Borderline personality disorder: causes, symptoms, treatment

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The intense rhythm of life, constant stress, individual characteristics of response to certain circumstances. All this can provoke various pathologies. Borderline personality disorder is characterized by the individual's emotional instability, impulsiveness, anger for no reason, and other unpleasant manifestations. The patient himself, as well as those around him, suffer from them.

The disorder is persistent, manifests itself throughout life, and occurs at an early age. The diagnosis is established based on the history of events, the results of diagnostic techniques, and a personal conversation with the patient. The Clinic of Doctor Isaev provides treatment for borderline personality disorder. To normalize the patient's condition, traditional techniques and original methods of psychotherapy are used. Drug therapy and related techniques are prescribed to restore mental balance.

General information about the disease

Borderline personality disorder is a form of psychopathy that significantly impairs the quality of life. A person suffering from it cannot build long-term relationships with partners, he has no friends, and adaptation to new conditions is extremely difficult. Conflict situations are aggravated by a lack of self-control. The patient is unable to monitor his reactions and control his own impulses in behavior.

The disease is diagnosed in approximately 3% of patients with mental disorders, 10% of them die by suicide. The first symptoms of BPD appear in adolescence, and the trigger is not necessarily stress. The development of mental illness can occur gradually. At first, it often remains invisible to others.

The inner world of such patients is very poor; they often describe their state as empty, “de-energized,” devoid of energy and strength. Borderline personality disorder is accompanied by the following symptoms:

frequent worries over minor issues;
emotional instability;
impulsiveness in decision making;
internal experiences;
inability to master basic communication skills.

Frustrated attempts to realize oneself in the profession and society aggravate the situation. Against the background of constant dissatisfaction with oneself, depression develops. Drug and alcohol addiction occurs. First, with the help of third-party stimulants, such patients try to relieve internal pain. Unnoticed, they become involved, exhibiting extreme forms of alcoholism and drug addiction.

Borderline personality disorder

The first signs of the disorder may be noticeable in early childhood. Children are emotionally unstable, restless, and often demonstrate emotional reactions that are inconsistent in strength with the stimulus that caused them. Impulsive behavior is observed. However, these symptoms are not enough to make a diagnosis, since the child’s behavior may change as life conditions change and as the child grows older. As a rule, the clinical picture of borderline personality disorder is formed around the age of 25.

A kind of identity disorder is revealed. The self-image is unstable and can change greatly depending on mood or external circumstances. Patients are constantly afraid of being abandoned (sometimes this fear corresponds to the real situation, sometimes not). To stabilize the image of their own “I” and eliminate fear, patients with borderline personality disorder try to find “a complement and reflection of themselves”, an ideal relationship that reproduces the child-parent fusion.

In a relationship between two adults, such a merger is impossible. Periods of idealization of the partner, arising as a result of unjustified expectations, alternate with periods of depreciation, provoked by severe disappointment. The relationship of a patient suffering from borderline personality disorder becomes tense, unstable, and based on unrealistic demands on the partner. The situation is aggravated by the patient’s impulsiveness and sudden mood swings with a tendency toward severe anxiety or dysphoria. Impulsive behavior in borderline personality disorder may include not only intemperance in relationships, but also overeating, unwise spontaneous spending of money, casual sex, and substance use. Threats and attempts at suicide are possible.

The patient constantly feels empty. It is difficult for him to control his own emotions when communicating with other people. Violent sudden quarrels, bright outbursts of anger or constant anger, frequent fights, irritability, etc. are possible. In stressful situations, patients suffering from borderline personality disorder experience paranoid ideas, which, unlike similar ideas in paranoia, are unstable, transient character. Manifestations of dissociation may occur. The entire listed set of symptoms becomes an obstacle both to building personal relationships and to normal life in society.

Psychotherapist Young identified a group of maladaptive patterns that arise in early years and are associated with emotional rejection by a significant adult. Patients with borderline personality disorder constantly experience fear of loss or rejection, which is expressed in the belief: “I will not find someone close to me and I will always be alone.” They place themselves in a subordinate position, believing that the desires of others are more important than their own. Patients do not believe in their ability to solve problems on their own and feel dependent on other people. They are convinced that they do not have the necessary volitional qualities, cannot control their own lives and manage their own behavior.

