Borderline personality disorder

Originally Published: June 3, 2005 - Last Updated / Reviewed On: March 18, 2014
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Hi Alice,

I think I might have borderline personality disorder. How is it diagnosed, how can it be treated, and what exactly is it?

Thanks.

Dear Reader,

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.

The specific cause(s) of BPD is currently unknown and research is still in its early stages. However, reserach suggests that common personality attributes of those with BPD are very likely inherited. Additionally, an unstable family or environment might also increase a person's risk of developing BPD. About 85 percent of people with BPD have co-occuring mental illnesses including depression, anxiety disorders, eating disorders, and substance abuse issues.

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 often 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. While there is no FDA approved medication for the treatment of BPD, many of those with the illness are prescribed medication in addition to psychotherapy. These medications are typically used to treat depression, anxiety and/or agression.

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 (Morningside) or the Mental Health Service (CUMC) to make an appointment for an evaluation.

For additional info about borderline personality disorder, you can check out the National Institute of Mental Health.

Alice