Borderline personality disorder spectrum

The Four Types of Borderline Personality Disorder - OPI Residential Treatment Center for Young Adults

Borderline personality disorder, commonly known as BPD, is a mental disorder usually diagnosed in young or early adulthood and affecting between 1.6 and 5.9 percent of Americans, according to Psych Central. It is commonly misdiagnosed or missed altogether as some of the symptoms can mirror other disorders, and BPD often coexists with another disorder. The major indicators of BPD are an inability to maintain healthy relationships, intense mood swings, and impulsivity leading to risky behavior.

Symptoms of BPD

In order to be diagnosed with Borderline Personality Disorder, at least five of the following BPD symptoms must be present and also form a chronic and repetitive pattern:

Extreme fear of rejection and abandonment, both real and imagined
Stormy personal relationships swinging from idealization to devaluation
Unstable self-image
Inappropriate bouts of intense anger
Chronic feelings of boredom or emptiness
Emotional instability, including irritability and anxiety
Paranoid and dissociative thoughts
Impulsivity leading to reckless and harmful behavior

Sufferers of BPD tend to do whatever they can to avoid any form of perceived abandonment or rejection, having extreme reactions to things such as a vacation or someone being a few minutes late to an appointment. These feelings can trigger intense anger and lead to impulsive and self-harming behavior. Sometimes these behaviors include suicidal tendencies, although usually, the intent is not to follow through.

Relationships are tough for those who suffer from BPD as feelings can quickly shift from one of intense love to a feeling of the recipient not caring enough or not being there for them. Usually, BPD causes turmoil in all relationships, not just personal ones, but can extend into the workplace as well. Those who suffer from BPD are extremely sensitive to their environment, and seemingly innocuous events can be a trigger.

Impulsive thoughts and actions can lead to self-harming actions like substance abuse, reckless driving, eating disorders, self-mutilation, risky sexual behavior, and inappropriate spending. According to Psychiatric Times, 50 to 70 percent of individuals diagnosed with borderline personality disorder also suffer from a substance abuse disorder, usually involving alcohol abuse.

An unstable sense of self, or self-image is indicative of BPD also. This can lead to quick changes in goals, careers and the like. Opinions of self tend to fluctuate from high to low rapidly. Sufferers of BPD sometimes describe “out-of-body” experiences and feelings of separateness.

Types of Borderline Personality Disorder

According to field expert Theodore Millon, there are four different types of borderline personality disorder:

Discouraged borderline personality disorder
Impulsive borderline personality disorder
Petulant borderline
Self-destructive borderline

Someone suffering from BPD may or may not fall into one of these subcategories, and some may even fall into more than one category. Over time, these symptoms can change and manifest differently as well.

The discouraged borderline exhibits clingy and codependent behavior, tending to follow along in a group setting although seeming dejected. They are usually brimming with disappointment and anger under the surface directed at those around them. Discouraged borderlines are more likely to engage in self-mutilation and even suicide. They seek approval but also tend to avoid people, feel unworthy, and can trend toward depression.

An impulsive borderline is often highly charismatic, energetic and engaging. They can be superficial, flirtatious and elusive, seeking thrills and becoming quickly bored. Impulsive borderlines thrive on attention and excitement and often get themselves into trouble after acting first and thinking later. This can lead to substance abuse and self-injurious behavior as they seek approval from those around them and seek to avoid disappointment and abandonment.

Unpredictability, irritability, defiance and impatience signify the petulant borderline. They tend to be stubborn, pessimistic and resentful as well. They teeter between extreme feelings of being unworthy and anger. They can explode with these episodes of anger. Petulant borderlines fear being disappointed by others but also can’t seem to help wanting to rely on them. They tend to be passive-aggressive and can display self-harming behavior to get attention.

The self-destructive borderline engages in self-destructive behavior. At times they may or may not even be aware of its destructive nature. They are bitter and self-loathing. They have no sense of self and are terrified of being abandoned. They may hurt themselves in an effort to feel something. A self-destructive borderline is most likely to engage in risky behavior like reckless driving and degrading sexual acts.

Education is important in treating any type of borderline personality disorder. The more you know, the easier it can be to address the issue. Defining a subtype or learning you don’t fit a specific one can help in learning how to cope and treat BPD.

What is Discouraged Borderline Personality Disorder?

If you have come to understand borderline personality disorder (BPD) through personal experience with an individual suffering from the disorder or your own struggle with it, the road has most certainly been a rocky one for you. For people with BPD, life is a bit like riding a rollercoaster with a blindfold on – not only are the highs and lows extreme and often back to back, but they are often unexpected, as well.

Impulsivity and instability are two of the major markers for BPD, which was coined in 1938 by Adolf Stern. Low self-esteem, fear of abandonment and deep-seated anger issues are common among sufferers. BPD makes a person highly sensitive to criticism or any other type of perceived rejection. Those with this disorder tend to see most aspects of life in black or white.

Their extreme thinking creates a “with me or against me” approach to assessing relationships at every level. People who are in a sufferer’s life are often idealized and seen as exceptionally good or demeaned and seen as exceptionally bad or even evil. Psychologist Marsha M. Linehan once described those with the disorder, which she had once been treated for as an adolescent, as having no “emotional skin.”

What Is Discouraged Borderline Personality Disorder?

There are four subtypes of BPD. One of those subtypes is discouraged borderline personality disorder. When a person suffers from discouraged borderline, much of how they think, feel, and behave is driven by the dependent aspects of their personality disorder. In fact, according to Psychology Today, from an outside perspective, a person with discouraged borderline might look a bit like someone with dependent personality disorder. This person displays signs of codependence in most relationships in life.

The dependence of a discouraged borderline type is often most noticeable when they become dependent on a person with whom dependence is inappropriate – a casual friend, for instance, or a boyfriend or girlfriend who they just started dating. A person with this subtype might seem outwardly depressed or serious, especially when compared to some of the other borderline disorder subtypes.

Discouraged borderline is marked by noticeable clinginess and a passive “follower” type of mentality. While on the outside this person might just seem indecisive or, at worst, weak-willed, they normally experience internal turmoil about their lack of leadership and bitterness toward those around them. This type of borderline disorder in a person might yield self-harm in the form of self-mutilation or even suicide.

Who Has This Disorder?

Both women and men from any background can develop BPD and its discouraged borderline subtype, though the diagnosis is seen more in women than in men. This might be related to the possible neurobiological factor of disturbed estrogen levels or perhaps a bias created by institutionalized sexism. Some research has suggested that the disorder actually does affect men and women equally, but that women are more likely to seek treatment, be encouraged to seek treatment, or to be officially diagnosed or misdiagnosed as BPD. This diagnosis usually is not made until adolescence, at the earliest, and it is typically made before young adulthood comes to a close. It is estimated that around 1.6 percent of Americans suffer from BPD in any given year.

Signs of Discouraged Borderline Personality Disorder

There are many different signs and symptoms of BPD, according to the DSM-V. The following are signs that professionals look for when attempting to diagnose BPD or the discouraged borderline subtype. These are considered to be impairments in personality functioning.

Impairments in self-functioning. These types of impairments might include an unstable or poor self-image, excessive self-criticism, chronic feelings of emptiness, and stress-induced dissociative states. This might also include instability in goals, values, career plans, or general aspirations.
Impairments in interpersonal functioning. These types of impairments might include decreased levels of empathy, which can manifest as a lowered ability to understand the position of others, a heightened and dramatic sensitivity to perceived criticism, or rejection and black-and-white thinking even regarding people – most people are seen as good or bad. Impairments in interpersonal functioning might also include intimacy issues. These types of issues might arise as incredibly intense and unstable relationships marked by high conflict, mistrust, clinginess, a fear of abandonment, and either over-involvement or withdrawal at different times.

There are other signs that distinguish a person with borderline BPD from others. Some of these signs and symptoms might include:

Unstable emotional experiences
Moodiness
Easily aroused emotions
Emotions that are significantly intense or disproportionate to the cause of the emotion
Increased nervousness, tension, worry, panic, or general anxiety
Fixation on unpleasant experiences from the past or possible unpleasant experiences in the future
Fearfulness and uncertainty
Discomfort with uncertainty
A fear of losing control
A fear of rejection
Separation anxiety
Excessive dependency and loss of autonomy or a fear of an “inevitable” loss of self
Depressed or hopeless feelings
Shame
Suicidal thoughts or behaviors
Impulsivity
Difficulty creating or sticking to plans
Distress-induced urgency
Dangerous risk-taking behavior without regard for consequences
Hostility, especially in relation to perceived criticism or rejection

Disassociation or “zoning out” and difficulty concentrating

Some BPD signs that are specific to the discouraged borderline include:

Loyalty, even to an excessive degree
Pliant and easily swayed by others, even when it goes against one’s own desires
Submissive and passive even when desiring a leading role
Humble as a result of low self-esteem, insecurity, and vulnerability
Constant feelings of vulnerability and weakness
Constant feelings of being in jeopardy
Feeling hopeless, helpless, powerless, and depressed
Excessive dependence upon others
Tearful episodes
Feelings of emptiness
Self-persecution and self-victimization; believing others are constantly attacking or ill-meaning
Destruction or intentional loss of belongings, whether through physical violence toward belongs or a cycling of acquiring and then giving away or selling
Reliance on fantasy as a means to escape, often engaged in fantasy-based media (novels, movies, comics, etc. )
Chronic or recurring illness complaints, sometimes somatic
Self-deprivation (as opposed to self-indulgence), rooted in feelings of worthlessness
Substance abuse

Causes and Correlations

Like all mental health disorders, it is difficult to pinpoint the cause of BPD or its discouraged subtype with precision. Researchers understand the cause of this disorder to be multifaceted and not easily or immediately identifiable.

Although the cause of BPD is thought to be multifaceted and complex, involving many different life factors, there are some potential contributing causes that many professionals in the field seem to agree on. Some of these causes and correlations include:

Post-traumatic stress disorder (PTSD) might be related to BPD
Childhood trauma, particularly abuse and neglect, often involving sexual abuse
Congenital brain abnormalities, like a smaller hippocampus or amygdala
Genetics, particularly in genes DRD4 and DAT and chromosome nine
Neurobiological factors, like estrogen levels
Environmental factors (aside from trauma) like family and social stability levels
Social factors, including social experiences as a child

Difficulty With Diagnosis

BPD and its subtypes are not necessarily easy for even the most seasoned mental health professional to diagnose. As discussed in a 2011 Scientific American article, the diagnosis of the disorder is often flawed in one sense or another.

To complicate diagnosis further, women with the disorder are particularly prone to experiencing co-occurring disorders that might make a proper diagnosis more difficult. Some of the other illnesses often found to be comorbid with BPD include major depression, anxiety disorders, eating disorders, substance abuse, or antisocial personality disorder. Many of these concurring disorders also involve a low self-esteem or unstable self-image.

Treatment

The management and treatment of BPD is essential in order for sufferers to lead functional and fulfilling lives to the best of their abilities. This is especially important because BPD carries a serious risk of suicide. People suffering from BPD make up a large chunk of suicides on an annual basis, so all self-harm and suicidal tendencies on behalf of a person with BPD should be immediately addressed and taken very seriously. If you or someone you know is at risk for suicide, it is important that you get help as soon as possible.

Psychotherapy is the primary method used for managing and treating BPD. Although there is no cure-all medication that can address BPD, some of the comorbid conditions that often coincide with BPD can be treated with prescription medication, which can increase the overall success rate of treatment. It is important to understand that these medications cannot treat BPD, but that the treatment of concurring conditions can help clear the way for a more successful treatment of BPD through psychotherapy.

Depression and anxiety are among the two most common comorbid conditions that are treated with medicine while the patient is treated for general BPD with psychotherapy. Antipsychotics might be used to reduce anger or suicidal tendencies as well as impulsivity, psychotic paranoid symptoms, anxiety, and depression.

It is important that comorbid conditions are examined and treated appropriately when treating a patient who suffers from BPD. Before treatment can truly begin, comorbid issues should be addressed and treatment should be initiated. For example, the substance abuse that often accompanies BPD should be removed as a factor for disturbed behavior before true treatment can begin. If it is not, a patient’s cognitive function might be impaired, and it might be difficult for a professional to accurately examine the patient.

Get Help Today

Recovery from BPD is possible and has been reinforced as possible through many studies. Managing, treating, and recovering from BPD is no easy task, but when attempted alongside the right medical professionals and support groups, it can be done.

At Optimum Performance Institute, we help people with this diagnosis, especially adolescents and young adults, to transition more easily into a self-sufficient adult life. We equip young adults suffering from BPD with the resources and skills they need to overcome their illness through our OPI Intensive, which is a specialized program within our institute. Through a 30-day immersion phase followed by a 30-day transformational phase, we have been able to see significant improvements in the young adults we treat.

We treat young adults on an individual basis while giving them all that they need in a group setting to persevere and succeed. Our approach to treating BPD, including its discouraged subtype, is like no other. That’s why Psychology Today named our OPI Intensive as the “Best In Treatment” available for BPD sufferers. Call us today for more information on our program.

Borderline personality disorder

Borderline personality disorder is associated with unstable mood and behavior that has a significant impact on a person's daily life

Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable moods and behaviors, and an altered "feeling of self".1 All of these can result in impulsive actions and relationship problems with friends and family members, impairing the person's ability to cope with everyday life. ^1.2

Borderline personality disorder is a serious illness associated with self-harm and suicidal attempts. One in ten patients complete suicide. ²

Facts About Borderline Personality Disorder

Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable mood and behavior, and an altered sense of self. ¹

^{One in ten patients complete suicide. ²}

Patients with borderline personality disorder are very sensitive to changes in their environment, and may respond inappropriately and acutely to such changes. They may, for example, be afraid of being abandoned by a loved one.2 If the person whom patient
is expecting arrives late, the patient easily changes the feeling of attachment to dislike or anger. 1,2 This reflects the extreme perception of the world by the patient, who sees everything and everyone - including oneself – either good or bad.1,2

People with borderline personality disorder are often insecure, may suddenly change their life goals and views on career, life values and friends. .2 They may develop intense unwarranted anger or feelings of emptiness, and are prone to self-harm.2 Patients with borderline personality disorder may also experience depression and anxiety.1,2

Facts about Borderline Personality Disorder

Estimates of the proportion of people who have borderline personality disorder vary from less than 1% to around 6%. ^2-4

Borderline personality disorder affects a roughly equal number of men and women, but appears to be more disabling in women the same frequency in men and women, but in women it is more severe. 3

Symptoms of borderline personality disorder most often first appear during adolescence.4 The disease is most severe and problematic in young adults and tends to improve with age.2 Symptoms may persist throughout life, but most patients with borderline personality disorder by the age of 30-40 have a stable job and a home.2

People with borderline personality disorder are emotionally and functionally unstable, which places a significant burden on their families.5 Mood swings are a source of stress for both the patient and his/her others, which can lead to the development of mental disorders in the latter.1,5

People who are concerned that they – or their loved ones – are experiencing symptoms of borderline personality disorder should see their doctor for help and advice.

Borderline personality disorder is diagnosed by a mental health professional using interviews and discussions about symptoms and medical history. ¹

Psychotherapy can help people with borderline personality disorder by, for example, teaching them how to interact with others and to express their thoughts and feelings more clearly. ¹ It may also be beneficial for caregivers and family members of those affected to receive therapy and guidance on how best to care for a person with borderline personality disorder. ¹ There is currently no cure, but one study showed that, after 10 years, 50% of people with borderline personality disorder had recovered, being able to function at work and maintain personal relationships. ⁶

National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.
National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. Available from: https://www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317 [accessed 30 September 2019].
Bailey RC, Grenyer BFS. Burden and support needs of carers of persons with borderline personality disorder: a systematic review. Harv Rev Psychiatry. 2013;21(5):248–258.
Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry. 2010;167(6):663–667.

1. National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
3. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.
4. National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. Available from: https://www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317 [accessed 30 September 2019].

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Borderline Personality Disorder (BPD) | Rehab Family Clinic

It is impossible to say that borderline personality disorder affects a certain layer of society. It affects both men and women, and adults, and children. It needs to be diagnosed in time, because the statistics of this disease are depressing - 1 out of 10 patients with this disorder commits suicide.

What is borderline personality disorder?

Borderline Personality Disorder (BPD) is a mental disorder in which a person is characterized by emotional instability and low self-control. A patient with this diagnosis is inherent in the fear of loneliness, at the same time he is absolutely not social - it is difficult for him to establish relationships with people, he is afraid of being misunderstood and rejected.

In general, abnormal behavior in BPD can be confused with another disorder, but this disease is distinguished by the fact that all the negative emotions of a person are directed at themselves. He does not seek to harm the people around him - they simply scare him. But he also cannot be left alone with himself.

