Borderline personality disorder
Originally Published: June 3, 2005
I think I might have borderline personality disorder. How is it diagnosed, how can it be treated, and what exactly is it?
Borderline personality disorder (BPD) is an emotional disorder affecting approximately two percent of the general population. BPD is a diagnosis where a person has persistent volatility in relationships, moods, behavior, and self-image. This constant fluctuation in actions often seriously hinders, or even destroys, one's impressions of his/her self-identity, work relationships, family life, and personal and professional growth. Twenty percent of people with BPD are in-patients at psychiatric facilities. Untreated, people with BPD have a high rate of self-injury. In the most severe instances of BPD, high incidences of attempted and completed suicides are noted.
Recent research indicates that 41 to 70 percent of those who have BPD come from childhoods where they were sexually abused, usually by a non-caregiver. While this number may seem high, others with BPD may be predisposed to responding to environmental stressors, perhaps a series of events as a young adult triggering the disorder, or the experience as a child of either neglect or abuse, or both. People with gambling addictions, eating disorders, and substance abuse issues are particularly prone to developing BPD. But others can certainly have BPD.
What is it that makes you think you might have BPD? Perhaps you've read a magazine article, or spoken with a friend who mentioned a diagnosis along with his/her own symptoms. It is important to identify your concerns and "clues," the things that you are worried about, when you see a clinician. It's possible that you could have something other than BPD, such as depression, anxiety, ADD, a combination of things, or you could be experiencing "normal" feelings.
If you feel that you have borderline personality disorder, it's useful to make an appointment with a psychiatrist or psychologist, for an appropriate diagnosis. When you speak with your medical provider or therapist, discuss what makes you think that you could have BPD.
BPD is diagnosed by a mental health care provider by taking a medical history and from talking with you. That way, the practitioner can identify certain traits that define this disorder. One attribute is a lack of psychosis, so that the person perceives reality correctly. Another trait is that of impaired ego integration, where the person does not understand who his/her true self is, as the perception of who s/he is constantly changes. Other "non-specific" signs include weak impulse control, low anxiety tolerance, inability to enjoy time spent with family and friends, and lack of pleasure from activities. Since BPD is extremely difficult to diagnose, this process takes several appointments to complete.
To treat BPD, both individual and group psychotherapy have been shown to help. A newer type of therapy specifically designed to address BPD, Dialectical Behavior Therapy (DBT), has been even more effective. Dialectical Behavior Therapy consists of weekly sessions where the therapist and patient focus on a past event with which the patient could not cope and, consequently, behaved erratically and emotionally. DBT teaches coping skills so that the person learns to deal with everyday situations that s/he normally could not handle well.
Another method used to treat borderline personality disorder is pharmacology. Mood stabilizers, such as valproic acid, and anti-depressants, such as paroxetine, have been shown to improve the depression of those with BPD. When thinking and perception are distorted, anti-psychotics, such as clozapine, are often used. Sometimes medications are also used in combinations, as well as used with a face-to-face form of talk therapy.
With a provider's help, and perhaps with appropriate medication, people can feel better, manage their feelings, and strengthen their personal/professional effectiveness. Either way, whether you have BPD or not, because you are concerned, it is smart to check this out with a mental health care provider. Regardless of your diagnosis, you deserve to feel better. Glad you reached out.
If you are a Columbia student, you can contact Counseling and Psychological Services (CPS) at x4-2878 to make an appointment for an evaluation.
For additional info about borderline personality disorder, you can check out the following resources: