Borderline personality disorder abandonment fear

Borderline Personality Disorder - Harvard Health

What Is It?

Borderline personality disorder is characterized by poor self-image, a feeling of emptiness, and great difficulty coping with being alone. People with this disorder have highly reactive and intense moods, and unstable relationships. Their behavior can be impulsive. They are also more likely than average to attempt or commit suicide. Sometimes, without intending to commit suicide, they harm themselves (for example, cutting or burning) as a form of self-punishment or to combat an empty feeling.

When stressed, people with borderline personality disorder may develop psychotic-like symptoms. They experience a distortion of their perceptions or beliefs rather than a distinct break with reality. Especially in close relationships, they tend to misinterpret or amplify what other people feel about them. For example, they may assume a friend or family member is having extremely hateful feelings toward them, when the person may be only mildly annoyed or angry.

People with borderline personality disorder have a deep fear of abandonment. They compete for social acceptance, are terrified of rejection and often feel lonely even in the context of an intimate relationship. Therefore, it is more difficult for them to manage the normal ups and downs of a romantic partnership. Impulsive, self-destructive behavior may be an attempt to ward off rising anxiety related to the fear of being left alone.

The flip side of the fear is the hope that a relationship will be completely soothing. People with this disorder may idealize a family member, romantic partner or friend, and then become enraged when an inevitable disappointment occurs. They might hold that person responsible for the pain they feel and devalue the relationship.

Most experts believe personality disorders develop as a result of both environmental and biological factors. Early research on this disorder focused on problems in growing up, for example, having gone through abuse or neglect as a child. A significant number of people with symptoms of this disorder have reported such a history in childhood.

Later research has suggested that people with this disorder may have inborn difficulties in regulating their anxiety or moods. They may be more vulnerable to loss or more sensitive to stress than average.

Scientists have begun to see how these characteristics are reflected in the brains of people with borderline personality disorder. Some people with this disorder have an exaggerated startle response to unpleasant stimuli. Brain regions involved in managing fear and controlling aggressive responses function differently in people with borderline personality disorder when compared to people without the disorder. Researchers have also discovered distinctive patterns in hormone levels and the immune system in people with the disorder.

It is quite common for people with borderline personality disorder to also have a mood disorder, eating disorder or substance abuse problem. The person may turn to alcohol or drugs to escape from painful, uncontrollable emotions.

Three times as many women as men are diagnosed with borderline personality disorder. It occurs in about 2% of the population in the United States.

Symptoms

Feeling vulnerable is a common human experience, so many people without this disorder also experience symptoms on this list. The diagnosis of borderline personality disorder is made only when a person has had many of these symptoms, they are severe in degree, and they are long-lasting.

Unstable, intense and difficult relationships
Poor self-image
Self-destructive, impulsive behavior
Suicidal threats or attempts
Self-mutilation
Extreme mood reactions, including intense, inappropriate anger
Feeling empty or alone
Fear of abandonment
Short-lived psychotic-like distortions of perception or belief, especially under stress

Diagnosis

There is no clear line between a personality style and a disorder. Personality patterns are considered to be a disorder when they impair a person's functioning and cause significant distress.

A diagnosis is usually made on the basis of the history and observations made by a mental health professional during an interview. There are no laboratory tests to determine whether someone has borderline personality disorder. Since there is often an overlap with mood disorder or substance abuse, these diagnoses should be considered by a mental health professional in anyone who has the symptoms of borderline personality disorder.

Expected Duration

All personality disorders are lifelong patterns, but there is now more optimism about the more distressing aspects of borderline personality disorder. Research indicates that the symptoms of borderline personality disorder get less intense as people grow older. With proper treatment, many people see significant improvement.

Prevention

There is no known way to prevent borderline personality disorder. Treatment is likely to better the chances of a person with the disorder getting relief from the most painful symptoms.

Treatment

Psychotherapy

Psychotherapy is a key part of the treatment of borderline personality disorder.

The problems in this disorder are related to the person's habitual ways of relating to others and coping with obstacles. People with this disorder tend either to idealize the therapist or to become frustrated easily. They have exaggerated reactions to disappointment. Therefore, it may be difficult for them to sustain a relationship with a mental health professional. This disorder tests the skill of therapists, who have to use a combination of techniques to be effective.

A key challenge in this disorder is that a person suffering with borderline personality disorder may understand interpersonal problems or coping strategies on an intellectual level, but still find it very difficult to tolerate the emotional discomfort that is common in relationships. Even when they do have insight, they may still have trouble managing intense emotions more successfully.

One popular form of structured psychotherapy is called dialectical behavior therapy (DBT). It tries to take the special problems of borderline personality disorder into account, using a combination of psychotherapy techniques, education, and both individual and group psychotherapy to support the patient's progress. A second therapy, called schema-focused therapy tries to address maladaptive points of view believed to originate in childhood and replace those "schemas" with a healthier one through a variety of cognitive therapy techniques.

Research on psychotherapy for borderline personality disorder is relatively difficult to do. Since the problems in this disorder vary widely, the researchers tend to study a few factors at a time. In some studies, DBT has reduced the frequency of self-harm and the intensity of suicidal thinking. It has also been shown to reduce the intensity of symptoms of depression or anxiety.

Structured forms of psychodynamic psychotherapy have also been used successfully.

In one version, transference-focused psychotherapy, the therapist and patient look closely at the emotional themes that arise between them. People with borderline personality disorder are thought to have great difficulty understanding the difference between their own perspective and that of other people (including the therapist). In one sense, therefore, the goal of therapy is for them to gain perspective on their worldview, and to use what they learn to manage their own feelings and behaviors better. Transference-based psychotherapy has been shown to be relatively effective at reducing irritability, impulsivity and assaultiveness.

Another method of psychotherapy is called "mentalization-based therapy" (MBT). It is based on the idea that people with borderline personality disorder have difficulty "mentalizing" or making sense of the emotions, feelings and beliefs of themselves and others. The therapist works to help a person develop more adaptive ways of thinking about emotion and expressing it. They try to help the individual stabilize their sense of self, while managing the ups and downs in the therapy. One focus of attention is the intensity of the patient’s feelings of attachment (or detachment) toward the therapist. MBT makes use of group and individual therapy and has been provided in both outpatient and hospital settings.

Whatever label it carries, treatment aims at helping the person endure feeling isolated, depressed or anxious without resorting to self-destructive behavior or a suicide attempt. Many patients find it difficult to discuss self-destructive impulses with their health care provider, but it can help to do so. Specific plans can be made for how to manage these thoughts or impulses when they arise. Hospitalization sometimes is necessary during periods of crisis.

Outside the hospital, a person with borderline personality disorder may need additional support, such as a day-treatment program, residential treatment, or group, couples or family therapy.

Given the limited amount of research in this area, and the difficulty gaining access to highly specialized treatment programs, it is often wise to employ a combination of psychotherapy techniques.

Medication

As with psychotherapy, there is no single medication that is clearly helpful in borderline personality disorder. Instead, medication is usually used to treat symptoms as they emerge or to treat other disorders that may be present (such as a mood or anxiety disorder or a substance abuse problem).

There is little evidence that antidepressants help with the core symptoms of borderline personality disorder, but they may be useful if there are clear symptoms of depression and anxiety. There is more evidence that mood stabilizers and antipsychotics improve problems with impulse control, aggression or distorted thinking. The benefits are modest and should be weighed against the adverse effects of these drugs.

When To Call a Professional

Because personality styles tend to become more entrenched with age, it is best to seek treatment as soon as significant distress or poor functioning is noticed.

Prognosis

The course of this illness varies and depends on the severity of the symptoms; the amount of stress; the availability of support; the degree of functional impairment; the extent of self-destructive or suicidal behavior; and the presence of other psychiatric disorders, such as depression or substance abuse. It also depends on the person's ability to stay in treatment. Some people are better able to bear the challenges of treatment. Others, however, find themselves in a cycle of seeking help, then feeling rejected and rejecting the help.

Also, it is sometimes difficult for people with borderline personality disorder to find a therapist they feel comfortable enough with. Given the problems maintaining perspective (see above, under Treatment), it may be difficult for them to distinguish between real and exaggerated disappointment in psychotherapy. One benefit of combining individual therapy with other therapy modes (for example, group therapy) is that it can diffuse some of the intensity and refocus the person on practical goals.

Researchers are now more optimistic about the long-term outcomes in borderline personality disorder. The vast majority of people with the disorder experience at least some reduction in symptoms with treatment. Significant numbers of patients recover from the disorder, meaning they no longer met the criteria for having borderline personality disorder and they function well. Therefore, at least with continuing treatment, it appears that many people with borderline personality disorder eventually can make significant progress, take some pleasure in their relationships and have satisfying life achievements.

Additional Info

National Institute of Mental Health
https://www.nimh.nih.gov/

American Psychiatric Association
https://www.psychiatry.org

American Psychological Association
https://www.apa.org

Borderline Personality Disorder (BPD) - Mental Health Disorders

Mark Zimmerman

, MD, Rhode Island Hospital

Full review/revision May 2021 | Modified Sep 2022

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Borderline personality disorder is characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment.

People with borderline personality disorder fear rejection and abandonment, partly because they do not want to be alone.
Doctors diagnose borderline personality disorder based on specific symptoms, including frequently changing relationships, self-image, and mood and self-destructive, impulsive behavior.
Psychotherapy can reduce suicidal behaviors, help relieve depression, and help people with this disorder function better, but drugs are sometimes used to lessen symptoms.

Personality disorders Overview of Personality Disorders Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function... read more are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with borderline personality disorder often have difficulty tolerating being alone and may resort to self-destructive actions to cope with or to avoid being alone. They may make frantic efforts to avoid abandonment, including creating crises. For example, they may attempt suicide as a way to communicate their distress and to get other people to rescue and care for them.

Estimates of how common borderline personality disorder vary. It probably occurs in between 2% to almost 6% of the general population in the United States. It is diagnosed more often in women than in men. With time, symptoms tend to lessen in most people.

Other disorders are also often present. They include

Depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more
Anxiety disorders Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more (such as panic disorder)
Posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) involves intense, unpleasant, and dysfunctional reactions beginning after an overwhelming traumatic event. Events that threaten death or serious injury can... read more
Eating disorders Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more
Substance use disorders Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more

Genes and environmental factors may contribute to the development of borderline personality disorder.