People with borderline personality disorder see themselves as bad people. They think that others will turn away from them if they find out what they really are, and they believe that they deserve to be punished. Patients suffer from mistrust and suspicion, do not feel trust and security in relationships, and are afraid that they will be used for their own purposes. The belief “my feelings and desires are insignificant to others” is accompanied by a fear of showing emotions.

With borderline personality disorder, patients constantly make unrealistic demands on themselves, believing that they must constantly control their own feelings. This entails suppression of experiences. Patients distance themselves from their grief, resentment, loss and disappointment. Experiences fall into the unconscious zone, and feelings get out of control at the most inopportune moment, for example, with a slight change in plans or failure to fulfill a small request.

With borderline personality disorder, fairly long periods of stability can be observed. During crises, patients turn to psychologists and psychotherapists in the hope of solving their problems, but after their condition improves, they often leave therapy, since the fear of confronting their own current feelings and negative old experiences becomes stronger than the fear of not being able to cope with their lives in a given period of time. As a result, by middle age, patients suffering from borderline personality disorder often have a complex history of contact with specialists and develop the belief “psychologists are useless, they cannot help me.”

Borderline personality disorder often co-occurs with other mental disorders, including:

panic disorder;
generalized anxiety disorder;
depression;
obsessive-compulsive neurosis;
manic-depressive psychosis;
paranoid, dependent, narcissistic, avoidant and schizotypal personality disorders.

Alcoholism and drug addiction are often observed. There may be repeated suicide attempts and a tendency to self-harm.

Causes of BPD

Borderline personality disorder develops due to exposure to a number of external factors that cannot be controlled by the person.

Heredity.

If the parents had this diagnosis, then the chances of it being diagnosed to the child in adolescence are quite high. Women suffer from this disease more often than men.

Character traits.

If a person has low self-esteem, he is a pessimist by nature, his psyche is not resistant to stressful situations, he has increased anxiety, and the risk of developing borderline disorder is high.

All forms of violence.

If a child suffered from emotional, sexual or physical abuse as a child, he or she may develop this disorder later in life. This also includes separation from one of the parents or their physical loss.

Lack of emotional contact with a significant person.

Lack of attention on the part of the parent, his emotional coldness, and a subconscious prohibition on expressing his feelings lead to mental disorders. A similar picture is observed if significant adults expressed excessive or contradictory demands on the child. Unfavorable living conditions form a maladaptive pattern of behavior that manifests itself at a late age.

Excessive activity of the limbic system of the brain.

This pathology occurs as a result of emotional deprivation, being a secondary disorder.

Information portal – Resource Center “Borderline Personality Disorder”

There are 151 possible different combinations of symptoms in the clinical picture of patients diagnosed with BPD (some authors cite the figure 256 as the possible number of symptom combinations for BPD) (Bateman, Fonagy, 2003).

Borderline personality disorder is a complex and severe psychiatric disorder (ICBA10, 1994; DSMAV, 2013), the hallmarks of which are a persistent pattern of dysregulation of affect and impulse control, as well as a lack of stability in relationships with other people and in one’s own identity, internal the image of your person. The range of borderline pathology also includes dissociative symptoms: derealization and depersonalization, flash back effects, psychogenic amnesia, symptoms of somatoform dissociation, etc. In addition, individuals with BPD are characterized by the use of primitive defense mechanisms, such as splitting and projective identification, as one of the links which is dissociation (Bateman, Fonagy, 2003).

Possible symptoms of BPD:

Hypersensitivity. Particular sensitivity to separations. Loneliness. Boredom, emptiness. Ambivalence. Generalized feeling of shame. Impulsivity and lack of behavioral control. Chaotic and turbulent interpersonal relationships. Mental pain. Suicidal attempts. Impulsive and dangerous behaviors (unsafe sex, alcohol and drug abuse, gambling, unnecessary spending of money). Low self-esteem and lack of self-esteem. Unstable mood. Expressed anger. Problems with controlling and expressing anger and aggression. Dissociation. Stress-related paranoid ideas. Lack of clear ideas about yourself. Frequent changes of jobs. Inability to finish a job started. Sudden mood changes. Mentalization disorder: an imaginary mental process in which a person has to imagine what another person is thinking or feeling (Bateman, Fonagy, 2006). Cognitive distortions. People with BPD may experience these feelings in response to certain events and stress. For example, they may have a strong reaction to criticism, which is perceived as a serious punishment and a special form of cruelty, they can think out and “read the thoughts” of other people, and misinterpret a person’s action in a certain situation.

