Personality Limit Disorder: Symptoms, Causes, Treatments

People with Borderline personality disorder (BPD) are characterized by turbulent lives, mood and unstable personal relationships, and by Have low self-esteem .

Some of the symptoms of people who have it are:

• They feel empty and are at risk of dying from suicide.
• They fear the abandonment of their near people.
• They have no control over their emotions.
• They engage in suicidal or self-mutilating behaviors, such as being cut or burned. A percentage - around 6% - commits suicide.
• They tend to be intense, and in a short time from anger to depression.
• They are impulsive, being able to consume substances.
• They have difficulty maintaining their own identity and often feel empty.

BPD occurs most often in early adulthood. The unsustainable pattern of interaction with others persists for years and is usually related to the person's self-image.

This pattern of behavior is present in several areas of life: home, work and social life.

These people are very sensitive to environmental circumstances. The perception of rejection or separation from another person can lead to profound changes in thoughts, behaviors, affection and self-image.

They experience deep fears of abandonment and inappropriate hatred, even when faced with temporary separations or when there are inevitable changes in plans.

These fears of abandonment are related to intolerance to being alone and to a need to have other people with them.

Specific symptoms of borderline personality disorder

A person with BPD will often show impulsive behaviors and will have most of the following symptoms:

• Frantic efforts to avoid a real or imagined abandonment.
• An unsustainable and intense pattern of personal relationships characterized by extremes of idealization and devaluation.
• Alteration of identity, as an unstable self-image.
• Impulsivity in at least two areas that are potentially harmful to self: expenses, sex, substance abuse, binge eating, reckless driving.
• Recurrent suicidal behavior, gestures, threats or self-harm.
• Emotional instability.
• Chronic feelings of emptiness.
• Intense and inappropriate anger or difficulty controlling anger; Constant anger, fights.
• Paranoid thoughts related to stress.
• Frantic efforts to avoid a real or imagined abandonment.
• The perception of impending separation or rejection can lead to profound changes in self-image, emotions, thoughts and behaviors.
• A person with BPD will be very sensitive to what is happening in their environment and will experience intense fears of abandonment or rejection, even when the separation is temporary.

Emotions

People with BPD feel emotions more deeply, more time and more easily than other people.

These emotions can appear repeatedly and persist for a long time, which makes it more difficult for people with BPD to return to a normalized state.

People with BPD are often enthusiastic and idealistic. However, they may feel overwhelmed by Negative emotions , Experiencing intense sadness, shame or humiliation.

They are especially sensitive to feelings of rejection, criticism or perceived failure. Before learning other coping strategies, your efforts to control negative emotions can lead to self-harm or suicidal behavior.

In addition to feeling intense emotions, people with BPD experience great emotional changes, being common the changes between anger and anxiety or between depression and anxiety.

Intense and unsustainable personal relationships

People with BPD can idealize their loved ones, demand to spend time with them, and often share intimate details in the early stages of relationships.

However, they can move quickly from idealization to devaluation, feeling that other people do not care enough or do not give enough.

These people can Empathize With others and contribute, but only with the expectation that"they will be there."

They are prone to sudden changes in the perception of others, seeing them as good supports or as cruel punishers.

This phenomenon is called black-and-white thinking, and includes the change from idealizing others to devaluing them.

Alteration of identity

There are sudden changes in self-image; Change of goals, values ​​and vocational aspirations.

There may be changes in opinions or plans about the career, sexual identity, values ​​or types of friends.

Although they typically have a self-image of being bad, people with BPD may sometimes have feelings of not existing at all.

These experiences often occur in situations where the person feels lack of affection and support.

Cognitions

The intense emotions experienced by people with BPD can make it difficult for them to control their focus or focus.

In fact, these people tend to dissociate in response to the experimentation of a painful event; The mind redirects attention away from the event, supposedly to ward off intense emotions.

Although this tendency to block intense emotions can give temporary relief, it can also have the side effect of reducing the experimentation of normal emotions.

