BPD

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Borderline Personality Disorder
What are Personality Disorders?

Borderline Peersonality Disorder (BPD)


Borderline Personality Disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, BPD was listed in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “Borderline Personality Disorder” is misleading, a more accurate term does not exist yet.

People with BPD tend to experience:

  • Problems with regulating emotions and thoughts;
  • Impulsive and reckless behavior;
  • Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

  • Extreme reactions — including panic, depression, rage, or frantic actions — to abandonment, whether real or perceived;
  • A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation);
  • Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices);
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating;
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting;
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days;
  • Chronic feelings of emptiness and / or boredom;
  • Inappropriate, intense anger or problems controlling anger;
  • Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.
  • Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

What are Personality Disorders?


Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.

There are 10 specific types of personality disorders (such as borderline personality disorder). Common to all personality disorders is a long-term pattern of behavior and inner experience that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood, and causes distress or problems in functioning. Without treatment, the behavior and experience is inflexible and usually long-lasting. The pattern is seen in at least two of these areas:

  • Way of thinking about oneself and others
  • Way of responding emotionally
  • Way of relating to other people
  • Way of controlling one’s behavior

The 10 specific personality disorders are grouped into three categories called “clusters”.

Cluster A

Paranoid personality disorder: a pattern of distrust and suspiciousness where others’ motives are seen as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and are reluctant to confide in others or become close to them.

Schizoid personality disorder: a pattern of detachment from social relationships and a limited range of emotional expression. A person with schizoid personality disorder typically does not seek close relationships, chooses solitary activities and appears indifferent to praise or criticism from others.

Schizotypal personality disorder: a pattern of acute discomfort in close relationships, distortions in thinking or perception, and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or magical thinking, odd or peculiar behavior or speech, or may incorrectly attribute meanings to events.

Cluster B: dramatic, emotional or erratic behavior

  • Antisocial personality disorder: a pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively.
  • Borderline personality disorder: a pattern of instability in personal relationships, emotional response, self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid abandonment (real or perceived), have recurrent suicidal behavior, display inappropriate intense anger or have chronic feelings of emptiness.
  • Histrionic personality disorder: a pattern of excessive emotion and attention seeking. A person with histrionic personality disorder may be uncomfortable when he/she is not the center of attention, consistently use physical appearance to draw attention or show rapidly shifting or exaggerated emotions.
  • Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.

Cluster C: anxious or fearful behavior

  • Avoidant personality disorder: a pattern of social inhibition, feelings of inadequacy and extreme sensitivity to criticism. A person with avoidant personality disorder may be unwilling to get involved with people unless he/she is certain of being liked, be preoccupied with being criticized or rejected, or may view himself/herself as being inferior or socially inept.
  • Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behavior. A person with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of himself or herself.
  • Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfectionism and control. A person with obsessive-compulsive personality disorder may be preoccupied with details or schedules, may work excessively to the exclusion of leisure or friendships, or may be inflexible in morality and values. (This is NOT the same as obsessive compulsive disorder.)

Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. For a person under 18 years old to be diagnosed, the symptoms must have been present for at least a year. Some people with personality disorders may not recognize a problem. Also, people often have more than one personality disorder. An estimated 9% of U.S. adults have at least one personality disorder.

In a related condition, people can experience a personality change due to another medical condition.

Treatment

Certain types of psychotherapy are effective for treating personality disorders. During psychotherapy, an individual can gain insight and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings and behaviors. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances.

  • Commonly used types of psychotherapy include:
  • Psychoanalytic/psychodynamic therapy
  • Dialectical behavior therapy
  • Cognitive behavioral therapy
  • Group therapy
  • Psychoeducation (teaching the individual and family members about the illness, treatment and ways of coping)

There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be helpful in treating some symptoms. More severe or long lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychologist, social worker and family members.

In addition to actively participating in a treatment plan, some self-care and coping strategies can be helpful for people with personality disorders.

  • Learn about the condition. Knowledge and understanding can help empower and motivate.
  • Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety.
  • Avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms or interact with medications.
  • Get routine medical care. Don’t neglect checkups or regular care from your family doctor.
  • Join a support group of others with personality disorders.
  • Write in a journal to express your emotions.
  • Try relaxation and stress management techniques such as yoga and meditation.
  • Stay connected with family and friends; avoid becoming isolated.

Source: Adapted from Mayo Clinic, Personality Disorders

Family members can be important in an individual’s recovery by working with the individual’s health care provider on the most effective ways to help and support. But having a family member with a personality disorder can also be distressing and stressful. Family members may benefit from talking with a mental health provider who can provide help coping with difficulties.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. (2013).

Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. 2007. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553-564.
Source: projectsemicolon.com/borderline-personality-disorder/

 
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