Certain people may have a genetic tendency to react poorly to life stresses, making them more likely to develop borderline personality disorder as well as other mental disorders. Also, borderline personality disorder tends to run in families, further suggesting that this tendency may be partly inherited. First-degree relatives of people with this disorder are 5 times more likely to have the disorder than the general population.

Stresses during early childhood may contribute to the development of borderline personality disorder. Many people with borderline personality disorder were physically or sexually abused, separated from caregivers, and/or lost a parent when they were children. The insecurity of their attachment to their caregivers contributes to the symptoms of borderline personality disorder.

People with borderline personality disorder often appear more stable than they feel inside.

People with borderline personality disorder fear abandonment, partly because they do not want to be alone. Sometimes they feel that they do not exist at all, often when they do not have someone who cares for them. They often feel empty inside.

When people with this disorder feel that they are about to be abandoned, they typically become fearful and angry. For example, they may become panicky or furious when someone important to them is a few minutes late or cancels an engagement. They assume these missteps are caused by how the person feels about them rather than by unrelated circumstances. They may believe that a cancelled engagement means the other person rejects them and that they are bad. The intensity of their reaction reflects their sensitivity to rejection.

People with borderline personality disorder can empathize with and care for another person but only if they feel that other person will be there for them whenever needed. Although they desire intimate relationships and care for others, it is difficult for them to sustain stable relationships. They tend to have very high expectations of how the people they feel close to should act, and their feelings about a relationship may fluctuate rapidly and intensely.

People with borderline personality disorder have difficulty controlling their anger and often become inappropriately and intensely angry. They may express their anger with biting sarcasm, bitterness, or angry tirades. Their anger is often directed at close friends, romantic partners, family members, and sometimes doctors because they feel neglected or abandoned.

After the outburst, they often feel ashamed and guilty, reinforcing their feeling of being bad.

People with borderline personality disorder tend to change their view of others abruptly and dramatically. For example, they may idealize someone early in the relationship, spend a lot of time together, and share everything. Suddenly, they may feel that the person does not care enough and become disillusioned. Then they may belittle or become angry with the person.

They may be needy one minute and righteously angry about being mistreated the next. Their attitude fluctuates based on their perception of the availability and support of the others. When feeling supported, they can be vulnerable and needy, and when feeling threatened or let down, they can become angry and devalue others.

People with borderline personality disorder may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, values, opinions, careers, or friends.

The changes in mood usually last only a few hours and rarely last more than a few days. Mood may change because people with this disorder are so sensitive to signs of rejection or criticism in their relationships.

Many people with borderline personality disorder act impulsively, often resulting in self-harm. They may gamble, engage in unsafe sex, binge eat, drive recklessly, have substance use problems, or overspend.

Suicide-related behaviors Suicidal Behavior Suicide is death caused by an intentional act of self-harm that is designed to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation. Suicide usually. .. read more , including suicidal attempts and threats and self-injury Nonsuicidal Self-Injury Nonsuicidal self-injury is a self-inflicted act that causes pain or superficial damage but is not intended to cause death. Although the methods people use to hurt themselves, such as cutting... read more (for example, by cutting or burning themselves), are very common. Although many of these self-destructive acts are not intended to end life, risk of suicide in these people is 40 times that of the general population. About 8 to 10% of people with borderline personality disorder die by suicide. These self-destructive acts are often triggered by rejection, perceived abandonment, or by disappointment in someone they are close to. People may also harm themselves to express their feelings of being bad or to revive their ability to feel when they are not feeling real or feeling detached from themselves (called dissociation Depersonalization/Derealization Disorder Depersonalization/derealization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of one's life (depersonalization). .. read more ). Sometimes, people with borderline personality disorder engage in self-harm to distract themselves from painful emotions.

People with borderline personality disorder often sabotage themselves when they are about to reach a goal, so that others will perceive them as struggling. For example, they may drop out of school just before graduation or ruin a promising relationship.

When these people feel very stressed, they may have brief episodes of paranoia, symptoms that resemble psychosis (such as hallucinations), or dissociation. The stress is usually caused by feeling that no one cares for them (that is, feeling abandoned and alone) or feeling broken and worthless. Dissociation Depersonalization/Derealization Disorder Depersonalization/derealization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of one's life (depersonalization)... read more includes not feeling real (called derealization) or feeling detached from their body or thoughts (called depersonalization). These episodes are temporary and usually not severe enough to be considered a separate disorder.

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 Classification and Diagnosis of Mental Illness In 1980, the American Psychiatric Association published the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), marking the first attempt to approach the diagnosis... read more ), published by the American Psychiatric Association.

For doctors to diagnose borderline personality disorder, people must have a history of unstable relationships, self-image, and mood, and act impulsively, as shown by at least five of the following:

They make desperate efforts to avoid abandonment (actual or imagined).
They have unstable, intense relationships that alternate between idealizing and devaluing the other person.
They frequently change their self-image or sense of self.
They act impulsively in at least two areas that could cause them harm (such as unsafe sex, binge eating, or reckless driving)
They repeatedly engage in suicide-related behavior, including attempting or threatening to commit suicide and hurting themselves.
They have rapid changes in mood, which last usually only a few hours and rarely more than a few days.
They chronically feel empty.
They become inappropriately and intensely angry or have problems controlling anger.
They have temporary paranoid thoughts or severe dissociative symptoms (feeling unreal or detached from themselves), triggered by stress.