Sometimes it can be said when a person with BPD dissociates, because their vocal or facial expressions become flat, or they seem distracted. At other times, dissociation is not noticeable.

Self-harm or suicide

Self-harm or Suicidal behavior Are one of the diagnostic criteria of DSM IV.

Treatment of this behavior can be complex.

There is evidence that men diagnosed with BPD are twice as likely to commit suicide as women. There is also evidence that a considerable percentage of men who commit suicide may have been diagnosed with BPD.

Self-harm is common and can occur with or without attempted suicide.

Reasons for self-harm include: expressing hatred, self-punishment, and distraction from emotional pain or difficult circumstances.

In contrast, suicide attempts reflect a belief that others will be better off after suicide.

Both self-harm and suicidal behavior are a response to negative emotions.

Causes

Evidence suggests that TLP and Posttraumatic stress disorder May be related in some way.

It is currently believed that the cause of this disorder is biopsychosocial; Biological, psychological and social factors.

Genetic Influences

Limb personality disorder (BPD) is related to mood disorders and is more frequent in families presenting the problem.

It is estimated that the heritability of TLP is 65%.

Some traits - such as impulsivity - may be hereditary, but environmental influences also matter.

Environmental influences

A psychosocial influence is the possible contribution of early traumas to BPD, such as sexual and physical abuse.

In 1994, researchers Wagner and Linehan found in a research study with women with BPD that 76% reported having suffered child sexual abuse.

In another 1997 study by Zanarini, 91% of people with BPD reported abuse and 92% inattention before age 18.

Brain Abnormalities

A number of neuroimaging studies in people with BPD have found reductions in brain Related to the regulation of stress responses and emotions: hippocampus , Orbitofrontal cortex and amygdala, among other areas.

Hippocampus

It is usually smaller in people with BPD, as in people with post-traumatic stress disorder.

However, in BPD, unlike in PET, the amygdala also tends to be smaller.

Amygdala

The amygdala is more active and smaller in someone with BPD, which has also been found in people with obsessive-compulsive disorder.

Prefrontal Cortex

It tends to be less active in people with BPD, especially when recalling experiences of abandonment.

Hypothalamic-pituitary-adrenal axis

The hypothalamic-pituitary-adrenal axis regulates the production of cortisol, a hormone related to stress.

Cortisol production tends to be elevated in people with BPD, indicating hyperactivity in the HPA axis.

This causes them to experience a greater biological response to stress, which may explain the greater vulnerability to irritability.

Increased cortisol production is also associated with an increased risk of suicidal behavior.

Neurobiological factors

Estrogen

A 2003 study found that the symptoms of women with BPD were predicted by changes in estrogen levels through menstrual cycles.

Neurological pattern

New research published in 2013 by Dr. Anthony Ruocco of the University of Toronto has highlighted two patterns of brain activity that may be underlying the emotional instability characteristic of this disorder:

• A greater activity has been described in the brain circuits responsible for the experiences of negative emotions.
• Reduced activation of brain circuits that normally regulate or suppress these negative emotions.

These two neural networks are dysfunctional in the limbic frontal regions, although specific regions vary widely among individuals.

Diagnosis

Diagnostic criteria according to DSM-IV

A general pattern of instability in interpersonal relationships, self-image and effectiveness, and a remarkable impulsivity, beginning at the beginning of adulthood and occurring in different contexts, as indicated by five (or more) of the following items:

1. Frantic efforts to avoid a real or imagined abandonment. Note: do not include suicide or self-mutilation behaviors listed in criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by the alternative between the extremes of idealization and devaluation.
3. Alteration of identity: self-image or sense of self accused and persistently unstable.
4. Impulsivity in at least two areas, which is potentially harmful to self (eg expenses, sex, substance abuse, reckless driving, binge eating). Note: do not include suicide or self-mutilation behaviors listed in criterion 5.
5. Recurrent suicidal behavior, attempts or threats, or self-mutilating behaviors.
6. Affective instability due to a marked reactivity of mood (eg episodes of intense dysphoria, irritability or anxiety, which usually last a few hours and rarely a few days).
7. Chronic feelings of emptiness.
8. Inappropriate and intense anger or difficulties in controlling anger (eg, frequent signs of bad temper, constant anger, recurring physical fights).
9. Transient paranoid ideation related to stress or severe dissociative symptoms.