Borderline disorder can be recognized by a non-standard attitude to the outside world: a person is overly impulsive, any failure, even the smallest one, will be perceived as a huge tragedy. For example, a person with BPD who is a couple of minutes late for a meeting will not be able to behave calmly at the event itself - he will be nervous and blame himself for ruining everything. Although, in fact, this is not the case.

The instability of emotions is also inherent in these people - nervousness is felt in all actions, they can react emphatically cheerfully to some positive events, but the reaction is very similar to a simulated one. Negative emotions are also experienced very sharply, others may think that a person with BPD is trying to attract attention to himself.

Always side by side with borderline personality disorder is social maladaptation. People with BPD are very dependent on the opinions of others, they blame themselves for all the troubles, so at some point it becomes easier for them to protect themselves from society, but they cannot be alone either, so a personal collapse occurs. In general, the "border guard" in any society is bored, he cannot find a place for himself in a noisy company.

BPD divides the sufferer's personality in two - constant fluctuations between self-hatred and excessive idealization also distinguish people with this disorder.

According to ICD-10, borderline personality disorder is a subspecies of emotionally unstable personality disorder. The diagnosis is officially recognized by psychiatrists all over the world. Although, a few decades ago, he was stigmatized both in the world of psychiatry and in society. Today the situation has changed, and the attitude towards BPD has become much more conscious and attentive.

The term appeared thanks to a group of American psychologists who conducted research in 1968-1980. The result of these works was the recognition of BPD as a separate mental disorder. And borderline personality disorder in the ICD-10 was included by specialists.

Any patient with this disorder is very sensitive in relation to other people - he is sensitive to any fluctuations in society, worries about what opinion others build towards him. Due to frequent lifestyle changes and emotional swings, people with BPD feel insecure in life. Often, thinking about their lives, they are overwhelmed with despair, which in most cases leads to depression. It is difficult for people with this disorder to choose their own life path. They are characterized by uncertainty about their personality, which has no core.

Borderline mental personality disorder generates high impulsiveness in a person. This leads to behavior that causes great damage to the patient: many dabble in gambling, may become addicted to alcohol or drugs, become prone to eating disorders, and commit theft. BPD can take many forms. It is characterized by instability, strong and sudden changes in feelings, mood, relationships, self-image and behavior. A person's impulsivity is expressed in affective instability and can manifest itself in at least two areas that, for a person with a borderline mental disorder, are potentially self-damaging: spending money, sex, drug addiction, theft, reckless driving, carousing.

It is wrong to assume that people with BPD manipulate loved ones with whims and threats of suicide. They thus express their lack of additional support and acceptance. They do not behave this way on purpose, they do not deliberately try to attract attention, to get some kind of benefit. Most often, they try to eradicate these feelings in themselves so that others do not consider such behavior demonstrative.

Borderline personality disorder (ICD code for it with the letter F) causes a person to oscillate between two extremes - "everything is very good" or "everything is very bad." That is how they feel about themselves. Therefore, one of the main researchers of this disorder, A. Stern, introduced the term "narcissism" - this is the idealization that occurs in a person with BPD in the stage of self-love. The scientist also appeals to the concept of "mental bleeding". It correlates with impotence in crisis situations, implies a tendency to compliance.

Borderline disorder, in simple terms, is a mental illness that can take many forms. It is characterized by instability, strong and sudden changes in feelings, mood, relationships, self-image and behavior.

BPD is characterized by recurrent suicidal thoughts in the patient, attempts to injure and mutilate oneself (cuts, cauterization), frequent emotional overreactions, or abrupt mood swings, including depression, irritability, or anxiety. These shifts usually last for several hours, and in some cases from 1 to 2 days. Borderline mental disorders give rise to a feeling of emptiness in a person. Sometimes paranoia can appear - suspicion of other people and a sense of loss of reality.

The disorder can occur most often in adulthood, statistics indicate a border between 17 and 25 years of age. The first signs of BPD may appear as early as childhood. Due to the fact that the psyche of children has not yet been formed, this disorder is diagnosed not in childhood, but in adolescence.

To fully appreciate the severity of the disease, it would be appropriate to give statistics on the connection between suicide and BPD:

A third of all suicides are committed by people with borderline psychological disorders.
The lifetime risk of suicide for people with BPD is as high as 10%.
The greatest risk of suicide in violation is at a young age (15-30 years).
Suicide in the disorder can have a particular burden on others: 44% of BPD suicides are committed in the presence of other people, compared with 17% for people with other diagnoses.

