Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a serious and complex mental health disorder marked by patterns of ongoing instability in moods, behaviour, self-image, and functioning. These patterns often result in impulsive actions, turbulent relationships, and self-harming behaviours. For instance, it’s estimated that 1.6% of the adult population in the UK has BPD, though it may be as high as 5.9%. Approximately 75% diagnosed are women, though recent research suggests men may be equally affected but often misdiagnosed with PTSD or depression. Treatment options for BPD include psychotherapy, medication, and hospitalisation.

If you suspect you or someone else is experiencing Borderline Personality Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.

Causes

BPD doesn't have a single cause. It’s believed to result from a combination of genetic, brain, environmental, and social factors. Childhood trauma, such as abuse or neglect, is strongly associated with the disorder. Certain brain structures involved in regulating emotions and decision-making may function differently in people with BPD, suggesting a neurological basis. Genetics might also play a role, as the disorder sometimes runs in families.

Risk Factors

The primary risk factors include:

1. Family History: Having a close family member, like a parent or sibling with BPD or another personality disorder, might increase the risk.

2. Traumatic Events: Many people with BPD report experiencing traumatic life events, such as abuse, abandonment, or adversity during childhood.

3. Brain Abnormalities: Structural and functional changes in regions that control emotions and impulses might contribute to symptoms. Complications arising from BPD can be severe and include self-harm, suicide attempts, co-existing mental health disorders like depression or eating disorders, and issues with work, social situations, and relationships.

Symptoms

BPD symptoms include:

1. Emotional Instability: Swift mood changes, which can last a few hours to a few days.

2. Disturbed Patterns of Thinking: Feeling suspicious or out of touch with reality.

3. Impulsive Behaviour: Engaging in potentially harmful activities like spending sprees or unsafe sex.

4. Intense and Unstable Relationships: Idealising someone one moment and feeling they don't care the next.

5. Fear of Abandonment: This can result in frantic efforts to avoid real or imagined abandonment.

6. Self-Image Issues: Changing goals, values, and seeing oneself as bad or non-existent.

7. Self-Harm and Suicidal Behaviour.

8. Chronic Feelings of Emptiness.

9. Anger: Intense or uncontrollable anger, frequent temper outbursts.

10. Paranoia and Disassociation.

Diagnosis

Medical Professionals Involved: Typically, a clinical psychologist, psychiatrist, or another mental health professional will be responsible for diagnosing BPD. These professionals are trained to understand the complexities and nuances associated with personality disorders.

1. Comprehensive Interview:

• Symptom Checklist: The professional might use a checklist to determine the presence of BPD-specific symptoms.

• Medical and Psychiatric History: An in-depth exploration of an individual's medical and psychiatric history can provide context and help distinguish BPD from other conditions.

• Personal Life and Relationships: Discussions about personal life, relationships, work, and school can provide insight into the longstanding patterns of behaviour and interpersonal difficulties characteristic of BPD.  

 2. Psychological Evaluation:

• Structured Clinical Interviews: These standardised interviews, such as the Structured Clinical Interview for DSM-5 (SCID-5), can help in ensuring that the BPD diagnosis is consistent with established diagnostic criteria.

• Questionnaires: Certain self-report questionnaires like the Borderline Personality Questionnaire can provide supplementary data, but they usually aren't solely relied upon for a diagnosis.

3. Differential Diagnosis: Because BPD shares many symptoms with other psychiatric disorders, it's crucial to distinguish it from:

• Mood Disorders: Like bipolar disorder, which also involves mood swings but typically over more extended periods.

• Other Personality Disorders: Especially histrionic, narcissistic, and avoidant personality disorders. Each of these has specific features that need to be teased out.

• Post-Traumatic Stress Disorder (PTSD): Some symptoms of PTSD, especially dissociative symptoms and impulsivity, can overlap with BPD.

4. Medical History and Physical Examination: Though BPD is a psychological diagnosis, a medical examination can:

• Rule Out Physical Illness: Some medical conditions can mimic or contribute to psychiatric symptoms. Thyroid disorders, for example, can influence mood.