Diagnostic criteria according to ICD-10

CIELO-10 of the World Health Organization defines a disorder that is conceptually similar to borderline personality disorder, called disorder from Emotional instability of the personality. Its two subtypes are described below.

Impulsive subtype

At least three of the following must be present, one of which must be (2):

1. Marked tendency to act unexpectedly and regardless of consequences;
2. Marked tendency to engage in quarrelsome behaviors and to have conflicts with others, especially when impulsive acts are criticized or frustrated;
3. Tendency to fall into outbursts of violence or anger, with no ability to control the outcome of the explosions;
4. Difficulty in maintaining any course of action that does not offer immediate reward;
5. Mood unstable and capricious.

Borderline type

At least three of the symptoms mentioned in the impulsive type must be present, with at least two of the following:

1. Uncertainty about the image itself;
2. Tendency to engage in intense and unstable relationships, often leading to emotional crises;
3. Excessive efforts to avoid abandonment;
4. Recurrent threats or acts of self-harm;
5. Chronic feelings of emptiness;
6. Demonstrates impulsive behavior, by., Speeding or substance abuse.

Differential diagnosis

There are comorbid (co-occurring) conditions that are common in BPD.

Compared with other personality disorders, people with BPD showed a higher rate by meeting the criteria for:

• Mood disorders, including major depression and bipolar disorder.
• Anxiety disorders, including panic disorder, social phobia, and posttraumatic stress disorder.
• Other personality disorders.
• Substance abuse.
• Eating disorders, including anorexia nervosa and bulimia.
• Attention deficit disorder and hyperactivity.
• Somatoform disorder.
• Dissociative disorders.

The diagnosis of BPD should not be made during an untreated mood disorder, unless the medical history supports the presence of a personality disorder.

Millon Subtypes

Psychologist Theodore Millon has proposed four subtypes of BPD.

Discouraged (including avoidance characteristics): submissive, loyal, humble, vulnerable, desperate, depressed, powerless and powerless.

Petulante (including negativistic characteristics): negative, impatient, restless, defiant, pessimistic, resentful, obstinate. Quickly disillusioned.

Impulsive (including histrionic or antisocial characteristics): capricious, superficial, frivolous, distracted, frantic, irritable, potentially suicidal.

Self-destructive (including depressive or masochistic characteristics).

Treatment

Psychotherapy is the first line of treatment for borderline personality disorder.

Treatments should be based on the individual, rather than on the general diagnosis of BPD.

The medication is useful for treating comorbid disorders such as anxiety and depression.

Psychotherapy

Long-term psychotherapy is currently the first option to treat BPD.

Cognitive-behavioral therapy

Although Cognitive behavioral therapy Is used in mental disorders, it has been shown to be less effective in BPD because of the difficulty in developing a therapeutic relationship and committing to treatment.

Behavioral dialectic therapy

It is derived from cognitive-behavioral techniques and focuses on the exchange and negotiation between the therapist and the patient.

The goals of therapy are agreed upon, prioritizing the problem of self-harm, learning new skills, Social skills , Adaptive control of anxiety and the regulation of emotional reactions.

Focal cognitive schema therapy

It is based on cognitive-behavioral techniques and skills acquisition techniques.

It focuses on deep aspects of emotion, personality, schemas, the relationship with the therapist, the traumatic experiences of childhood and daily life.

Cognitive-analytical therapy

It is a brief therapy that aims to provide an effective and accessible treatment, combining cognitive and psychoanalytic approaches.