Also, symptoms must have begun by early adulthood.

In most people with borderline personality disorder, symptoms lessen dramatically and often resolve. However, these improvements do not necessarily translate into being able to maintain stable relationships or to hold a job. Treatments aim to help people function better as well as to reduce symptoms. However, symptoms typically improve more than overall function.

Psychotherapy
Drugs

General treatment Treatment Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function... read more of borderline personality disorder is the same as that for all personality disorders.

Identifying and treating coexisting disorders is important for effective treatment of borderline personality disorder.

Treatment includes psychotherapy and certain drugs.

The main treatment for borderline personality disorder is psychotherapy. Specific psychotherapies for borderline personality disorder can reduce suicide-related behaviors, help relieve depression, and help people function better.

These therapies include the following:

Dialectical behavioral therapy
Systems training for emotional predictability and problem solving (STEPPS)
Mentalization-based treatment
Transference-focused psychotherapy
Schema-focused therapy
General psychiatric management

Dialectical behavioral therapy provides weekly individual and group sessions and a therapist who is also available by telephone. The therapist acts as a behavior coach. The aim is to help people find better ways of responding to stress—for example, to resist urges to behave self-destructively.

STEPPS involves weekly group sessions for 20 weeks. People learn skills to manage their emotions, to challenge their negative expectations, and to better care for themselves. For example, they learn to distance themselves from what they are feeling at the moment. They learn to set goals, avoid illegal substances, and improve their eating, sleeping, and exercise habits. People are also asked to identify a support team of friends, family members, and health care practitioners who are willing to coach them when they are in crisis.

Mentalization refers to people's ability to reflect on and understand their own state of mind (what they are feeling and why) and the state of mind of others. Mentalization-based treatment helps people do the following:

Effectively regulate their emotions (for example, calm down when they are upset)
Understand how they contribute to their own problems and difficulties with others
Reflect on and understand how other people are thinking and feeling

It thus helps them relate to others with empathy and compassion, which also helps others understand and support them.

Transference-focused psychotherapy centers on the interaction between the person and the therapist. The therapist asks questions and helps the person examine exaggerated, distorted, and unrealistic self-images and reactions to various situations. The current moment (including how the person is relating to the therapist) is emphasized rather than the past. For example, when a timid, quiet person suddenly becomes hostile and argumentative, the therapist may ask whether the person noticed a shift in feelings and then ask the person to think about how the person was experiencing the therapist and self when things changed. The purposes are

Schema-focused therapy focuses on identifying lifelong maladaptive patterns of thinking, feeling, behaving, and coping (called schemas) and replacing negative thoughts, feelings, and behaviors with healthier ones.

General psychiatric management is designed for the general practitioner, rather than a specialist. It uses individual therapy once a week and sometimes drugs. To enhance self-reliance, therapy prioritizes the ability to work over improving relationships. It also teaches people with borderline personality disorder how to make sense of their symptoms and to understand what the goals and expected results of treatment are.

Supportive psychotherapy is also useful. The therapist's goal is to establish an emotional, encouraging, supportive relationship with the person and thus help the person develop healthy defense mechanisms, especially in interpersonal relationships. However, supportive treatments alone may not reduce the more immediate problems of borderline personality disorder (such as suicidal behavior and self-harm) as effectively as the other, more specific psychotherapies for borderline personality disorder.

When needed, drugs are used to treat specific symptoms. These drugs include

Drugs that help stabilize mood Treatment In bipolar disorder (formerly called manic-depressive illness), episodes of depression alternate with episodes of mania or a less severe form of mania called hypomania. Mania is characterized... read more : To help lessen depression, anxiety, mood swings, and impulsive tendencies
Newer (second-generation) antipsychotic drugs Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more : To help lessen anxiety, anger, and stress-related distortions in thinking (such as paranoid or very disorganized thoughts)
Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (SSRIs), a type of antidepressant: To lessen depression and anxiety

However, SSRIs are only slightly effective in people with borderline personality disorder.

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90,000 Millions of people suffer from borderline personality disorder. What do the first symptoms of BPD look like and how to treat it? Many are accustomed to thinking that this diagnosis is characteristic of psychopaths and is extremely dangerous for others. The fact is that patients with BPD often suffer from mood swings and are prone to aggression in relation to other people. However, is it really that simple? How to identify BPD and interact with the "border guards" - in the material "Lenta.

ru".

What is borderline personality disorder?

Everyone experiences mood swings and self-esteem, but sometimes excessive instability can indicate the presence of an emotionally unstable disorder.

ICD-10 divides it into two subspecies - impulsive and borderline. Impulsive disorder is characterized by frequent mood swings, a tendency to act impulsively, and an increased level of aggression in relationships with others.

Borderline personality disorder (BPD) is also expressed in constant instability, hypersensitivity in relationships with other people, floating self-esteem. Unlike impulsive disorder, people with BPD are less aggressive towards others, but such people are prone to self-harm, to the point of attempting suicide

The main symptom of borderline disorder, which is its basis, is an identity defect, a lack of self-perception and self-understanding. A person does not have a clear idea of himself, his properties and qualities, he lacks internal support.

