AAMFT Consumer Update
Borderline
Personality Disorder
Borderline
personality disorder (BPD) is a serious and complex mental illness
that affects 2 – 3% of the population. Once thought to be on the “border”
of schizophrenia, BPD is now believed to be more closely related to
mood disorders such as depression, or possibly to impulse control disorders
like Attention-Deficit/Hyperactivity Disorder. People with BPD have
difficulty regulating their emotions and controlling their impulses.
They often act out their emotions or impulses, either through intense
inappropriate displays of anger, or through self-injurious or suicidal
behavior. Although self-injury often occurs without suicidal intent,
a significant number of people with BPD die by suicide.
Depression and anxiety are common in people with BPD, and many also struggle
with addiction problems. Individuals with BPD often need extensive
mental health services, and they account for 20% of psychiatric hospitalizations.
Despite the seriousness of the disorder, recent research indicates
that treatment can lead to considerable improvement over time, and
there is hope for recovery.
What are the
symptoms of BPD?
Individuals with BPD display a pattern of dramatic mood swings, irritability,
and intense anger. Mood swings typically occur in response to stressful
life situations, and in particular to difficulties in interpersonal
relationships or interpersonal conflict. Individuals with BPD are intensely
sensitive to rejection or perceived abandonment, and when they feel
they are being abandoned they often respond with explosive anger or
with self-injurious or suicidal behavior. Because these behaviors take
a toll on close interpersonal relationships, individuals with BPD often
provoke the very rejection and abandonment they fear.
Other BPD symptoms include feelings of emptiness or boredom; identity confusion;
and impulsive behavior such as over-spending, risky sex, substance
abuse, reckless driving, or binge eating. BPD individuals sometimes
display brief stress-related periods of paranoid or irrational thinking.
They also tend to think in “black and white” terms, alternating between
extremes of idealization (everything is wonderful) and devaluation
(everything is terrible).
What causes
BPD?
At
one point, BPD was believed to be caused by faulty parenting, and many
families felt unfairly blamed. Our current understanding is that BPD
has a strong biological component, and that it results from a combination
of genetic and environmental factors. Recent research suggests that individuals
suffering from BPD have imbalances in the neurotransmitters that regulate
emotion and impulse control. Serotonin is one neurotransmitter believed
to play a significant role in BPD. When individuals suffer from this
type of an imbalance, life stresses can easily overwhelm their coping
abilities.
Although
BPD may develop purely as a result of a biological “vulnerability,” research
indicates that many individuals with BPD do have a history of traumatic
early childhood experiences. About 50 – 70% of individuals with BPD report
a history of childhood sexual abuse. Many also report histories of verbal
or physical abuse. Often there is a pattern of inconsistent parenting
and poorly met needs that may stem from parental addictions or mental
illness. A history of early loss or traumatic abandonment is also common,
possibly due to death of a parent or parental separation.
What is the
effect of BPD on family members?
Family members often feel mystified and exhausted by their relative’s illness.
The intense mood swings and anger outbursts can be frightening and
disruptive. Impulsive acting out in areas such as spending, substance
abuse, or sex can be a major source of marital conflict. Relatives
are often overwhelmed with worry regarding their loved one’s safety
following repeated suicide attempts or acts of self-mutilation. At
times, partners and family members feel manipulated by these suicidal
or self-destructive behaviors, and are torn between reaching out to
their loved one, and setting personal limits and boundaries. It is
not unusual for relatives and spouses of BPD individuals to feel depressed
themselves, and to struggle with feelings of guilt, shame and helplessness.
What help is
available?
A
number of effective treatment options are emerging to help BPD individuals
and their families. Some of these options include:
Medication– Medications can be helpful in reducing symptoms of depression,
anxiety, irritability and paranoid thoughts. Medications may also help
improve emotional and impulse control, thereby reducing stress in marital
or family relationships and making it easier to develop new interpersonal
or stress management skills in psychotherapy.
Individual Psychotherapy– Often, psychotherapy is required to achieve lasting
personality change. Short-term or brief-therapy may be helpful in stabilizing
immediate crises. Psychodynamic Therapy helps make connections
between early traumatic experiences and ways that learned behavior patterns
are repeated in current relationships. Cognitive-Behavioral Therapy,
and in particular a version of it known as Dialectical Behavior
Therapy, has proven helpful in altering negative patterns of thinking,
and in learning new behaviors and coping strategies.
Group Therapy– Group Therapy is often helpful in learning and practicing
new interpersonal skills and increasing awareness of problematic interpersonal
traits and behaviors.
Brief Hospitalization– Hospitalization may be necessary to ensure safety
during suicidal crises or episodes of self-injury. Some hospitals offer
brief intensive treatment programs for BPD.
Marital or Family Therapy– Marital Therapy can
be helpful in stabilizing the marital relationship and in reducing marital
conflict and stress that can worsen BPD symptoms. Family Therapy or Family
Psychoeducation can help educate family members regarding BPD, improve
family communication and problem solving, and provide support to family
members in dealing with their loved one’s illness.
Marriage and Family Therapists (MFTs) can be excellent treatment providers
for individuals and families who are struggling with the effects of
BPD. MFTs are trained to recognize and treat BPD using many of the
treatments described above. Because of their knowledge and expertise
in family relationships, MFTs can help reduce the impact of BPD symptoms
on family relationships, and improve overall marital and family functioning.
Consumer Resources
Books
New Hope for People with
Borderline Personality Disorder: Your Friendly, Authoritative Guide
to the Latest in Traditional and Complementary Solutions, by Neil R. Bockian, Nora
Elizabeth Villagran, and Valerie Porr. Prima Publishing, 2002.
Stop Walking on Eggshells:
Taking Your Life Back When Someone You Care About Has Borderline Personality
Disorder,
by Paul T. Mason and Randi Kreger. New Harbinger, 1998.
The Stop Walking on Eggshells
Workbook: Practical Strategies for Living with Someone Who Has Borderline
Personality Disorder, by Randi Kreger and James Paul Shirley. New Harbinger, 2002.
Lost in the Mirror: An Inside
Look at Borderline Personality Disorder, by Richard A. Moskovitz.
Taylor Publishing, 2001.
I Hate You—Don’t Leave Me:
Understanding the Borderline Personality, by Jerold J. Kreisman and Hal Straus. HarperCollins,
1989.
Organizations
Personality Disorders Awareness
Network (PDAN)
A non-profit organization
offering Internet resources and support for family members.
www.BPDCentral.com
National Educational Alliance
for Borderline Personality Disorder (NEA-BPD)
A non-profit organization
focused on families that aims to provide education regarding BPD. Phone:
914-835-9011
www.borderlinepersonalitydisorder.com
Internet Resources
Borderline
Personality Today
An excellent website providing
a wide range of information on BPD.
www.mental-health-today.com/bpd/index.html
The text for this brochure was authored by Malcolm M. MacFarlane, M.A.