Psychotherapy based on mentalization

It is based on the assumption that people with BPD have a distortion of attachment due to problems in paternal-filial relationships in childhood.

The intention is to Develop self-regulation Of patients through psychodynamic group therapy and individual psychotherapy in the therapeutic community, partial or ambulatory hospitalization.

Marriage, spousal or family therapy

Couple therapy or family Can be effective in stabilizing relationships, reducing conflict and stress.

It is psychoeducated to the family and improves communication within the family, fostering problem solving within them and supporting family members.

Medication

Some drugs may have an impact on isolated symptoms as- sociated with BPD or the symptoms of other comorbid (co-occurring) conditions.

• Of the Antipsychotics Haloperidol may reduce anger and flupenthixol may reduce the likelihood of suicidal behavior.
• Of atypical antipsychotics, aripiprazole may reduce interpersonal problems, anger, impulsivity, paranoid symptoms, anxiety, and general psychiatric pathology.
• Olanzapine can reduce affective instability, hatred, paranoid symptoms and anxiety.
• Antidepressants (SSRIs) have been shown in randomized controlled trials to improve the comorbid symptoms of anxiety and depression.
• Studies have been conducted to evaluate the use of some anticonvulsants in the treatment of BPD symptomatology. Among them, Topiramate and Oxcarbazepine as well as opioid receptor antagonists such as naltrexone to treat dissociative symptoms or clonidine, an antihypertensive for the same purpose.

Due to the weak evidence and potential side effects of some of these medications, the National Institute for Health and Clinical Excellence (NICE) recommends:

Drug treatment should not be treated specifically for BPD or for the individual symptoms or behaviors associated with the disorder." However,"drug treatment could be considered in the general treatment of comorbid conditions."

Forecast

With proper treatment, most people with BPD can decrease the symptoms associated with the disorder.

Recovery from BPD is common, even for people who have more severe symptoms. However, recovery only occurs in people who receive some kind of treatment.

The patient's personality can play an important role in recovery.

In addition to symptom recovery, people with BPD also achieve better psychosocial functioning.

Epidemiology

A 2008 study found that the prevalence in the general population is 5.9%, occurring in 5.6% of men and 6.2% of women.

TLP is estimated to contribute to 20% of psychiatric hospitalizations.