According to statistics, women suffer from BPD three times more often than men.

What are the symptoms of borderline personality disorder?

As psychotherapist Aleksey Pribytkov explains, people with borderline disorder are most often overly afraid of being alone, of being abandoned, and therefore tend to make great efforts to prevent this from happening.

Photo: unsplash

Signs of BPD (borderline personality disorder)

1. Emotional swing . In one moment, people with such a diagnosis idealize a partner, and in another second they already hate him. Despite this, relationships with people with BPD can be long-lasting but emotionally unstable. Because of the fear of being alone, people with this diagnosis can become dependent on other people.

2. Excessive outbursts of anger, intense anger . Patients may express their anger by directing it to loved ones as payment for neglect and abandonment. Then they begin to blame themselves for this behavior.

3. Strong fear of being abandoned . People with BPD can be unsettled when someone significant to them cancels an appointment or is a couple of minutes late.

4. Rapid changes in life orientation and self-esteem . Goals and values change for no particular reason. Since such people tend to consider themselves bad, they need impulses from outside to feel alive and needed.

5. Impulsive acts, self-destructive behavior . Examples include substance abuse, reckless spending, reckless driving, and overeating.

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6. Paranoia associated with severe stress . The loss of contact with reality, the feeling of a separate existence from the body, can last from several minutes to several hours.

7. Sabotaging success . People with BPD may drop out of school unexpectedly shortly before graduation or ruin a promising relationship.

8. Feeling of emptiness and lack of interest in what is happening .

9. Suicidal thoughts and actions . Inflicting damage to "relieve emotional stress." Often occur in response to separation anxiety or partner rejection.

A number of other disorders may be present, including depression, anxiety disorders, post-traumatic stress disorder, and eating disorders and drug use problems

Why does borderline personality disorder occur?

Although the causes of BPD are not fully known, scientists argue that early childhood stress may contribute to the diagnosis. Many patients have been victims of sexual or physical abuse, lost a parent as a teenager, or experienced neglect by loved ones.

Some people have a genetic predisposition to an abnormal response to stress in their environment. In this case, BPD may appear as a hereditary component. The risk that a child may develop a disorder increases five times if there are people with a similar disease among his relatives.

Photo: unsplash

It is possible to encounter BPD if a person has any disturbances in the functions of the brain and neuroregulatory systems. For example, patients may have malfunctions in the regulation of chemicals, the production of serotonin, which affects mood.

Can borderline personality disorder be cured?

Borderline personality disorder is difficult to treat, but therapy and medication can help people with this disorder improve their quality of life and relieve their symptoms.

There are several types of psychotherapy for people with BPD.

1. Cognitive behavioral therapy (CBT) . Combines individual and group sessions where therapists act as coaches and are available on call around the clock. In addition, patients are taught skills to manage their emotions and negative expectations. During therapy, they learn to set goals, improve their habits, and take care of themselves.

2. Therapy based on mentalization . It refers to people's ability to reflect on and understand the state of their own mind and that of others, helps regulate their emotions and understand how patients' interactions with others affect themselves. Mentalization can be mastered through secure attachment to a loved one.

3. Transference-focused psychotherapy . It primarily focuses on the interaction between the patient and the therapist. The specialist asks questions and helps to see the distorted and unreal self-perception during the session. For example, a sudden change in the patient's behavior during a meeting can be an occasion for discussion and reflection. The result should be healthier relationships with others through transference to the therapist.

4. Dialectical Behavioral Therapy (DBT) . It uses the principles of awareness and acceptance of the current situation and emotional state. DBT teaches control skills and reduces self-destructive behavior.

Photo: unsplash

Medications help control specific symptoms and are most often used in conjunction with psychotherapy. Mood stabilizers and atypical antipsychotics, which are used to treat anxiety, anger, and cognitive disorders, may be effective in reducing the symptoms of BPD.

How to identify borderline personality disorder in yourself and loved ones?

If you suspect you have BPD, try answering a few questions:

1. Would you call yourself a "risk person"?

2. Are you prone to impulsive actions that you later regret?

3. Have you ever felt insecure, thought that you do not have a clear picture of yourself?

4. Have you ever had suicidal thoughts or a desire to harm yourself during difficult emotional experiences?

5. Do you find it difficult to control outbursts of anger and aggression towards other people?

6. Have you had to abruptly switch from love to hate in relation to your partner?

7. Do you experience severe mood swings - from short-term, but strong anger and irritability to days of apathy and depression?

8. Do you have a fear of being alone that makes you act inappropriately? For example, constantly calling close people, trying to be always close to your partner?

If you answered “yes” to most of the questions, then it makes sense to contact a specialist. Symptoms can be associated not only with BPD, but also indicate other health problems. Only a psychotherapist can make a competent diagnosis and conduct a detailed consultation.

How to communicate with people with borderline disorder?

Living with “border guards” can be like an emotional swing and raises many challenges, including the question, “How can you deal with this?”

Author of the book “Far Close. How to live with a person with borderline personality disorder: emotions, boundaries, conflicts "Jerold Kreisman created a manual on how to successfully interact with people who have been diagnosed with borderline personality disorder.

