Emotional Dependence in Borderline Personality Disorder

Let's see what the psychological link between emotional dependence and BPD looks like.

A personality disorder is defined as a maladjustment based on a rigid and unhealthy pattern of thinking. This term encompasses a set of disturbances or abnormalities that occur in affective dimensions, social relationship with individuals and motivational domains. Up to 60% of psychiatric patients present some type of personality disorder, so it is considered the most frequent diagnosis in psychiatry.

Borderline Personality Disorder (BPD) is defined as a personality disorder that is characterized by emotional instability, extremely polarized and dichotomous thoughtsIt is characterized by emotional instability, extremely polarized and dichotomous thinking, chaotic interpersonal relationships and marked impulsivity. It is included in the B-cluster at the diagnostic level, within the so-called "dramatic-emotional" disorders. It shares this category with histrionic, narcissistic and antisocial personality disorders.

The prevalence of BPD is estimated to be 1.6% in the general population, but it accounts for 20% of psychiatric patients. These figures could be biased and the prevalences are probably much higher, due to the social stigma that (unfortunately) is still attached to being diagnosed with a psychological disorder. In the following lines, we explore the relationship of emotional dependence in Borderline Personality Disorder.. Do not miss it.

The diagnosis of Borderline Personality Disorder (BPD)

Before diving into the correlation between the two events, we feel it is necessary to give the public a brief overview of the characteristics of Borderline Personality Disorder. The Diagnostic and Statistical Manual of Mental Disorders (DMS-5), ratified in 2013 by the American Psychiatric Association (APA) sets the standard for the diagnosis of mental disorders.

According to this source, the patient with BPD must present at least 5 of the following traits for more than a year:

• Frantic efforts to avoid abandonment, whether real or imagined.
• A pattern of unstable interpersonal relationships, characterized by extreme poles of idealization and devaluation of people.
• Identity disturbance: constant changes in the patient's perception of himself/herself.
• Impulsivity in at least two areas that may be harmful to the patient: overspending, substance abuse, overeating, etc.
• Affective instability, marked by character reactivity. For example, episodes of dysphoria, anxiety or irritability, lasting only a few hours, are typical.
• A chronic feeling of emptiness.
• Difficulty in controlling feelings of anger and aggressiveness. Fights and direct confrontations are common in these patients.
• Transient paranoid ideas.

In addition to all these interesting data, medical researches such as Borderline Personality Disorder (StatPearls, NCBI) stipulates that Borderline Personality Disorder arises as a combination of genetic predisposition combined with events during childhood and certain neurobiological dysfunctionalities.. The heritability pattern of BPD has been found to be 50%, even higher than that of depressive disorders. On the other hand, up to 70% of patients have experienced violence, sexual abuse or neglect during childhood.

Emotional dependence and BPD

In the first of the points of the diagnosis of this pathology, it is evident that emotional dependence and Borderline Personality Disorder are closely linked.. The BPD patient is characterized by a marked feeling of emptiness and, in addition, has an irrational (and unjustified) fear of being abandoned by the people around him. However, beyond "obvious" causalities, we require scientific sources to confirm our suspicions.

The study Dependency, mood instability, and inconsequence traits for discriminating borderline personality disorderpublished in 2019, explores the correlation of BPD with emotional dependence, emotional instability, and inconsistency.. For this purpose, a total of 305 patients were divided into 3 groups: patients diagnosed with BPD, patients with other personality disorders and a standard sample group, i.e., a non-pathological sector of the population.

After this, a standardized survey (IDCP-2) was administered to each person in all sample groups, consisting of 206 questions that could be rated from 1 to 4, from "it has nothing to do with me" to "it defines me". This questionnaire quantifies the factors most related to Borderline Personality Disorder, such as self-devaluation, insecurity, anxiety, fear of abandonment, self-image problems, impulsivity, risky decision-making, etc.

The statistical analysis showed a significant correlation between BPD patients and emotional dependence, but also with emotional instability and inconsequence. In addition, it was observed that, within the factors included in the "dependence" sector (self-devaluation, fear of abandonment and insecurity), fear of abandonment was the best predictor of all factors.. This makes a lot of sense at the psychological level, since insecurity, low self-esteem and impulsivity are easily associated with the fear of being left alone.

The scientific article Interpersonal dependency in borderline personality disorder: clinical context and empirical evidence goes even further, as it stipulates that there is a clear comorbidity a clear comorbidity between Borderline Personality Disorder and Borderline Dependent Personality Disorder.. It is estimated that BPD presents with other emotional disorders in 80-96% of cases, so it is to be expected that commonalities between several of these entities will be found in many patients.

A clear causality

With these scientific data, we have shown that the correlation between BPD and emotional dependence is more than clear. Fear of abandonment is a very powerful diagnostic criterion when it comes to identifying a patient with Borderline Personality Disorder.Thus, the need not to lose those close to him or her is a typical feature of people suffering from this pathology.

Finally, we want to emphasize that BPD and other disorders can be treated. In this particular case, there is no medication approved by the Food and Drug Administration (FDA) for the pathology, as the effect of antidepressants, antipsychotics and other drugs is quite limited. De todas formas, sí que se ha demostrado la utilidad de la psicoterapia para mejorar la sintomatología de los pacientes, por lo que ante esta alteración es importante acudir al psicólogo.

Referencias bibliográficas:

• Carvalho, L. D. F., & Pianowski, G. (2019). Dependency, mood instability, and inconsequence traits for discriminating borderline personality disorder. Trends in psychiatry and psychotherapy, (AHEAD).
• Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364(9432): 453 - 461.
• Borderline Personality Disorder, Jennifer Chapman; Radia T. Jamil; Carl Fleisher (2020). StatPearls.
• Bornstein, R. F., Becker-Matero, N., Winarick, D. J., & Reichman, A. L. (2010). Interpersonal dependency in borderline personality disorder: Clinical context and empirical evidence. Journal of Personality Disorders, 24(1), 109 - 127.