Behavioral patterns in BPD

Emotional vulnerability. A pattern of significant difficulties in regulating negative emotions, including high sensitivity to negative emotional stimuli and slow return to normal emotional states, as well as awareness and perception of one's own emotional vulnerability. May include a tendency to blame the social environment for unrealistic expectations and demands.
Self-invalidation. The tendency to ignore or not acknowledge one's own emotional reactions, thoughts, perceptions, and behaviors. Setting unrealistically high standards and expectations for yourself. May include intense shame, self-hatred, and self-directed anger.
Ongoing crisis. A model of frequent stressful, negative environmental events, disruptions and obstacles, some of which arise as a result of an individual’s dysfunctional lifestyle, inadequate social environment or random circumstances.
Suppressed experiences. A tendency to suppress and overcontrol negative emotional reactions—especially those associated with grief and loss, including sadness, anger, guilt, shame, anxiety, and panic.
Active passivity. A tendency towards a passive style of solving interpersonal problems, including an inability to actively overcome the difficulties of life, often in combination with energetic attempts to involve members of one’s environment in solving one’s own problems; a person’s lack of motivation to respond with action in situations where there is a real possibility of improving the situation; hopelessness.
Perceived competence. The tendency of an individual to appear more competent than he actually is; usually explained by an inability to generalize characteristics of mood, situation and time; also an inability to demonstrate adequate nonverbal cues of emotional distress. (M. Lainen, 2007).

Learning to respond to stressful situations is an important step in recovery for people with BPD.

Borderline clients suffer from "MISERY" (misery, insignificance).

M (Mother) = PROBLEMS WITH MOTHER. They failed to completely separate and individuate from the primary parent.

I (identity) = IDENTITY PROBLEMS. Instead of responding to each interpersonal situation as a whole that is stable most of the time, the borderline client may respond only in terms of one of his partial selves.

S (Splitting) = SPLITTING. The borderline client uses splitting (keeping opposing affective states separate to prevent negative affect from flooding and ultimately destroying the positive) and other primitive defenses (denial, projection, projective identification, dissociation) to maintain good feelings about themselves and significant others.

E (Engulfment) = FEAR OF ABSORPTION AND Abandonment. These twin fears dominate the borderline client's interactions with others. They experience any closeness as a potential threat and, as a result, cannot find a comfortable interpersonal distance.

R (Rage) = RAGE. Borderline clients are full of anger. They often feel as if there is a core of inner rage hidden within them that has no boundaries.

Y (Yearning) = MEANING. The borderline client goes through life yearning for the perfect Other. Someone who will give them unconditional love and acceptance, permission for separation, individuation and subsequent personal growth; will be devoted twenty-four hours a day and will not ask for anything in return; all within the context of incredibly tense relationships within the dyad (Elinor Greenberg, 2011).

Symptoms of BPD:

a pattern of unstable and intense interpersonal relationships that are characterized by extreme fluctuations between over-idealization and over-underestimation;
impulsivity in at least two areas that are potentially self-injurious, such as spending money, sex, drug addiction, theft, careless driving, carousing (does not include suicidal or self-injurious behavior mentioned in item 5);
affective instability: pronounced deviations from the baseline from mood to depression, irritability, anxiety, usually lasting several hours and only rarely more than a few days;
inappropriate strong anger or lack of anger control, for example, often exhibits short temper, constant anger, attacks others;
repeated suicidal threats, gestures or behavior, or self-injurious behavior;
severe and persistent identity disorder, manifested by uncertainty in at least 2 of the following: self-esteem or self-image, sexual orientation, long-term goal setting and career choice, type of friends preferred, preferred values;
chronic feelings of emptiness or boredom;
frantic attempts to escape the real or imagined horror of abandonment (does not include suicidal or self-injurious behavior (Kaplan G.I., Sadok B.J., 1994).

