Borderline Personality Disorder: What It Is, Causes, Symptoms And Treatment

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)⁽¹⁾personality disorder borderline o Borderline personality disorder (BPD) is attributed to those people who carry out impulsive actions with an unstable mood minimal planning capacity and angry outbursts with minimal self-control.

In this disorder there is a meeting point between psychosis and neurosis. The concept of borderline from which the limit is derived begins to be used in patients who have schizophrenic symptoms, without being sufficiently disabling and/or lasting. Some authors consider it a bridge personality between the infantile or primitive personality and the immature one.

When identifying it, it is important to know the characteristics of the personality disorder borderline and what behaviors people who suffer from it have. We see them below:

• Intense fears of being abandoned : They could be related to the intolerance of being alone and the need to be accompanied by other people. Vacuum sensation.
• Prone to idealize the people who care for them or to their lovers the first few times they deal with them. It is common for them to share very intimate details quickly and demand attention so that they are by their side.
• Dramatic changes in opinion of others who tend to reflect disappointment and dissatisfaction because their demands are not understood or met, they feel that they are going to be rejected or that they are not paid enough attention.
• Lack of impulse control and search for intense sensations.
• Sudden and dramatic changes in your self-image , opinion, future plans, sexual identity, scale of values ​​and type of friendships that are given as a reason for the perception of lack of significant relationships of help and support. Feeling of non-existence or presence.
• They may engage in risky behavior : managing money irresponsibly, binge eating, substance abuse, unsafe sexual practices, or reckless driving.
• Completed suicide in 8-10% : Suicide threats and self-mutilation are also very common.
• Basic mood of dysphoric type : May be interrupted by periods of anger, anguish, or despair. Anger may be triggered when they perceive a caregiver or lover as neglectful, repressive, uncaring, or abandoning them. It is followed by grief and guilt.
• They can show extreme sarcasm persistent bitterness or verbal outbursts.
• They can symptoms such as paranoid ideation appear that subside when the person’s attention returns.
• Poor work or school performance , due to their emotional instability, and they get bored very easily. If this happens to you, we recommend reading this article on how to be more productive at work.

When discussing the principles of personality and associated disorders, Millon, TE, (1997)⁽²⁾ emphasizes that personality develops from interaction between genetic and environmental factors If we take the above into account, the causes of personality disorder borderline They are the result of the imbalance of the systems that make it up, with neither one nor the other being decisive.

In addition, it is also important to note that the cause of a personality disorder is independent of the level of education and socioeconomic situation.

personality disorder borderline It is one of the personality disorders with the largest number of studies on effective treatments.

Although it is true that there are many therapies that have demonstrated effectiveness, such as analytical psychotherapy in therapies focused on transference and mentalization therapy, the treatments that have demonstrated the greatest effectiveness for this type of disorder are cognitive-behavioral therapy, specifically the following two therapies:

• Marsh Linehan Dialectical Behavior Therapy : based on problem solving, changing the basic response pattern, and training in social and emotional skills.
• Jeffrey Young Schema Therapy : based on the existence of maladaptive schemes. It is an integrative therapy of various models.

At a pharmacological level, effective functioning has been demonstrated in response to antidepressants, antipsychotics, anxiolytics and euthymizers. Furthermore, some mood stabilizers such as lithium, carbamazepine, valproic acid and some newer ones such as topiramate, lamotrigine or pregabalin (lyrica), are also effective.

Other therapies such as electroconvulsive therapy or lobotomy have not shown significant or favorable effects for personality disorder. borderline, unlike the transcranial magnetic stimulation which appears as an alternative to electroconvulsive therapy and seems to be useful for this disorder and other cluster C personality disorders.

personality disorder borderline has several disorders with which it is diagnosed comorbidly such as depression or schizoaffective disorder and other personality disorders such as the following:

• Cluster B is co-diagnosed with histrionic personality disorder or antisocial personality disorder.
• From cluster C as dependent personality disorder.
• It can even be diagnosed jointly with cluster A personality disorders such as schizotypy.

To avoid confusion and the labels that come with having multiple diagnoses, it is important to make a good differential diagnosis and rule out other disorders. In the case of personality disorder borderlineit will be important to correctly differentiate it from other personality or affective disorders:

• Differences with mood disorders : If both are manifested and the diagnostic criteria are met for both diagnoses, this will be effective. Yes, we will always avoid diagnosing BPD if the problem does not appear in adolescence or adulthood.
• Differences with histrionic personality disorder (HSPD) : Unlike HSPD, BPD is more self-destructive, they make angry breakups of interpersonal relationships and manifest chronic feelings of emptiness and loneliness.
• Differences with schizotypal personality disorder (SPD) : in BPD we can observe the appearance of hallucinations or passing paranoid ideas and interpersonally they are more reactive in response to external structures, unlike SPD which does not manifest these signs.
• Differences with paranoid personality disorder (PPD) and narcissistic personality disorder (NPD) : Both disorders (PPD and NPD), unlike BPD, show relative stability in their self-image and lack self-destructive behaviors, impulsivity, or concerns about abandonment.
• Differences with antisocial personality disorder (ASD) : Although both use manipulation, the purpose is different. The goal of BPD patients is to get attention and interest, while the goal of APD patients is to get some benefit.
• Differences with Dependent Personality Disorder (DPD) : BPD reacts to abandonment with feelings of emptiness, anger, and demands for attention, which leads to a pattern of intense and unstable relationships. On the other hand, the DPD after a breakup quickly seeks a relationship to replace the ended one and adopts submissive behaviors in their interpersonal relationships.

Differences between TPB and bipolar disorder type II

The main differences between bipolar disorder type II and personality disorder borderline are:

• Start : Bipolar disorder has an abrupt onset with spontaneous mood changes, while personality disorder borderline It has a gradual onset and the mood changes are reactive.
• Symptoms : in the case of BPD they are dissociative symptoms, and depersonalization, contradiction of speech, interpersonal hyperreactivity, punishment towards others and self-harm may appear. In bipolar II disorder, psychotic symptoms appear, tachycardia, reactions to internal stimuli, morning depressive symptoms, ideas of guilt and severe suicide attempts, with frequent cognitive dysfunction.
• Comorbid disorders : BPD can appear comorbid with sexual identity disorders, while bipolar disorder is more associated with sexual desire disorders.
• Treatment : personality disorder borderline It gives a partially good pharmacological response to antidepressants and a poor one to lithium. On the other hand, bipolar II disorder offers a good response to lithium and antidepressants for hypomanic phases.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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