Borderline Personality Disorder is an often misdiagnosed, vague, but relatively common mental illness.  About 1 in 20 individuals will live with this condition and never really have a defining reason for its characteristics.  The following list of symptoms gives you an idea why this is true, as most of us can relate to degrees of quite a few of the items listed!

  1. Marked mood swings with periods of intensity, irritability and/or anxiety lasting a few hours to a few days.
  2. Inappropriate or intense anger that gets out of control.
  3. Impulsive behaviors that have adverse outcomes that include psychological distress. This may include excessive spending on a shopping spree, substance abuse, unwise sexual encounters.
  4. Making suicidal threats or non-suicidal self-injurious behavior such as cutting.
  5. Having unstable, intense personal relationships that are sometimes “all good” (Idealization) or “all bad” (devaluation).
  6. Persistent second guessing oneself about self-image, goals, friendships and values.
  7. Constant boredom and feelings of emptiness.
  8. Frantic efforts to avoid being left alone or abandoned.

The exact causes of Borderline Personality Disorder remain unknown, which adds to its perplexity.  It is thought, however, that both environmental and biological factors could be significant.  There has been no specific gene singled out to be directly involved in the cause, but there are a number of genes that have been identified as having a role in the development of the illness.  With brain image testing the brain’s functioning often appears different in people with Borderline Personality Disorder.  This suggests there is some neurological basis.  Also playing a role, a number of hormones seem to be involved such as oxytocin and signaling molecules in the brain which are neurotransmitters such as serotonin.  One thing we do know is that people who have experienced traumatic life events such as physical or sexual abuse in their childhood, and people that have dealt with a chronic medical illness in childhood are more prone to manifest Borderline Personality Disorder.

Psychotherapy is the cornerstone for treatment in this diagnosis.  Dialectical behavioral therapy is the most well researched and effective treatment to date.  Dialectical behavioral therapy is therapy that examines the idea or opinions of the patient through questions and answers to determine the validity of feelings and reactions they are dealing with and applying logical argumentation with the theory that the argumentation will generate the possibility of reconciliation to an opposite reactionary thought , thus dispelling “borderline” thinking.  This helps instill coping skills that can be used to help recognize and control their symptoms.  Some of these coping skills include practicing mindfulness, deep breathing, meditation, and forms of relaxation.

Medications play a role in dealing with specific situations derived from Borderline Personality Disorder such as calming medications during an anger episode, valproate helps decrease impulsiveness, omega-3 fatty acids such as fish oil may be helpful in decreasing mood swings, and naltrexone has helped some people decrease urges for self-injury.  It needs to noted, however, that people with Borderline Personality Disorder are especially vulnerable to the side effects of medications.

During times of extreme stress, dangerous impulsive behavior, or substance abuse, hospitalization may be necessary, however in other cases using inpatient psychiatric hospitalization may be paradoxically detrimental.

In summation, the most critical factor in the care and treatment of someone with Borderline Personality Disorder is the support of family and friends who offer encouragement and consolation during those difficult times when the symptoms are manifested, and they tend to isolate themselves.  Ongoing psychotherapy supplemented by a healthy lifestyle that incorporates regular exercise, healthy diet, and good sleeping habits help promote a significant relief from symptoms.  While complete recovery is not in their future, all these avenues contribute to their living meaningful and productive lives.

 

Dani Kolsrud, TVLC Mental Health Representative