Symptoms of Borderline Personality Disorder

Although the full clinical picture is formed around age 25, the first signs of BPD appear in early childhood. Such children demonstrate inadequate emotional reactions to the situation. They may be too strong, although the stimulus is quite weak. Constant anxiety, emotional instability, and decision-making under the influence of impulse are the main characteristics of a child who has borderline personality disorder.

Identity defect

The main symptom of the disease, which creates great problems for the socialization of the patient. The patient is partially aware of his situation and at some moments understands that he lacks his own emotions, desires and habits.

Inability to build stable relationships

A person with borderline personality disorder is very vulnerable and suffers from pain caused by other people. He knows that a new relationship is doomed to failure, but he subconsciously strives for it. A timely visit to a psychiatric clinic will give a good prognosis for recovery.

The incentive for such behavior is the inability to tolerate loneliness. This condition is very painful for such people. They spend a lot of time in places where they can meet someone. They agree to go anywhere, just not to be alone.

One of the main symptoms of borderline personality disorder is the inability to recognize one's emotions. This leads to difficulties in controlling the distance between a partner and oneself.

Such patients have only one way to compensate for unbearable pain and loneliness - a change in mood. They fall into unreasonable anger, and after a few minutes they turn to joy.

Feeling empty inside yourself

The person feels unwanted, and this condition is chronic. Periods of exacerbation and remission alternate with each other. Often during psychotherapy sessions, patients describe an emptiness in their soul that looks like a huge black hole. Everything that is dear to a person falls into it. Panic arises due to the inability to take control of this process.

If you don’t have your own emotions, their substitutes are often physical pain and random acquaintances. It is important for the patient to feel the adrenaline, which tones the body. People with this pathology often say that their soul hurts. On a physical level, these sensations manifest themselves in the form of tightness in the chest and abdomen.

Tendency to self-destruction.

The behavior of a person with borderline personality disorder is almost always impulsive. This happens because he cannot stand his own experiences and doubts that those around him can also do this. By failing to cope with this situation, the patient tends to harm his psyche and physical body. These are not necessarily wounds or cuts on the skin; often self-aggression and self-destruction manifest themselves in the form of the following tendencies:

eating large amounts of food so that the body loses its attractiveness;
a large number of tattoos on the skin, a gloomy style in the form of symbols of evil and death predominates;
alcoholism and drug addiction, which lead to personality degradation;
unprotected sex is a risk factor for diseases such as HIV, STIs and hepatitis;
non-compliance with traffic rules, increasing speed as a subconscious desire not to return from a trip by car (risk when crossing the road and other deviations from the norm).

Constant mood swings

Patients with this diagnosis get used to the fact that emotional highs are replaced by lows. In the morning they can wake up with very gloomy thoughts and desires, at lunchtime they can be the happiest in the world, and in the evening they can sit and stare at one point, not seeing any light in their inconsolable sadness.

Such mental metamorphoses greatly deplete the nervous system and affect all organs. This condition drags on for many years. The symptoms are very similar to other mental disorders, making diagnosis difficult.

Lack of control over one's actions.

When the patient experiences intense anger, he may cause physical harm to others. Paranoid thoughts strengthen his belief that close people and friends are constantly plotting something and wishing him death. Constant mood swings provoke fights and crime. Often such patients end up in the dock; it is not always possible to suspect their inadequacy and refer them for treatment. Attacks can be made not only on people, but also on animals. The latter are weak and defenseless, and therefore cannot resist the patient’s aggression.

Common symptoms that may indicate mental problems in a loved one include:

low self-esteem, lack of self-confidence;
thoughts of suicide and attempts to implement them;
the desire to be dependent and submissive;
minor speech disorder;
in any situation the patient blames only himself;
lack of self-discipline and punctuality;
resistance to change and the desire to maintain one’s status by any means necessary;
confusion about life goals and one’s own feelings;
inability to decide on sexual orientation;
spontaneous spending of large sums of money;
resistance to close contact and reduction of distance;
casual sexual encounters and episodes;
exacerbation of paranoid thoughts.

Borderline Personality Disorder - Symptoms and Treatment

Psychotherapy is the main treatment for this disorder. Treatment should be based on the needs of the patient rather than on the standards of the established diagnosis. Medications are useful in treating comorbidities such as anxiety disorders or depression. Short-term hospitalization has not been shown to be effective compared with outpatient psychotherapy and direct socialization assistance.