• Substance Use Assessment: It's crucial to distinguish between symptoms caused by substance abuse and chronic personality-related symptoms. For instance, alcohol or drug use can lead to impulsive behaviour or mood swings.

5. Co-occurring Disorders: Many with BPD also have another co-existing mental health disorder. Recognising these is vital for comprehensive treatment. Common co-occurring disorders include:

• Depression

• Anxiety Disorders

• Substance Use Disorders

• Eating Disorders

• Bipolar Disorder

Diagnosing BPD can be challenging because its symptoms overlap with many other conditions, and individuals can present very differently. It's not uncommon for a person with BPD to be misdiagnosed initially and only receive the correct diagnosis after further evaluation. It's worth noting that, while diagnostic criteria provide a framework, the real-life presentation of BPD can be diverse. The key is the pattern of longstanding interpersonal difficulties, unstable self-image, impulsivity, and emotional instability. Making an accurate diagnosis requires a holistic understanding of the individual and their life circumstances.

Treatments

1. Psychotherapy: This is the primary treatment, including Dialectical Behaviour Therapy (DBT), which focuses on teaching coping skills.

2. Medication: No drug is FDA-approved for BPD, but some, like antidepressants, antipsychotics, and mood stabilisers can help with certain symptoms.

3. Hospitalisation: For those who pose a risk to themselves.

Preventive Measures

Early intervention during teenage or young adult years might help reduce the severity of symptoms. Therapeutic interventions can also reduce the chance of developing co-occurring disorders.

1. Early Intervention:

• Identifying At-Risk Individuals: Children or adolescents displaying early symptoms of emotional dysregulation, impulsivity, or interpersonal difficulties might benefit from early intervention.

• Professional Counselling: Young individuals showing signs of BPD can be referred for therapy to address symptoms before they intensify.

2. Trauma Prevention and Management:

• Address Childhood Trauma: Given the strong link between BPD and traumatic events like abuse, neglect, or loss, early identification and intervention for trauma victims can be crucial. This might include therapy, support groups, or other community resources.

• Safe Environment: Ensuring a safe and stable environment for children can significantly reduce the risk of trauma that might predispose someone to BPD.

3. Family Therapy:

• Educate Families: Families can be educated about BPD and its risk factors, helping them recognise and address potential issues early on.

• Improve Communication: Family therapy can promote healthier communication, reducing environmental stress that might exacerbate BPD symptoms.

4. Substance Abuse Prevention:

• Education and Awareness: Given the relationship between substance misuse and BPD symptoms, early education about the dangers of drugs and alcohol can be preventive.

• Access to Treatment: Ensuring young people have access to substance abuse treatment can help address one risk factor for BPD.

5. School-Based Interventions:

• Social and Emotional Learning Programs: These can teach children better emotion regulation, resilience, and interpersonal skills.

• Counselling Services: Access to school counsellors can provide a frontline of defence against the emergence of BPD symptoms.

6. Community Support:

• Support Groups: For those at risk or showing early signs, support groups can provide understanding, validation, and coping strategies. 

• Public Awareness: Raising awareness about BPD in the wider community can reduce stigma, leading to earlier diagnosis and intervention.

7. Regular Medical Check-ups:

• Monitoring Mental Health: Routine medical and psychological check-ups can help identify emerging symptoms or escalating behaviours associated with BPD, leading to timely interventions.

8. Promote General Well-being:

• Healthy Lifestyle Choices: Regular exercise, a balanced diet, adequate sleep, and avoiding drugs or excessive alcohol can support overall mental well-being.

• Mindfulness and Stress Reduction: Techniques such as meditation, deep breathing exercises, and yoga can help with emotion regulation, a core challenge for those with BPD.

9. Genetic and Prenatal Factors:

• Research: While there's evidence of a genetic predisposition towards BPD, ongoing research might provide clearer guidelines on prevention in the future.

• Prenatal Care: Ensuring pregnant individuals receive adequate prenatal care, including addressing maternal stress or substance use, might reduce risk factors associated with BPD.

Do's & Don’t's

If you suspect you or someone else is experiencing Borderline Personality Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.