The psychiatrist offers the SET-UP strategy, which was developed in the early 1980s as part of a program to treat patients with BPD in the hospital. The statements associated with the S component (from English support - "support") sound like this: "I care about how you feel", "I'm sorry that this is happening to you", "I want to help you. " E (empathy) is empathy. You acknowledge that the person with BPD is unwell, conflicted, and uncomfortable. It is important to show the person that you understand the challenges they face.

T (truth) draws attention to a realistic assessment of the situation and to the fact that a person with borderline disorder must take responsibility for their behavior. Most often, statements here relate to the solution of pressing problems. You can say to a person, “We know what happened, but now we need to deal with the consequences. Here's how I can help. What are you going to do for your part?"

Photo: Vladimir Astapkovich / RIA Novosti

The UP component is a constant reminder to you and your loved one that healthy relationships always need understanding, perseverance and proper building.

In addition, you need to remind people with BPD that you care about them. They often need confirmation of their worth and importance in your eyes.

People with BPD tend to withdraw into themselves out of fear of rejection, so it is important to take an interest in their affairs and how they feel. This is a great strategy for building rapport.

Soften the bad news with support and empathy so that the person with the diagnosis understands that their feelings and emotions are important to you. If your joint plans are canceled, then try to suggest another day for the meeting.

It is important to observe what triggers a loved one with BPD has. As mentioned in the previous sections, the two main ones are getting rejected and being abandoned. Simple situations that most people are used to can hit the “border guards” hard. Let's say if you didn't reply to a message for a long time because you were busy. In this case, it is worth explaining that your personal attitude towards the person has not changed because of this situation

Border guards in movies

Characters with BPD are often seen in movies. For example, the behavior of the "border guard" is demonstrated in the second and third episodes of Star Wars in the person of Anakin Skywalker and Darth Vader. The girl is desperately afraid of losing her love, claims that she cannot live without it, while the villain Vader feels lost and finds it difficult to define himself.

In the cartoon "Ralph" the main character also shows signs of BPD more than once - he is prone to making impulsive decisions, sudden mood swings and depends on his girlfriend Vanellope. In the second film, he is afraid that the girl might leave him alone. At the same time, the hero's mental illness makes him an understanding and sensitive friend.

Frame: Girl, Interrupted

Another popular character with borderline disorder is BoJack from the animated series BoJack Horseman. The protagonist is an anthropomorphic horse, a popular sitcom star of the 90s, suffering from diminishing public attention every year. BoJack does not have a clear understanding of himself, and self-esteem depends on the opinions of others. He manipulates others, impulsively falls in love. At the same time, the horse is very vulnerable, and his disorder harms, first of all, himself.

Angelina Jolie's character Lisa Rowe in Girl, Interrupted is prone to self-destruction and violent outbursts, manipulates people and generally shows all the signs of a person with BPD. He is, however, diagnosed by another heroine who ends up in a psychiatric hospital after a suicide attempt.

Borderline personality disorder: symptoms, treatment, communication tips

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Expert commentary

What is borderline personality disorder

Borderline personality disorder (BPD, in English terminology - borderline), inevitably affects how a person thinks and feels, how he interacts with others [1]. The diagnosis is recorded in the ICD-10 and is considered a subspecies of an emotionally unstable personality disorder. The disorder manifests itself in problems with self-esteem, the management of emotions and behavior, high anxiety and desocialization, and leads to unstable relationships with others. With borderline personality disorder, a person experiences a fear of being alone or abandoned. Misplaced anger, impulsiveness, frequent mood swings can alienate potential partners.

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Deviations are usually recorded in young people and may worsen with age. However, many patients diagnosed with BPD are able to live a full life, having worked through the main problems.

Borderline Personality Disorder Test

Some symptoms may point directly to BPD, but only the attending physician will give exact information. If you suspect you have a disorder, answer a few questions:

Do you have a fear of being alone that makes you act inappropriately? For example, constantly call a partner, try to be always near him.
Have you had to drastically change your mind in relation to your partner, move from love to hate for no particular reason?
Have you ever felt that you do not have a clear idea of yourself, that you are not sure of your self-esteem?
Have you committed impulsive dangerous acts? For example, have you taken drugs, spent large sums of money recklessly, or had unprotected sex?
Have you harmed yourself, threatened suicide in the presence of loved ones?
Do you experience severe mood swings, from anxiety and irritability to days of depression and apathy?
Do you find it difficult to control your anger?
When you find yourself in a stressful situation, do you feel as if you are disconnected from reality and your own body, do not control your thoughts and behavior?

If you answered "yes" to more questions, it makes sense to talk to a therapist. Symptoms do not always point to borderline personality disorder and may be due to other health problems. Only a specialist can make a correct diagnosis and give competent advice.