References

1. American Psychiatric Association 2013, p. 645
2. American Psychiatric Association 2013, pp. 646-9
3. Linehan et al. 2006, pp. 757-66
4. "Borderline Personality Disorder: Proposal to include a supplementary name in the DSM-IV text revision".
5. Koenigsberg HW, Harvey PD, Mitropoulou V et al. (May 2002). "Characterizing affective instability in borderline personality disorder". Am J Psychiatry 159 (5): 784-8. Doi: 10.1176 / appi.ajp.159.5.784. PMID 11986132.
6. National Education Alliance for Borderline Personality Disorder. "A BPD Brief"(PDF). P. 4. Retrieved 2013.
7. Arntz A (September 2005). "Introduction to special issue: cognition and emotion in borderline personality disorder". Behav Ther Exp Psychiatry 36 (3): 167-72.
8. "What Is BPD: Symptoms". Retrieved January 2013.
9. Robinson, David J. (2005). Disordered Personalities. Rapid Psychler Press. Pp. 255-310. ISBN 1-894328-09-4.
10. Torgersen, S (March 2000). "Genetics of patients with borderline personality disorder". Psychiatr. Clin. North Am. 23 (1): 1-9. Doi: 10.1016 / S0193-953X (05) 70139-8. PMID 10729927.
11. Goodman, M; New, A; Siever, L (December 2004). "Trauma, genes, and the neurobiology of personality disorders". Annals of the New York Academy of Sciences 1032: 104-16. Bibcode: 2004NYASA1032..104G.
12. "Possible Genetic Causes Of Borderline Personality Disorder Identified". Sciencedaily.com. 20 Dec 2008.
13. O'Neil, Aisling; Thomas Frodl (January 18, 2012). "Brain structure and function in borderline personality disorder". Brain Structure and Function.
14. Gunderson, JG; Sabo, AN (1993). "The phenomenological and conceptual interface between borderline personality disorder and PTSD." Am J Psychiatry 150 (1): 19-27. Doi: 10.1176 / ajp.150.1.19. PMID 8417576.
15. Kluft, Richard P. (1990). Incest-Related Syndromes of Adult Psychopathology. American Psychiatric Pub, Inc. pp. 83, 89. ISBN 0-88048-160-9.
16. Zanarini, MC; Frankenburg, FR (1997). "Pathways to the development of borderline personality disorder". J. Pers. Disord. 11 (1): 93-104. Doi: 10.1521 / pedi.1997.11.1.93. PMID 9113824.
17. Torgersen, S; Lygren, S; Oien, PA, et al. (2000). "A twin study of personality disorders". Compr Psychiatry 41 (6): 416-25. Doi: 10.1053 / comp.2000.16560. PMID 11086146.
18. Goodman, M; New, A; Siever, L (December 2004). "Trauma, genes, and the neurobiology of personality disorders". Annals of the New York Academy of Sciences 1032: 104-16. Bibcode: 2004NYASA1032..104G.
19. Szeszko PR, Robinson D, Alvir JM et al. (October 1999). "Frontal orbital and amygdala volume reductions in obsessive-compulsive disorder". Arch. Gen. Psychiatry 56 (10): 913-9. Doi: 10.1001 / archpsyc.56.10.913. PMID 10530633.
20. Van Heeringen K, Audenaert K, Van de Wiele L, Verstraete A (November 2000). "Cortisol in violent suicidal behavior: association with personality and monoaminergic activity". J Affect Disord 60 (3): 181-9. Doi: 10.1016 / S0165-0327 (99) 00180-9. PMID 11074106.
21. DeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L (August 2003). "Estrogen fluctuations, oral contraceptives and borderline personality". Psychoneuroendocrinology 28 (6): 751-66. Doi: 10.1016 / S0306-4530 (02) 00068-9. PMID 12812862.
22. Brown GR, Anderson B (January 1991). "Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse". Am J Psychiatry 148 (1): 55-61. Doi: 10.1176 / ajp.148.1.55. PMID 1984707.
23. Zanarini M.C., Frankenburg F.R. (1997). "Pathways to the development of borderline personality disorder". Journal of Personality Disorders 11 (1): 93-104.
24. Dozier, Mary; Stovall-McClough, K. Chase; Albus, Kathleen E. (1999). "Attachment and psychopathology in adulthood". In Cassidy, Jude; Shaver, Phillip R. Handbook of attachment. New York: Guilford Press. Pp. 497-519.
25. Rosenthal, MZ; Cheavens, JS; Lejuez, CW; Lynch, TR (September 2005). "Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms". Behav Res Ther 43 (9): 1173-85. Doi: 10.1016 / j.brat.2004.08.006. PMID 16005704.
