symptoms

Diagnosis of teenagers

In the past, mental health professionals have been reluctant to diagnose anyone under the age of 18 with BPD, although symptoms typically develop during adolescence. This was partly because emotional tension and impulsive risk-taking are to some extent characteristic of adolescence itself. It was believed that typical adolescent behavior could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different between typical adolescents and people with BPD. Typical teenagers experiment with alcohol and sex out of curiosity and impulsiveness, while people with BPD use them to avoid acute painful feelings. They may seek sexual encounters, for example, because they feel abandoned and crave intimacy rather than sex itself. They may take dangerous risks because “in a moment of desperation, the need to change how they feel makes their behavior seem right.”

Another reason for not diagnosing BPD in adolescents was to avoid labeling it a serious illness that is difficult to treat. But as the treatment landscape has changed, so has the attitude toward diagnosis in adolescence.

Why early diagnosis is important

If BPD is defined as a deficit in emotional regulation skills, it is important to bring someone who develops symptoms into treatment as soon as possible, before maladaptive behavior patterns develop.

This is especially important as young people develop their identity and self-esteem, which is incredibly difficult for young people with BPD symptoms. When your environment doesn't reflect your experiences, it's difficult to understand who you are and what your values ​​are.

Another reason why experts push for earlier diagnosis of BPD is to reduce underdiagnosis of more common disorders such as ADHD, depression and bipolar disorder. Sometimes these are co-occurring disorders, but often this is a misdiagnosis. As a result, these teens are given ineffective medications, including mood stabilizers and antipsychotics.

Treatment for BPD

There are a number of specialized psychotherapies designed to treat BPD, but the gold standard treatment—the method with the most evidence for its effectiveness—is called dialectical behavior therapy, or DBT. The reason it is called "dialectical" is because it involves two things that may seem opposite, but are both important: the need for acceptance and the need for change.

First, the patient's feelings need to be validated or accepted without judgment so that she learns more effective ways to manage and respond to them. “It’s essentially ‘I’m doing the best I can’ on the one hand and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means acknowledging and accepting another person's feelings as real. This does not mean agreeing with the thoughts or feelings. When people feel accepted and understood, it has a calming effect and allows them to gain emotion regulation skills and develop safer and more effective alternatives to the self-destructive behaviors they have been engaging in.

Essentially, it is a skills-based approach that says that if our patients could do better, they would, but they lack the skills. It's so easy for us to tell people to stop the problem behavior, but it's better to teach them new skills.

DBT skills are very effective in getting patients to stop self-harm and suicidal behavior. It is more difficult to change the self-hatred that may merge with the borderline's personality.

Author: Psychologist Kirill Filippov

Borderline mental state in psychiatry and severity of personality disorders

In clinical psychiatry, three levels of mental disorder are traditionally distinguished:

• Neurotic
  . This includes neuroses of various types, implying reversible temporary conditions that can be treated.
• Psychopathic
  level. In its plane lie personality disorders, which include character anomalies of various pathogenesis or painful changes in his traits, with which nothing can be done, since they relate to the personal structure of the individual.
• And finally, the deepest damage to the psyche manifests itself at the psychotic
  level. This includes manifestations such as delusions, hallucinations, and twilight consciousness.

In modern psychoanalysis, there are 4 levels of deviations. Between the state of psychosis and neurosis the “ borderline”

level", also called
borderline state
. A borderline state can mean both the disorder itself and a designation of the level of mental damage.

Treatment of borderline disorder in Moscow

Therapy for this disease is based on a combination of conservative methods and the latest techniques with medications. All patients require courses of psychotherapy, as well as the use of medications with a specific spectrum of action. Cognitive behavioral therapy has proven itself well, helping to restore the adaptive potential of the psyche.

The specialist works in the following areas:

• rethinking the patient’s lifestyle;
• a detailed discussion of his problems, aspirations, desires;
• developing skills to control one’s behavior and spontaneously arising emotions;
• formation of protective mechanisms that will help in time to get rid of stress and anxiety;
• developing skills of constructive communication with other people.

Consultations can be individual or group. Communication with a psychologist in a confidential environment helps to relax, understand and acknowledge your condition. The second option involves the participation of friends, relatives, and other significant persons in the program. The specialist teaches all participants how to avoid conflict situations. Individual indicators of the course of the disease include the use of drugs from the following groups:

• antidepressants;
• neuroleptics;
• tranquilizers.

How to Reliably Identify Borderline Personality Disorder (BPD)

Borderline personality disorder is extremely difficult to diagnose and differentiate, as it has a high level of comorbidity, in other words, it is combined with a large number of concomitant disorders. For example, panic anxiety, eating disorder, bipolar affective disorder, attention deficit disorder, sociopathy, and so on. Due to the above, the patient has to undergo a lengthy diagnostic process and special tests.

Test for borderline personality disorder BPD

One of the fairly popular tools for identifying the presence of psychopathy are tests, which are essentially a personality questionnaire. The test used in modern clinical psychology to screen for strong signs of BPD was developed in 2012 by a group of scientists. In their work, the authors relied on the basic criteria for differentiating borderline disorder.

The questionnaire edited by them is a fairly effective tool for diagnostic verification and confirmation of symptoms. It is used both in psychiatric and general clinical settings, as well as in other practices that are not directly related to medicine.

The test itself consists of 20 questions and asks the test taker to answer only yes or no. For each answer, the system counts a certain number of points. The likelihood of diagnosing BPD appears if the respondent scores more than 25 points.

Summarize

What is borderline personality disorder Photo: Depositphotos

BPD is a disease that is accompanied by a whole bunch of other disorders. It is difficult to diagnose and takes a long time to treat, because the person perceives the symptoms as part of himself.

People with borderline personality disorder create many problems for their loved ones. But this disease can and should be treated. The main thing is not to try to solve the problem yourself, but to contact a specialist and follow all his instructions.

Material prepared by: Alexander Sergeev Cover photo: Depositphotos

Sources

Borderline Personality Disorder Borderline personality disorder (BPD) Borderline personality disorder Borderline personality disorder. In outline