The disorder is difficult to diagnose because it can manifest itself in many forms that are often difficult to compare.

The general classification of all types of this type of disorder is as follows:

The dominant affect is anger.
Inability to build interpersonal relationships.
Self rejection.
One of the main manifestations is depression.

The essence of borderline personality disorder lies in the fact that a person experiences great difficulties with self-identification. This leaves an imprint on his relationship with other people, self-acceptance and creates significant problems in many areas of life.

Symptoms of borderline disorder

The comparison by US psychologist M. Lainen is very true - she said that people with BPD do not have “emotional skin”. And this statement perfectly describes all the symptoms of borderline disorder in the aggregate.

A person can be suspected of having BPD if four or more signs of the disease can be traced in his behavior. It is very important that impulsiveness is clearly expressed. It is also worth watching for stability - if the symptoms make themselves felt every day, then you need to see a specialist.

Every potential patient with BPD will experience dramatic emotional swings and mood swings. This is called lability. For example, when a fit of anger and uncontrolled aggression changes dramatically with regret and remorse for one's behavior.

Symptoms of borderline personality disorder:

Emotional instability, significant mood reactivity.
Unstable and tense interpersonal relationships with everyone around.
Impulsiveness.
Attempts to avoid the real or imagined possibility of being neglected by loved ones.
Suicidal thoughts and conversations, even attempts are possible, which are repeated from time to time.
Aggression, hostility.
Violation of the mental identity of the individual.
Chronic feeling of spiritual emptiness.
Transient paranoid ideas associated with stress.

Symptoms and signs of borderline personality disorder also include a pronounced and persistent identity disorder, which manifests itself in insecurity in at least two of the following:

values;
sexual orientation;
ranking friends by preference;
self-esteem and self-image;
setting long-term goals.

A person with BPD may be self-limiting, deliberately beating himself up and worrying about his diagnosis. It will seem to him that he is not like everyone else, that the presence of a disease makes him different, special, but this feature has a negative connotation.

The signs of borderline disorder always take on the color of hyperbole - if a person is sad, then this sadness borders on depression, if he is happy, then he does it too emotionally, and negative events can cause aggression.

Why Borderline Disorder Occurs

The psychiatric community believes that a person must have certain prerequisites for the development of BPD. That is, it is a disease that occurs as a result of the action of a number of factors.

The causes of borderline personality disorder can be different:

Violation of identity - persistent hostility to one's image, rejection of it.
The tendency to engage in unstable and polar relationships with people is the idealization of a person or, conversely, his depreciation.
Impulsivity, which manifests itself in a number of areas and involves self-harm - in addition to suicide, it can be unprotected sex, drug use, overeating.
Character traits - low self-esteem, increased anxiety, a tendency to pessimistic forecasts, low resistance to stress.

These prerequisites relate rather to the characteristics of the character or type of personality of a person, but there are causes of borderline disorder that do not depend on personality factors:

genetic predisposition.
Gender affiliation. Women suffer from BPD more often than men.

People at risk are advised to visit a psychologist periodically in order to prevent the development of BPD and establish a painless connection with the outside world.

Disease pathogenesis

This disease, like many other mental disorders, is considered not fully understood. But one thing is for sure - there is a connection between borderline disorder syndrome and emotional trauma in childhood. This point of view is shared by most researchers. Therefore, less attention is paid to the factors of neurobiology, dysfunction of brain regions and social causes (the influence of the environment in the process of growing up, building communication and interaction with various social groups).

The state of borderline disorder occurs because the amygdala, which is responsible for generating ideas, increases in volume. This provokes an increased manifestation of various states - a person is sad, happy and angry much brighter and more actively than people without a violation.

In the prefrontal cortex, in contrast, there is a decrease in activity during the disorder. It is most concentrated in the right anterior gyrus. This is due to the inability of the "border guards" to regulate their emotions, to stop them. It is the cortex that regulates the degree of arousal, and in the case of BPD, it is less involved. The level of cortisol, which is produced by the hypothalamus, also has a direct effect. This hormone is marked by an overestimated level of indicators in BPD, it provokes increased activity of the hypothalamic-pituitary-adrenal axis, which enters into a state of activity. As a result, there is an increased reaction to stress, and vulnerability to external factors appears.

