Borderline Personality Disorder

Borderline personality disorder is a disorder of relating to others and to self. Persons diagnosed with borderline personality disorder display a pervasive pattern of instability of interpersonal relationships, self-image, and affects (feelings), and marked impulsiveness beginning by early adulthood and present in a variety of contexts.

Persons with BPD tend to have difficulty understanding themselves, other people, and the nature of the relationships they have with other people. They tend to see themselves as fairly worthless and empty inside, or to not really "know" who they are.

They tend to use the defense mechanism known as splitting a lot, and to see others (and themselves) in a very black or white, good or bad sort of way. They are typically emotionally unstable (labile), and frequently will have outbursts of anger or depression, alternating rapidly with good feelings about themselves.

As you might imagine, they have intensive relationships that do not tend to last very long. BPD persons are also very impulsive and frequently cannot or do not stop themselves from acting out in self-destructive ways (spending money they don't have, abusing drugs and alcohol, binge eating, sexual promiscuity, etc.).

They are also prone to feelings of suicidality. Some BPD persons (not all) engage in 'cutting' behaviors where they cut or burn their skin - not to kill themselves - but rather to self-punish or to have a sense of control over their internal chaos or to feel the sensation and know that they are indeed alive (and not just empty inside).

There are treatments for BPD that are proven effective, not as a 100% cure, but in alleviating some of the suffering these people go through. The best studied form of psychotherapy, (Dialectical Behavior Therapy or DBT; Marsha Linehan, Ph.D) is known to be helpful, as are some psychiatric medications. See the Personality Disorders center for more information.

Symptoms

A person who suffers from this disorder has labile interpersonal relationships characterized by instability. This pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's affect, or feelings. Relationships and the person's affect may often be characterized as being shallow. A person with this disorder may also exhibit impulsive behaviors and exhibit a majority of the following symptoms:

• frantic efforts to avoid real or imagined abandonment.
• a pattern 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