Symptoms of borderline personality disorder

BPD affects how a person relates to himself and others, how he behaves in society. Signs and symptoms vary, there may be several, or just a couple from the list [2]:

Strong fear of being abandoned. A person is ready to go to extreme measures to avoid the real or imagined withdrawal or rejection of a partner.
Tendency to unstable relationships. For example, a person idealizes a partner, but at some point suddenly decides that the latter is cruel and unfair.
Rapid changes in self-identification and self-esteem. Goals and values switch disproportionately to the circumstances - abruptly and for no particular reason. A person tends to consider himself bad, he needs impulses from the outside in order to feel alive and needed.
Stress related paranoia. Loss of contact with reality lasting from several minutes to several hours.
Impulsive behavior, propensity to take risks. Gambling, reckless driving, unsafe sex, alcohol abuse, overeating, drugs.
Success sabotage. Sudden unreasonable rejection of positive relationships, good work.
Self-mutilation, suicidal tendencies. Often occur in response to separation anxiety or partner rejection.
Sudden mood swings lasting from several hours to several days. Bright, hypertrophied emotions: happiness, anxiety, shame and irritability.
Constant feeling of emptiness, lack of interest in what is happening.
Aggression - strong anger, cruel sarcastic remarks about interlocutors, fights.

Causes and risk factors

As with other mental health problems, the causes of borderline personality disorder are not fully understood. In addition to circumstances such as childhood abuse or neglect, borderline personality disorder may be associated with the following factors.

Genetics. Studies involving twins and their relatives suggest that BPD may be inherited and be part of a mental health complex [3].
Anomalies of the brain. Several studies have confirmed changes in certain parts of the brain involved in the regulation of emotions, especially impulsivity and aggression [4]. Patients with BPD may have malfunctions in the regulation of chemicals, such as the production of serotonin, which affects mood.

Is there a cure for borderline personality disorder

BPD is difficult to treat. But with the help of modern, evidence-based therapies, people with the disorder can be helped to manage their symptoms and improve their quality of life. It is good if the treatment is carried out by a licensed doctor who specializes in this disease. Sometimes the patient will need to interact not only with a psychiatrist, but also with a social worker who will help to adapt in the absence of loved ones.

The doctor usually conducts an interview and discusses the person's symptoms. Then there is a thorough medical examination and testing, which allows you to exclude other diseases. Comorbid disorders can make BPD difficult to diagnose and treat, especially if their symptoms overlap. For example, a person may show signs of depression, bipolar disorder, anxiety, substance use problems, or eating disorders. If a patient with borderline personality disorder does not receive proper treatment, they are more likely to develop chronic illnesses. And not only mentally, but also physically - patients with BPD tend to make choices in favor of an unhealthy lifestyle and self-harm.

Psychotherapy is the first line of treatment for a person with BPD. It can take place both individually and in a group. The second option helps the patient to interact with other people and express himself in society. Most often, the doctor uses one of two therapy options, or combines them:

Dialectical Behavioral Therapy (DBT). It uses the concepts of awareness and acceptance of the current situation and emotional state. DBT also teaches skills to control and reduce self-destructive behavior.
Cognitive behavioral therapy (CBT). This type of assistance allows you to identify and change the core beliefs that underlie inaccurate acceptance of yourself and others, as well as problems associated with communication.

Because their benefits are unclear, medications are not commonly used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat certain symptoms, such as controlling mood swings and depression. The psychotherapist should specialize in borderline personality disorder, that is, receive additional education in this area.

How to communicate with a person with BPD

People with BPD are often very suspicious and vulnerable. They need support, and it is important for them to realize that they have someone to turn to in case of exacerbations. Eliza Gordezki, a writer, artist and queer feminist with BPD, has developed a manual for interacting with people who have been diagnosed with BPD [5]. Here are the main recommendations.

Tell loved ones that you will take care of them

People with BPD tend to think that if they don't hear this confirmation, then they are indifferent to others. Suitable phrases:

"Just writing to you to tell you I care about you."
"I wanted you to know that I'm thinking of you right now."
"I love having you in my life and I wanted to make sure you knew that."

Take an interest in well-being and affairs

For people with BPD, this is a vicious circle: they are afraid of being rejected, so they do not share their experiences in order to eliminate the risks of negative reactions from others. Asking how you are doing is a good strategy for making contact.

“Hi, how are you?”
“I saw you posted a sad post on Facebook. I wanted to make sure you were okay."

Soften bad news with support and sympathy

When you tell your loved one some unpleasant information, try to remind him that he is important to you and that you will support him in any case. A person with BPD needs to be aware that his feelings are taken into account and not perceived as something feigned.

"It's not easy for me to support you in this crisis, but I need to know what to do to make it easier for you to deal with it."

Match words

Marsha Linehan, who developed the Dialectical Behavior Model (one of the most common treatments for people with BPD), uses specific vocabulary in her manuals [6]. Rather than characterize a person or their actions with judgmental words, she prefers adjectives such as "efficient, skillful, and wise" (or the reverse, "inefficient, inept, and unwise"). These words separate a person from his behavior, they name qualities that can be changed. If someone is being violent, negative, or insulting, you can say something like:

“I can see you're upset. I understand why you are upset, but these actions are very inefficient and will not bring you the desired results. Let's think together how we can achieve greater sense and achieve the desired prospects.

Compare this phrase with those that many people are used to using in similar situations: “It's not normal if you react like that!”, “It's impossible to communicate with you, there is too much drama”, “Why are you overreacting? You are always so sensitive!”