Long-term psychotherapy is currently the treatment of choice for BPD. Below are several methods, arranged in order of decreasing degree of understanding of their effect on the course of the disorder.[24]

Dialectical Behavioral Therapy (DBT)[25]

The treatment period is one year or more. DBT is an adaptation of cognitive and behavioral psychotherapy methods aimed at reducing the symptoms of BPD, including suicidal behavior and parasuicides. The main therapeutic factor in this approach is the need to accept patients as they are, while at the same time encouraging them to make internal changes and teaching specific behaviors.

Acceptance into DBT is based on acceptance by the clinician, with further clarification of the patient's current emotions, judgments and behavior. This is called validation.

Whatever the form of validation, the patient always understands its content the same: “your thoughts and feelings are acceptable, you have the right to them.” Patients are actively taught emotional regulation, social effectiveness, stress management skills, goal setting, and self-control.

SET-UP (Support, Empathy, Truth, Understanding, and Perseverance)[26]

The SET-UP system developed as a structured framework for psychotherapeutic work with borderline patients in times of crisis. At such moments, communication with them is significantly hampered by three main emotional states: melancholy and anxious loneliness, a feeling of separation and misunderstanding by others, an overwhelming idea of one’s own inadequacy.

The acronym “SET” translates to “Support, Empathy, Truth” and refers to a communication system consisting of these three parts. And the abbreviation “UP” stands for “understanding and perseverance” and indicates the goals that all participants in communication strive to achieve.

A statement representing Truth or Reality emphasizes that the borderline person is responsible for his or her own life and that attempts by others to help cannot replace that responsibility. The truth recognizes the existing problems and turns to the practical and objective side: “How to solve it?”, “What will you do about it?”

based treatment (MBT)[27]

MVT is a structured treatment. In this approach, the total duration of treatment (12-18 months) and the timing of each session are clearly indicated. MBT is conducted in individual and group formats. The goal of the intervention is to increase the level of meaningfulness of one’s own actions, emotions, needs and life goals. The so-called “cognitive confusion” is overcome.

Schema therapy

The effectiveness of this method has been confirmed by American psychologist Jeffrey Young.[28]

Schema therapy is based on several areas of psychotherapy: cognitive behavioral therapy, psychoanalysis, object relations theory, attachment theory, gestalt therapy. The core of schema therapy methodology is working with so-called early maladaptive schemas (EDS). RDS is a way of perceiving reality that was formed in childhood under the influence of traumatic events or abuse and is activated throughout life if there is some similarity of circumstances with childhood events.

Schema therapy aims to help the patient identify their schemas, recognize the source of the emotions that arise when the schema is activated, experience those emotions, and find ways to respond differently to events that activate the schema.

Transference-Focused Psychotherapy (TFP)[29]

The method is based on O. Kernberg’s model of object relations for borderline personality disorder. TFP is a form of guided psychodynamic psychotherapy specifically designed for the treatment of BPD.

Transference interpretation is a key aspect of therapy and therapeutic change, but it is one of many treatment elements of this approach.

Pharmacotherapy

A 2010 systematic review by Cochrane, an international organization that studies the effectiveness of health technologies, found that there are no medications effective for treating the core symptoms of BPD, such as feelings of chronic emotional devastation, identity disorders, and abandonment (loneliness).

However, the authors of the above review found that some medications may have an isolated effect on the symptoms associated with BPD. Haloperidol has been shown to relieve attacks of aggression, and Flupenthixol reduces the likelihood of suicidal behavior. One study found that Aripiprazole may reduce relationship problems and impulsivity.

Valproic acid salts can reduce (weaken) symptoms of depression, interpersonal problems and anger. Lamotrigine reduces impulsivity and anger.

