BORDERLINE PERSONALITY DISORDER

Symptoms

Borderline personality disorder manifests itself both in the person’s attitudes and beliefs and in their behavior. Their regular emotional repertoire includes fear, anger, rage, frustration, sadness, shame, and boredom (with themselves, other people, and the world). Such emotions cause stress, which further reinforces a negative attitude and negative perception of the world. Under severe stress, misconceptions or paranoid symptoms may also occur. Borderline personality disorder is the inability to independently overcome stressful and crisis situations—instead of taking action, a person with this disorder tends to become discouraged, panicked, and anxious. They are unable to organize their thoughts and develop a plan to get out of the situation. Patients with borderline personality disorder have a strong fear of rejection and abandonment. A person with borderline personality disorder tends to enter into unstable and intense relationships that lead to emotional crises associated with suicide threats or self-harm (for example, self-injury). The inconsistency of the borderline person’s ‘self’ is that they cut themselves off from certain feelings, causing their ‘self’ to become somewhat fragmented. Also characteristic of borderline personality is strong emotional lability, expressed in rapidly changing, extreme moods. Such people are very sensitive to the judgment of others, and in their love and friendships they feel a constant need to be reassured about their partner’s feelings. They can be possessive and jealous—this behavior is caused by fear of rejection and abandonment.

Causes

According to the DSM classification, borderline personality disorder occurs when at least five of these nine criteria persist over a long period:

1. Frantic efforts to avoid actual or imagined rejection;
2. Unstable and intense interpersonal relationships characterized by fluctuations between the extremes of idealization and devaluation;
3. Identity disturbance: a clearly and persistently unstable self-image or sense of self;
4. Impulsivity in at least two areas that may be self-destructive (e.g. spending money, sex, substance abuse, reckless driving, compulsive eating);
5. Recurrent suicidal behavior, gestures, or threats, or acts of a self-harming nature;
6. Emotional instability resulting from pronounced mood swings (e.g. severe episodic low mood (dysphoria), irritability, or anxiety, usually lasting several hours, rarely longer than a few days);
7. Chronic feelings of emptiness;
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, repeated fights);
9. Transient, stress-related paranoid thoughts or severe symptoms of a personality disorder.

Thus, borderline personality disorder is associated with a tendency to take various risks, use psychoactive substances for experimental purposes, eating problems (anorexia and bulimia), pathological lying and confabulation, suicide attempts, self-harm, and a tendency to burn bridges.

Treatment

Simply put, the treatment methods used can be divided into pharmacological and psychological. In most cases, both approaches are used simultaneously. The effects of pharmacological treatment are usually temporary and serve to reduce the intensity of individual symptoms, such as anxiety, depression, and sudden mood swings. Of the available psychotherapeutic methods, psychoanalytic psychotherapy with its derivatives is considered the most effective, such as mentalization-based therapy (MBT) and transference-focused therapy (TFT). Another effective method is dialectical behavior therapy.