Be attentive to triggers

The only way to determine what is bothering a loved one is to ask and observe. Among people with BPD, two triggers are common (eng. trigger - a reason, a trigger; in psychology - an irritant that causes a certain reaction) - to be thrown and to be rejected. Simple situations that most people are used to can cause a strong negative reaction with borderline personality disorder. For example, if you reschedule a meeting or began to devote more time to other things, did not respond to a message for a long time, or forgot to call. Of course, changing plans is normal, but when communicating with a person with BPD, it is worth taking a little time to explain your actions to him:

“I remember that we planned to meet on Friday and have dinner together, and I'm sorry, but I have to cancel this meeting. I was assigned to make an urgent report, and I will be at work all evening. It will be great if, along with the cancellation of plans, you offer a quick alternative: “But I really want to spend time with you! Maybe we can meet on Saturday for lunch?

Repeat and confirm

People with BPD need to be reminded of your positive attitude. Frequent reinforcement and support is an important part of their well-being and confidence in the world. Be patient and focus on good moments, convince your loved one if he breaks into negative emotions, even if it seems to you that they are unreasonable. For example, your friend is upset that they don't reply to a message. At this point, he may seriously believe that the interlocutor hates him. Inform that this is not the case, most likely, the person is just busy, he will definitely write or call as soon as he has time.

What works well for one person may not work for another, so it's always best to talk to your loved ones and ask what they need.

Expert comment

Andrey Yudin, psychologist, Gestalt therapist, co-founder of Stemning Gestalt Center

It is not always possible to build relationships with a person with BPD [7]. But if it's not a destructive abusive relationship and it's important for you to keep the relationship going, you need to put in a lot of effort. First of all, set boundaries - when you can come or call, whether you can shout. Sometimes it can take years to rebuild, especially when it comes to older relatives. It will take a lot of labor and therapeutic support.

Borderline personality disorder is one of the three basic personality disorders in modern psychotherapy, the other two being schizoid and narcissistic. BPD is the most well studied and isolated, it is in the public eye due to its clinical manifestations. The disorder is included in the ICD-10, but the difficulty lies in the lack of uniform criteria for the diagnosis. There are three obvious signs of borderline personality disorder:

The person does not take care of himself. For example, he does not visit doctors, while experiencing guilt and shame for his choice. This factor applies to both hygiene and personal relationships.
Approach speed. People with BPD tend to quickly make contacts and just as quickly become disillusioned with new acquaintances, friends, and romantic relationships.
Extreme fear of rejection. If a person is afraid of being abandoned, being rejected by relatives, friends or partners, then this is a clear sign of BPD.

With BPD, there is a clear lack of self-activation - urging oneself to some kind of action. At the same time, it is difficult for a person to explain to himself why he cannot do this. Trying to rouse himself to action, he begins to worry. Borderline personality disorder begins in childhood, between 16 and 24 months. It is often the result of severe abuse, physical, emotional or sexual abuse, or a parent's negative response to a child's need for emotional closeness. In the case of premature separation, a mental structure is formed from two separate parts, which normally should be integrated into each other, but in BPD these are two separate modules.

BPD is often associated with drug addiction. Suffering, feelings of frustration, dissatisfaction encourage a person to chemically regulate his emotional state. This is alcohol, and drugs, and self-damaging behavior, and not only in relation to the body. For example, a person can spend all the money on payday.

With regard to BPD during adolescence, for this stage of human development, many of the "symptoms" are actually normal behavior. Severe emotional experiences, dulling the sense of self-preservation, experiments with substances and partners. But from the age of 16-18, when the transitional stage has been passed, the persistence of these signs may be a reason to contact a specialist.

Those close to people with BPD face, first of all, their emotional instability. The biggest difficulty is the chaotic influence on the lives of others. If a person with a narcissistic disorder extends his suspiciousness to the assessments of others, then with BPD people tend to have a different focus - love / not love, rejection / acceptance. A person may try to return the location of the partner or play ahead of the curve - break off the relationship, if he assumes that he may be abandoned. People with BPD may become abusers because of the unbearable emotional experiences they are trying to change in this way.

In the professional field, BPD can be suspected, for example, in rock stars. Moreover, the presence of such a feature for people in this profession will even be a plus. There will be a lot of life and pain in their work, it is very sincere and can be healing for other people.

If you encounter a person with BPD at work—a boss, a colleague, a subordinate—they are likely to have fairly loose boundaries because they find it difficult to set and maintain them. This may be a person who perfidiously treats other people's borders or, conversely, distances himself and avoids communication. People with BPD are very successful. Such bosses have reactive behavior, chaos in the department, and many will be uncomfortable. But there are qualities in BPD that are good for management: empathy, intuition, even being aggressive can be an asset for career advancement.

The diagnosis and treatment of borderline personality disorder requires a specific set of skills that are not taught in psychology departments, at least not in basic education programs. Most psychologists do not have such qualifications; a maximum of 10% of practicing specialists have it. Therefore, educational work is especially important so that people can find the understanding and support that are so needed. The peculiarity of therapy for BPD will be directed to the very two modules of consciousness (patterns) of the patient. A person with BPD may go to the doctor from their positive childhood pattern and talk about how well the treatment is working. He does this because he is used to being held in relationships in this way, he has learned that he must give positive emotional nourishment "so as not to be abandoned." The therapist must frustrate this pattern, help to go beyond it.

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