Borderline Personality Disorder: causes, symptomatology and treatment

What are the characteristics of this personality disorder, and how to treat it?

The Borderline Personality Disorder o BPD is considered one of the most severe personality disorders, along with Paranoid Personality Disorder and Schizotypal Disorder, as many experts conceive of them as more pronounced versions of each other.

In that sense, BPD may share many characteristics with other personality disorders. personality disorderssuch as dependent, histrionic, avoidant or antisocial.

Borderline Personality Disorder

The concept of Borderline Personality Disorder has raised various doubts and characteristics that have been debated among the academic community. However, according to the DSM-V we can now know the symptoms, causes and most effective treatments for this disorder.

Symptoms

DSM diagnostic criteria include:

• Frantic efforts to avoid abandonment, real or imagined;
• Alternating extremes of idealization and devaluation in interpersonal relationships;
• Markedly unstable self-image;
• Potentially dangerous impulsivity, for example in relation to money, sex, substance abuse or binge eating;
• Self-harm or suicide threats or attempts;
• Mood instability due to marked emotional reactivity;
• Chronic feelings of emptiness;
• Intense and inappropriate anger or difficulty controlling anger;
• Paranoid ideation or severe, transient, stress-related dissociative symptoms.

Causes

It is currently believed that Borderline Personality Disorder is the result of a combination of a Biological predisposition to feel high emotional reactivitywhich would lead to especially frequent and intense episodes of impulsivity or irritability, and a disabling environment.

Marsha Linehan, creator of this concept and expert in Borderline Personality Disorder, defines the disabling environment as one in which caregivers project their own emotions and motivations onto the child instead of acknowledging and approving of the child's emotions, with negative emotional displays not being tolerated. Thus, the child's analysis of his or her experiences would be trivialized (e.g., by saying "You are angry but don't want to admit it") and conveyed as being caused by negative personality traits, which would be summarized in messages such as "You are bad". Without proper validation of one's own experiences, the child cannot learn to correctly label his or her emotions or consider his or her reactions natural, which hinders the development of identity.

Childhood traumas

Borderline Personality Disorder has also been frequently associated with childhood trauma.Among the risk factors for the development of the disorder are neglect and emotional abuse, witnessing domestic violence, parental criminality and substance abuse, and, in particular, repeated sexual abuse. It has been hypothesized that this type of chronic victimization would lead the child to believe that he is vulnerable and helpless and others are dangerous and thus affect his ability to form secure and satisfying attachments.

According to Pretzer (1996), people with Borderline Personality Disorder conceive of the world in dichotomous terms, i.e., their views of themselves, the world and the future tend to be either completely positive or completely negative. This way of thinking would lead to ever intense and rapidly shifting emotions from one extreme to the other, with no possibility of middle ground. As a natural consequence, others perceive these changes as irrational and random.

Self-injurious behaviors

The tendency of people with Borderline Personality Disorder to feel negative emotions more intensely and frequently than most people explains in part their propensity for drug use. propensity for drug use, binge eatingThe tendency of people with Borderline Personality Disorder to feel negative emotions more intensely and frequently than most people explains in part their propensity for drug use, binge eating - and thus bulimia nervosa - or risky sexual relationships.

All of these behaviors are carried out with the intention of reducing distress, as is also sometimes the case with self-injurious behaviors, which are used to temporarily divert attention away from negative emotions. Many people with Borderline Personality Disorder who engage in these behaviors report that they feel little or no pain during these episodes, which are most common between the ages of 18 and 24.

Relationship to emotional dependence

The self-devaluation inherent to Borderline Personality Disorder is related to the intense need to have an intimate relationship with another person, whether romantic or not.. These relationships reduce feelings of emptiness and lack of personal value and make the person with Borderline Personality Disorder feel protected in a world that, as has been said, he or she conceives as dangerous. Their need to be attached to the significant other being so strong, it is not surprising that people with Borderline Personality Disorder are extremely sensitive to the possibility of being abandoned; banal acts of others are often interpreted as signs of impending abandonment.

Thus, not only are frequent outbursts of despair and anger at others a consequence, but self-injurious behaviors may be used as attempts to manipulate others into not leaving them or as a way of getting revenge if they feel they have been abandoned. BPD symptoms tend to decrease with age, including self-injurious behaviors. However, in older people these may manifest themselves in somewhat different ways, such as through neglect of diet or pharmacological treatments.

Paradoxically, however, the strong attachment to the other can also lead to the fear that one's own identity, fragile and unstable, will be absorbed. It is also feared that the more intimate the relationship, the more painful the perceived inevitable abandonment will be. This is why the chaotic interpersonal behavior of people with Borderline Personality Disorder may in some ways be considered an unconscious strategy to avoid a stability that may be feared as much as feelings of emptiness.

In this way, many people with BPD fluctuate between fear of loneliness and fear of dependence, maintaining and fear of dependence, keeping their relationships for a time in an unstable and pathological equilibrium. Others, feeling frustrated and exasperated, tend to withdraw from them, which reinforces their belief that they deserve to be abandoned, setting up a vicious circle in which the person with BPD causes the very thing he or she fears will happen.

BPD and depression

BPD entails a strong predisposition strong predisposition to depressive episodesIt is associated with low self-esteem, feelings of guilt, hopelessness and hostility towards others. In fact, some experts state that BPD could be considered a mood disorderand the emotional instability characteristic of BPD has even been linked to bipolar disorder, which is defined by alternating between periods of weeks or months of depression and others of pathologically elevated mood.

Treatments

It is probably the very severity of Borderline Personality Disorder that has led to more research being done on its treatment than on that of any other personality disorder, so that it is currently the only one for which an effective treatment is known. We refer to Dialectical Behavior Therapy, devised in the 1990s by the aforementioned Linehan (1993), who, to the surprise of the scientific community, recently revealed that she herself was diagnosed with BPD.

The Dialectical Behavior Therapy is based on the apparent paradox that, according to Linehan, led to her improvement and motivated her to develop her therapy: in order to change, radical self-acceptance is necessary. Among other strategies, this treatment includes emotional regulation, social skills training and belief modification.

Bibliographical references:

• Carey, B. Expert on Mental Illness Reveals Her Own Fight. The New York Times Online. June 23, 2011. Retrieved from http://www.nytimes.com/2011/06/23/health/23lives.h...
• Linehan, M. M. (1993). Cognitive-behavioral therapy of borderline personality disorder. New York: Guilford Press.
• Millon, T.; Grossman, S.; Millon, C.; Meagher, S.; Ramnath, R. (2004). Personality disorders in modern life, 2nd Ed (pp. 493-535). Hoboken, New Jersey: John Wiley & Sons.
• Pretzer, J. L. & Beck, A. T. (1996). A cognitive theory of personality disorders. En J. F. Clarkin & M. F. Lenzenweger (Eds.), Major theories of personality disorder (pp. 36–105). New York: Guilford Press.
• Stone, M. H. (1981). Borderline síndromes: A consideration of subtypes and an overview, directions for research. Psychiatric Clinics of North America, 4, 3-24.