Borderline Personality Disorder (BPD) is a mental illness where sufferers lack the ability to regulate their emotions. As a result, they are hypersensitive to rejection, have unstable relationships with others, and are highly impulsive. They also have problems with their self-image, affect, and with their behaviors.

Prevalence is estimated to be around 1.6% and a lifetime prevalence of 5.9%. Males and females are equally afflicted with BPD. In psychiatric institutions, as high as 20% are diagnosed to have BPD.

There are multiple reasons for BPD. BPD has been attributed to genes, which means having BPD is due to the fact that your parents or grandparents have had it. Next, environmental factors are also believed to play a part. About 70% of people who have BPD were maltreated in their childhood such as but not limited to, physical and/or sexual abuses, or neglect. Scientists have also proposed that low levels of serotonin in BPD patients could explain their behavior. 

People with BPD experience intense mood swings and feel unsure of their self-image. Their feelings for others change quickly and swing from affection to loathing. It is mainly because of this fluctuation in feelings that they develop unstable relationships with other people and cause them emotional pain.

They also tend to view things as black and white. Their values in life change quickly so they act impulsively.

Other signs and symptoms include:

• Efforts to avoid real or perceived abandonment;
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating;
• Self-harming behavior;
• Recurring thoughts of suicidal behaviors or threats;
• Chronic feelings of emptiness;
• Feelings of dissociation, such as feeling cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.

According to DSM V, to clinically diagnose BPD the patient must have five or more of the following:

1. Frantic efforts to avoid real or imagined abandonment; 
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation;
3. Identity disturbance: markedly and persistently unstable self-image or sense of self;
4. Impulsivity in at least two areas that are potentially self-damaging, for example, spending, substance abuse, reckless driving, sex, binge eating, etc; 
5. Affective instability caused by a marked reactivity of mood, for example, intense episodic dysphoria, anxiety, or irritability, usually lasting a few hours and rarely more than a few days;
6. Chronic feelings of emptiness;
7. Inappropriate, intense anger, or difficulty controlling anger, for example, frequent displays of temper, constant anger, recurrent physical fights;
8. Transient paranoid ideation or severe dissociative symptoms.

Note: suicidal or self-mutilating behavior is not part of criteria 1 and 4, only in 5.

Additionally, other professionals also use the following to aid diagnose BPD:

• The McClean screening instrument for borderline personality disorder;
• Personality diagnostic questionnaire;
• Structured clinical interview for DSM-5 personality disorders.

Treatment

Psychotherapy is the main treatment for BPD. Professionals use three therapy techniques, namely, mentalizing-based therapy (MBT), dialectical behavior therapy (DBT), and transference-focused psychotherapy (TFP). By helping patients feel understood, MBT enables them (patients) to be more inquisitive and less presumptuous about the motives of others around them. DBT integrates mindfulness techniques with practical interpersonal and emotion-management abilities. TFP is centered on using the patient-therapist interaction to enhance the patient’s awareness of negative interpersonal relationships.

No drugs have been approved yet to treat BPD.

Patients and their family should be informed on BPD and given access to the appropriate material. Families should be informed that their loved ones may become furious and suicidal, and they should seek care promptly. Furthermore, patients should be encouraged to seek and maintain psychotherapy until they find long-term improvement.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/

National Institute of Mental Health (2022). Borderline Personality Disorders. Retrieved October 21, 2022, from https://www.nimh.nih.gov/health/topics/ borderline-personality-disorder.