What is a Borderline Personality Disorder?

Borderline personality disorder is a severe mental illness.
It is marked by unstable moods, behavior, and relationships.

Borderline Personality Disorder

In the past psychological literature described patients with symptoms of neurosis and psychosis.
These descriptions caused a lot of diagnostic confusion.
They gave these cases names and in identifying the problem stressed their "borderline situation".
Gradually, a precise diagnosis was established.
This Borderline Personality Disorder was included in the category of personality disorders.

Causes of Borderline Personality Disorder

Many theories have been used to explain BPD.
Described below are the major theories.

Psychoanalytic Theory

In particular, according to Object Relationships Theory, individuals diagnosed with Borderline Personality Disorder had early relationships defined by a lack of warmth and emotional support.
These relationships led them to develop a fragile ego.

This fragile ego in turn caused them always to seek the approval of others.

There are some cases in which the BPD is part of a post-traumatic disorder or dissociative disorder.

This has its roots in serious, frightening abuse or childhood neglect.

The inability to understand the conflicting aspects of themselves or others and to accept uncertainty makes it difficult to control emotions and leads to passionate and emotional fits.
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Behavioural Approach

According to dialectical behaviour therapy, the key feature of the borderline person is "the removal of emotional regulation."

Emotional deregulation is the result of having difficulty in defending themselves emotionally and inability to manage feelings.

Dialectical behaviour therapy also argues that many individuals diagnosed with Borderline Personality Disorder come from families that tend to disprove the emotional experiences of their children and expect them always to be happy and without difficulties.

If they fail at something, this is interpreted as their fault.

So the child never receives support for small daily difficulties and can only gain the attention and care of the parents through intense emotional outbursts, which are a learned behaviour.

Additionally, since these little worries and trials are not dealt with by their parents, children do not learn ways to deal with their emotions or to comfort and soothe themselves.

Cognitive Approach
According to the cognitive model, three basic assumptions are often attributed to borderline patients and believed to play key roles in the disorder.

These are:
• "the world is dangerous and malicious."
• "I am weak and vulnerable."
• "I am naturally unacceptable."

Borderline Personality Disorder Risk Factors

Symptoms of Borderline Personality Disorder often present during puberty, almost always by young adulthood and are more frequent in women than men.

BPD occurs more frequently in people with the following features:

Environmental factors: a history of unstable relationships, childhood neglect, sexual abuse and family violence
Genetic/hereditary factors: family history of the disorder

Borderline Personality Disorder Symptoms

The four major components of BPD according to Morey are:

1. difficulties in establishing a secure identity; low self-esteem; instability of the idea, conception, or mental image one has of oneself; always changing personal and professional goals
2. unstable personal relationships; strong fear of abandonment often demonstrated as a pattern of extreme attachment and intimacy followed by a sudden withdrawal (from idealisation to devaluation).
3. impulsive and suicidal behaviour
4. difficulty in controlling anger and other emotions; unpredictable changes in mood; lack of emotional control, stress, panic, hopelessness, anger.
   Individuals also complain about a profound sense of emptiness and in extremely stressful situations may present paranoid ideation, illusions or dissociative symptoms.

BPD Treatment

Treatment for this disorder is long-term in nature because the symptoms have been present for an extended time and interfere with many aspects of the person's life.

Some professionals suggest supportive psychotherapy and others insight-oriented therapy.

Research shows increased support for a cognitive-behavioural approach.

A combined approach may be best, but all treatments require intensive time and effort.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.
Beck, A.T. (1990). Cognitive therapy of personality disorders. ed New York, Guilford Kernberg
Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
Morey, L. C. (1991). Personality Assessment Inventory: Professional manual.Odessa, FL:Psychological Assessment Resources

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