Borderline Personality Disorder: Causes, Symptoms And Treatment
He Borderline Personality Disorder either TLP It is considered one of the most serious personality disorders, along with Paranoid Personality Disorder and Schizotypal Disorder, since many experts conceive them as more pronounced versions of the rest.
In that sense, BPD may share many characteristics with other personality disorderssuch as the dependent, the histrionic, the avoidant or the antisocial.
Various doubts and characteristics have arisen around the concept of Borderline Personality Disorder that have been debated among the academic community. However, according to the DSM-V we can already know the symptoms, causes and most effective treatments for this condition.
Symptoms
DSM diagnostic criteria include:
Causes
It is currently believed that Borderline Personality Disorder It is the result of the combination between the biological predisposition to feel high emotional reactivitywhich would lead to especially frequent and intense episodes of impulsivity or irritability, and a disabling environment.
Marsha Linehan, creator of this concept and expert in Borderline Personality Disorder, defines the disabling environment as one in which caregivers project their own emotions and motivations onto the child instead of recognizing and approving those of the child, and the displays are not tolerated. of negative emotions. In this way, the analysis that the child carries out of his experiences would be trivialized (for example, by telling him “You are angry but you don’t want to admit it”) and it would be conveyed to him that these are caused by personality traits classified as negative, which is would be summarized in messages like “You are bad.” Without adequate validation of his own experiences, the child cannot learn to correctly label her emotions or consider her reactions natural, which hinders identity development.
Borderline Personality Disorder It has also been frequently associated with childhood trauma; Risk factors for the development of the disorder include neglect and emotional abuse, witnessing domestic violence, criminality and parental substance abuse, and, in particular, repeated sexual abuse. It has been hypothesized that this type of chronic victimization would lead the child to believe that he is vulnerable and helpless and others are dangerous and would therefore affect her ability to form secure and satisfying attachment bonds.
According to Pretzer (1996), people with Borderline Personality Disorder conceive of the world in dichotomous terms, that is, their opinions about themselves, the world, and the future tend to be completely positive or completely negative. This way of thinking would lead to emotions that are always intense and rapidly changing from one extreme to the other, with no possibility of middle ground. As a natural consequence, others perceive these changes as irrational and random.
Self-harming behaviors
The tendency of people with Borderline Personality Disorder to feel negative emotions more intensely and frequently than most people partly explains their propensity to use drugsto binge eating – and therefore to bulimia nervosa – or to risky sexual relations.
All of these behaviors are carried out with the intention of reducing discomfort, as is sometimes the case with self-harming behaviors, which are used to temporarily divert attention from negative emotions. Many people with Borderline Personality Disorder who engage in these types of behaviors report that they feel little or no pain during these episodes, which are most common between the ages of 18 and 24.
The self-devaluation inherent in Borderline Personality Disorder is related to the intense need to have an intimate relationship with another person, whether romantic or not. These relationships reduce feelings of emptiness and lack of personal value and make the person with Borderline Personality Disorder feel protected in a world that, as has been said, they perceive as dangerous. With their need to be connected to a significant other being so strong, it is not surprising that people with Borderline Personality Disorder are extremely sensitive to the possibility of being abandoned; Banal acts of others are often interpreted as signs of imminent abandonment.
Thus, not only do frequent outbursts of despair and anger against others occur as a consequence, but self-harming behaviors can be used as attempts to manipulate others so that they do not leave them or as a way of getting revenge if they feel that they have been abandoned. . BPD symptoms tend to decrease with age, including self-harming behaviors. However, in older people these can manifest themselves in somewhat different ways, such as through neglect of diet or pharmacological treatments.
However, and paradoxically, the strong attachment to the other can also lead to the fear that one’s own identity, fragile and unstable, will be absorbed. It is also feared that abandonment perceived as inevitable will be more painful the more intimate the relationship. This is why the chaotic interpersonal behavior of people with Borderline Personality Disorder can in a way be considered an unconscious strategy to avoid a stability that can be feared as much as feelings of emptiness.
Thus, many people with BPD fluctuate between fear of loneliness and the fear of dependency, maintaining their relationships for a time in an unstable and pathological balance. Others, feeling frustrated and exasperated, tend to withdraw from them, which reinforces their belief that they deserve to be abandoned, creating a vicious circle in which the person with BPD causes the very thing they fear will happen.
TLP carries a strong predisposition to depressive episodesbecause it is related to low self-esteem, feelings of guilt, hopelessness and hostility towards others. In fact, some experts claim that the TLP could be considered a mood disorderand the emotional instability characteristic of BPD has even been related to bipolar disorder, which is defined by the alternation between periods of weeks or months of depression and others of pathologically elevated mood.
Treatments
It is probably the severity of Borderline Personality Disorder itself that has led to more research being done on its treatment than on any other personality disorder, such that it is currently the only one for which a treatment is known. effective. We are referring to Dialectical Behavior Therapy, devised in the 90s by the aforementioned Linehan (1993), who, to the surprise of the scientific community, recently revealed that she herself was diagnosed with BPD.
The Dialectical Behavior Therapy It is based on the apparent paradox that, according to Linehan, led her to improve and motivated her to develop her therapy: in order to change, radical acceptance of oneself is necessary. Among other strategies, this treatment includes strategies of emotional regulationsocial skills training and belief modification.