26. Bradley R, Jenei J, Westen D (January 2005). "Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antedents". J. Nerv. Ment. Dis. 193 (1): 24-31. Doi: 10.1097 / 01.nmd.0000149215.88020.7c. PMID 15674131.
27. Sauer, SE; Baer, ​​Ruth A.; Baer, ​​RA (February 2009). "Relationships between thought suppression and symptoms of borderline personality disorder". J. Pers. Disord. 23 (1): 48-61. Doi: 10.1521 / pedi.2009.23.1.48. PMID 19267661.
28. Emotionally unstable personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) - World Health Organization
29. Allen DM, Farmer RG (1996). "Family relationships of adults with borderline personality disorder". Compr Psychiatry 37 (1): 43-51. Doi: 10.1016 / S0010-440X (96) 90050-4. PMID 8770526.
30. Zanarini MC, Frankenburg FR, Dubo ED et al. (December 1998). "Axis I comorbidity of borderline personality disorder". Am J Psychiatry 155 (12): 1733-9. Doi: 10.1176 / ajp.155.12.1733. PMID 9842784.
31. Gregory, Robert J. (November 1, 2006). "Clinical Challenges in Co-occurring Borderline Personality and Substance Use Disorders." Psychiatric Times.
32. Jamison, Kay R.; Goodwin, Frederick Joseph (1990). Manic-depressive illness. Oxford [Oxfordshire]: Oxford University Press. P. 108. ISBN 0-19-503934-3.
33. Gunderson JG, Elliott GR (March 1985). "The interface between borderline personality disorder and affective disorder". Am J Psychiatry 142 (3): 277-88. Doi: 10.1176 / ajp.142.3.277. PMID 2857532.
34. Jamison, Kay R.; Goodwin, Frederick Joseph (1990). Manic-depressive illness. Oxford [Oxfordshire]: Oxford University Press. P. 336. ISBN 0-19-503934-3.
35. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (January 2011). "Borderline personality disorder". Lancet 377 (9759): 74-84. Doi: 10.1016 / S0140-6736 (10) 61422-5. PMID 21195251.
36. Zanarini MC (November 2009). "Psychotherapy of borderline personality disorder". Acta Psychiatr Scand 120 (5): 373-7. Doi: 10.1111 / j.1600-0447.2009.01448.x. PMID 19807718.
37. Blechner, Mark J. (July 1994). "Projective identification, countertransference, and the 'maybe-me'." Contemporary Psychoanalysis 30 (3): 619-30.
38. Chafos VH, Economou P (July 2014). "Beyond Borderline Personality Disorder: The Mindful Brain". Social Work 59 (4): 297-302. Doi: 10.1093 / sw / swu030.
39. Johnson, R. Skip (26 July 2014). "Treatment of Borderline Personality Disorder." BPDFamily.com. Retrieved 5 August 2014.
40. Links, Paul S.; Bergmans, Yvonne; Warwar, Serine H. (July 1, 2004). "Assessing Suicide Risk in Patients With Borderline Personality Disorder." Psychiatric Times.
41. Oldham, John M. (July 2004). "Borderline Personality Disorder: An Overview". Psychiatric Times XXI (8).
42. Skodol AE, Bender DS (2003). "Why are women diagnosed with borderline more than men?". Psychiatr. Q 74 (4): 349-60. Doi: 101023 / A: 1026087410516. PMID 14686459.
43. C. Hughes (1884). "Borderline psychiatric records - prodronal symptoms of physical impairments". Alienists & Neurology 5: 85-90.
44. Stone MH (2005). "Borderline Personality Disorder: History of the Concept". In Zanarini MC. Borderline personality disorder. Boca Raton, FL: Taylor & Francis. Pp. 1-18. ISBN 0-8247-2928-5.
45. Becker D. (October 2000). "When she was bad: borderline personality disorder in a posttraumatic age". Am J Orthopsychiatry. 70 (4): 422-32. Doi: 10.1037 / h0087769. PMID 11086521.
46. Deans C, Meocevic E (2006). "Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder". Contemp Nurse 21 (1): 43-9. Doi: 10.5172 / conu.2006.21.1.43. PMID 16594881.
47. Bogod, Elizabeth. "Borderline Personality Disorder Label Creates Stigma". Retrieved 2013.
48. Robinson, David J. (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Michigan: Rapid Psychler Press. P. 234. ISBN 1-894328-07-8.
49. Robinson, David J. (1999). The Field Guide to Personality Disorders. Rapid Psychler Press. P. 113. ISBN 0-9680324-6-X.
50. Bujold, Lois McMaster (July 1999). "_Komarr_, Tien, and Borderline Personality". UK: Herald. Digest 2552, 4th msg. Retrieved September 9, 2011.
51. Image source.