Borderline Personality Disorder: how it affects the patient and his or her environment.

We explain how this disorder can influence the day-to-day life of the affected person.

Borderline personality disorder (BPD) is a type of personality disorder (PD) characterized by a long-term pattern in the patient of unstable relationships, distorted self-perception, extremely polarized and dichotomous thinking, and stronger than normal emotional and passionate reactions. In addition, BPD patients have an inclination to have a profound fear of loneliness and abandonment.

Although it may seem to be a condition confined to books and the psychiatric clinic, it is worth noting that the prevalence of BPD in general society at any given time is 1.6% of the population, with a probability of occurrence at any given time.with a lifetime probability of occurrence of almost 6%. Although no gender bias has been detected in the bulk of the population, it is known that the female population attends the clinic more often to treat this disorder, in a ratio of 3 women for every affected man.

With all these data, we want to show that borderline personality disorder is much more common than it seems, and maybe even someone in your environment has received treatment to address it without you knowing it. You may even suffer from it, without even being aware of it. In order to empathize, know and understand, today we will delve into how borderline personality disorder affects the patient and their environment.

The criteria for borderline personality disorder

As we have already mentioned, borderline personality disorder (BPD) is a mental a mental condition in which a person has prolonged patterns of turbulent, disorganized or unstable emotions.. The patient's inner experiences cause him/her to repeatedly behave impulsively and exhibit chaotic relationships with others. As a clinical condition/pathology/entity, BPD can be objectively quantified.

The American Psychological Association publishes, from time to time, its clinical work Diagnostic and Statistical Manual of Mental Disorders (DSM-V). As indicated in the latest update (2013) of this diagnostic guide, a patient with BPD must meet the following requirements:

• The patient makes frantic efforts not to be alone, whether this feared loneliness is real or imagined.
• Interpersonal relationships are intense and unstable, oscillating between idealization and devaluation events.
• Disturbance of identity: the patient's self-perception fluctuates constantly.
• Impulsivity in at least two areas that may be potentially dangerous (spending, sexual approaches, substance abuse, binge eating, etc).
• Recurrent suicidal behaviors, whether in the form of plans, threats, gestures or self-injury.
• Affective instability due to mood instability (dysphoria, irritability or anxiety). These outbreaks usually last a few hours or a few days.
• Chronic feeling of emptiness.
• Inappropriate and intense anger or difficulty in managing anger.
• Severe dissociative symptoms or transient stress-related paranoia.

All these symptoms are typical of the BPD patient, but he does not have to present all 9 to be diagnosed. According to the DSM-V, 5 of them being present from early adulthood to the time of diagnosis is sufficient.

The extent of BPD in the patient's life and environment

The pathophysiology of borderline personality disorder appears to be based on a genetic component encoding neurological abnormalities and a clear environmental influence. For example, neuroimaging studies have identified variations in the BPD patient in the amygdala, hippocampus, and temporal lobes, compared to individuals who do not manifest the condition.

In addition, it should be noted that the BPD patient is much more prone to show comorbidity with other pathologiessuch as mood disorders (88% of patients), anxiety disorders (88%), substance abuse disorders (64%), eating disorders (54%), adhd (10-30%), bipolar disorder (15%) and somatoform disorders (10%).

Based on these figures, we can say that BPD affects the patient in many more areas than it might at first appear. One of the main features is undoubtedly the fear of abandonment and rejection. A person with BPD type will feel, for example, that their life is not complete without their partner and that they cannot be without them, a trait that also falls under the symptomatology of dependent personality disorder (DPD).

He will also have a greater proclivity to carry out acts that he later regrets, such as overspending, reckless driving, gambling, sabotaging success, or suddenly cutting off a relationship that was actually positive. The environment, therefore, will perceive the BPD patient as a volatile, chaotic person with behaviors that are difficult to explain. To the outside world, BPD is synonymous with instability.

The environment may also perceive a clear emotional blackmail on the part of the patient.. In order not to be alone, the person may resort to threats, suicidal ideas or even self-harm, in order not to be abandoned at any time. Unconsciously, the person is making third parties responsible for his pain who have no reason to manage it, which fosters a very marked toxicity in interpersonal relationships in cases of BPD.

In the most marked cases, the patient may not finish his studies, have legal problems due to his impulsivity, become involved in abusive relationships, fall into some form of addiction (substance use disorder) and even experience frequent hospitalizations due to self-injury at critical moments. Undoubtedly, this condition must be addressed before any of these events take place.

BPD can be treated

If you have BPD and have been reading these lines, do not be discouraged.. You are not a worse person, less valid or less deserving of support and affection from your environment. Many people express this condition throughout their lives and, fortunately, it can be treated.

The first step is always to go to psychotherapy: mentalization-based therapy (MBT), dialectical behavioral therapy (DBT) and transference-focused psychotherapy (TFP) give very good results, in prolonged treatments lasting several months.

On the other hand, pharmacological treatment is also often used in patients who require it. Although they do not treat the condition by themselves, antidepressants (SSRIs), mood stabilizers and antipsychotics can help with anxiety attacks, self-harm impulses and many other events. With proper therapy and medical support, this disorder can be regulated.

If you are interested in having therapeutic support for an addiction, we invite you to contact us to start a treatment process as soon as possible. In Despertares Psicólogos we have been working for many years in the field of mental health and therapy adapted to all types of psychological disorders, and we can help you from any of our centers located in the main cities of the Community of Madrid.