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Borderline personality disorder (BPD) is a form of mental illness that affects over four million Americans. It’s a serious mental health problem that is characterized by unstable moods, behavior and self-image. Because of the intensity of unstable emotions that is experienced by a person with BPD, this disorder often leads to self-harm and suicide.
Signs and Symptoms of BPD
A person with BPD struggles with an inability to manage emotions effectively. Symptoms usually begin in adolescence or early adulthood. Some of the signs and symptoms of BPD include:
- Intense fear of abandonment
- Rapid shifts in moods
- Unstable self-image
- Being highly sensitive to rejection
- Impulsive behaviors
- Unstable personal relationships
- Dissociative feelings such as disconnecting from one’s identity
- Hopelessness possibly leading to self-harm or suicide
- Intense anger and rage
- Self-harm
- Suicidal thoughts and behaviors
Why It’s Called Borderline
Borderline personality disorder wasn’t recognized as a psychiatric illness by the American Psychiatric Association until 1980. It’s classified as a personality disorder, which means it’s a disorder in how the individual relates to himself or herself and to other people.
Originally, this severe form of mental illness was considered to be on the borderline between psychosis and neurosis, which is where the term “borderline” came from. At one time, people with neuroses were thought to be treatable, while people with psychoses were thought to be untreatable.
A person with BPD tends to see things in extremes, and their feelings can change quickly. It’s really about emotional dysregulation rather than being psychotic, neurotic or something on the borderline between them.
What is Known About BPD Today
Today, the term “neurosis” isn’t used as a diagnosis, and BPD is not considered a disorder falling under the category of psychosis. BPD officially became a personality disorder in 1980 in the Diagnostic and Statistical Manual of Mental Disorders III (DSM III).
A personality disorder is a way of feeling, behaving and thinking that is different from cultural expectations and that causes distress and difficulty functioning. Some experts believe that BDP should be characterized as a mood disorder rather than a personality disorder, while others believe a personality disorder is more accurate, because BPD affects not just moods but also a person’s ways of interacting with others.
Diagnosing BPD
Diagnosing mental illnesses can be challenging, because there is no quick blood test or scan that can identify or properly diagnose this type of disorder. A mental health professional has to look at long-term patterns of symptoms and functioning
BPD is often underdiagnosed or misdiagnosed. People with BPD are often misdiagnosed as having other forms of mental illness, such as bipolar disorder. It may also be difficult to recognize BPD, because an individual may have other disorders at the same time such as depression, anxiety, eating disorders, PTSD or substance use disorder.
Treating BPD
Evidence-based therapy is one approach that can be effective in treating BPD because it creates a safe environment for a person with BPD to discuss their feelings and learn new behaviors. Examples of this type of therapy include:
- Cognitive Behavioral Therapy (CBT)
- Mentalization-based therapy
- Transference-focused psychotherapy
Dialectical Behavior Therapy (DBT) is a proactive, problem-solving approach that was designed specifically to control BPD. DBT targets out-of-control behaviors, particularly those that are life-threatening. It teaches skills for improving relationships, controlling intense emotions and reducing self-destructive behaviors.
The critical thing is to find a therapist and a support network that allows the individual to bring symptoms under control. For a person with BPD, what’s important is not what the disorder is called or what category it is put into, but coming up with a BPD treatment plan that allows them to be able to live a productive and stable life.