Of the antidepressants, only Amitriptyline has proven its effectiveness. Additionally, omega-3 fatty acids have been surprisingly found to reduce depression and suicidal tendencies.[24]

Diagnosis of BPD

Diagnostics is the first and main stage before prescribing a course of therapy. The specialist takes the following steps step by step:

a detailed survey of relatives, work colleagues and friends, which helps to establish the exact time when signs of borderline personality disorder first appeared;
studying family history - it is important to make sure that close relatives do not have similar diseases;
collecting maximum information about the patient’s life;
conversation with the patient and observation of him from the outside in order to identify characteristic symptoms of mental pathology;
conducting psychological testing to obtain a complete picture of the internal state of a mentally ill person.

Treatment of borderline disorder in Moscow

Therapy for this disease is based on a combination of conservative methods and the latest techniques with medications. All patients require courses of psychotherapy, as well as the use of medications with a specific spectrum of action. Cognitive behavioral therapy has proven itself well, helping to restore the adaptive potential of the psyche.

The specialist works in the following areas:

rethinking the patient’s lifestyle;
a detailed discussion of his problems, aspirations, desires;
developing skills to control one’s behavior and spontaneously arising emotions;
formation of protective mechanisms that will help in time to get rid of stress and anxiety;
developing skills of constructive communication with other people.

Consultations can be individual or group. Communication with a psychologist in a confidential environment helps to relax, understand and acknowledge your condition. The second option involves the participation of friends, relatives, and other significant persons in the program. The specialist teaches all participants how to avoid conflict situations. Individual indicators of the course of the disease include the use of drugs from the following groups:

antidepressants;
neuroleptics;
tranquilizers.

Principles of Personality Disorder Treatment

Usually they practice an integrated approach: a combination of psychotherapy and medication. The exact tactics to cure the disease largely depend on the specific variant of the disease. Typically, preference is given to individual or group sessions with a psychologist. At the same time, our specialists have sufficient qualifications and many years of experience to establish close, friendly contact with the patient. In some cases, family therapy provides good results.

Drug treatment

The role of drug use is controversial. For example, with the paranoid subtype of the disease, any attempts to prescribe medications are viewed with great suspicion and sabotage the prescribed treatment. Therefore, medications are used when there are pronounced signs of a personality disorder.

Prescribed:

antidepressants;
neuroleptics (outpatient or inpatient, for borderline form);
sedatives;
anxiolytics.

Based on their own practice, medical doctors are convinced that personality disorders are treatable in most cases. Our doctors know very well what to do to improve the quality of life not only of the patient, but also of his loved ones. Call us by phone +7 (495) 268-09-02!

Complications without treatment

Timely contact with a specialist in a psychiatric department improves the prognosis of recovery. Ignoring the clinical manifestations of the disease leads to its aggravation and acquisition of a chronic form.

Among the negative consequences are:

lack of opportunity to build personal and business relationships with partners;
constant thoughts of suicide, which will sooner or later be realized;
chronic depression, lack of interest in the outside world;
social isolation, secluded lifestyle;
lack of desire to leave the house.

Borderline personality disorder develops in childhood. It is very important to take some preventive measures to prevent the manifestation of the disease. Among them are:

visiting a specialist in critical situations (divorce of parents or death of a loved one);
allowing the child to express his own emotions, even if they are negative;
exclusion of physical, emotional, sexual violence;
providing conditions for full communication with significant adults;
creating an atmosphere in which it is comfortable to live and study;
building a trusting relationship in which the child can freely share his problems.

The duration of therapy is determined by several factors:

features of relationships with loved ones;
age;
the primary source of the disease;
willingness to undergo long-term therapy;
level of personal, professional, social development.

Questions and answers

Can borderline disorder be treated at home?

No. Such mental disorders are treated in a hospital setting. The patient can cause physical harm to the life and health of others, as well as to himself. Therefore, he needs hospitalization.

Is it possible to get rid of BPD using folk remedies?

No, using questionable drugs will only worsen the situation. Any medications are used after prior consultation with a doctor.

Causes

It is believed that this is a polyetiological disease. Genetic predisposition plays a major role. This theory is supported by clinical studies conducted in the 1970s and 1980s. When studying the anamnesis of patients with a similar mental disorder, it was found that the incidence of symptoms of the disease is 5 times higher in children whose parents suffered from a similar pathology.

Considerable importance is also attached to exogenous organic lesions of the brain during intrauterine development, during childbirth or infancy. These injuries are not severe enough to cause significant symptoms of neurological disease, but are sufficient to impair mental functioning.