Stages of borderline disorder

If you do not deal with the treatment of a mental disorder, then it will be aggravated. It is important to identify the symptoms of the disease as soon as possible and consult a doctor. If this is not done, then the signs of a violation will dominate the behavior of a person, he will increasingly move away from his relatives and society, he will begin to develop suicidal tendencies.

Once an indicator of borderline personality disorder is identified, the disease proceeds according to the following stages:

interpersonal instability. At this stage, a person tries to avoid abandonment, tries to seem normal, build social relationships, although this is not easy for him. This stage is also marked by the instability of relations - it is difficult for others to understand the "border guard".
Cognitive disorders, identity disorders. Signs of paranoia begin to appear, a person's idea of himself and his place in the world around him is disturbed.
Violations of effective and emotional regulation. This is an indicator of borderline disorder of a more severe stage. There is mood instability, unreasonable anger, an inner feeling of emptiness.
Dysregulation of behavior - the last stage is marked by suicidal tendencies, the desire to injure oneself, uncontrolled emotional outbursts.

How can the disorder be classified

First of all, a classification was adopted in accordance with ICD-10:

F4 - Neurotic disorders associated with stress and somatoform disorders.
F5 - Behavioral syndromes associated with physiological disorders and physical factors
F6 - Personality and behavioral disorders in adulthood.

The types of borderline disorder can be divided into 4 subgroups. They are arranged in order of severity, starting with the least:

Sad borderline disorder. It is characterized by submissive and compliant behavior. A person behaves very modestly, but inside he experiences helplessness, self-pity, a sense of his own worthlessness. Along with this, there is physical fatigue, unwillingness to do anything.
Touchy PR. The person is not as malleable as in the dull type. He can express negativity, take everything with hostility. The main distinguishing feature is resentment. A patient with this type is quickly disappointed in everything and everyone.
Impulsive PR. This is a type of borderline personality disorder in which a person with a disorder is naughty, shows hysterical inclinations, and demonstrates infantilism. He is characterized by unreasonable excitement, inability to concentrate, suicidal manifestations are possible.
Self-damaging PR. The most severe of the four subtypes. A person is suicidal and no longer hides his thoughts. He has a clear craving for self-destruction, inflicting damage on himself. In relation to others, he behaves ingratiatingly, but at the same time closed.

Levels of borderline personality disorder can vary and are classified according to severity. There are three in total:

Easy, when non-standard human behavior is not yet clearly distinguishable. There are difficulties in building relationships with society. And yet the ability to maintain adequate contact is not completely lost. With a mild form, the "border guard" does not express a desire to injure himself or harm others.
Average, when relationships with relatives and friends become more difficult. A person with a disability transfers these problems to other areas - he believes that everything in his career is compromised against him. In this form of borderline, there are threats of ending their lives, but they usually do not come to fruition.
Severe, when self-rejection is reflected in absolutely all areas of life, a person feels not accepted by society, ceases to function and try to establish relationships with other people. He is completely immersed in himself, blaming himself for all the failures. There is a high probability of causing bodily harm to yourself. Often it can lead to suicide.

The disease is not divided into gender and age groups. It can be said that borderline disorder is more common in women than in men. But there is no difference in approaches and treatment - a patient of either gender will undergo therapy in accordance with the severity. It is important to pay attention to the type of BPD, the person's genetics, lifestyle and personality characteristics.

What are the possible complications

First of all, the complications of the disease are associated with destructive behavior - the patient, unwittingly, causes negative emotions in those around him, attempts to harm himself begin to appear. During this period, the manifestation of alcohol, drug addiction is possible, which negatively affects the overall health of the body. All organs and systems suffer, great damage is done to the psyche.

A person with BPD may be prone to overeating - hence the violations of the gastrointestinal tract and the corresponding mental disorders (bulimia, anorexia). Attempts to bring yourself physical harm turn into wounds, cuts, burns. During aggression, the patient can harm strangers, although cases of physical harm are very rare - the "border guard" mostly experiences aggression on his own, injuring himself or suffering from internal contradictions.

The worst thing that BPD can turn into is death. Indeed, according to statistics, about 70% of people with this disorder have made at least one suicidal attempt. These attempts can end in failure - due to the deliberate demonstration of suicide or through negligence.

When to see a doctor

The slightest deviation from normal behavior is a reason to visit a specialist. If a person notices any symptoms of BPD, feels lonely, cannot cope with uncontrolled aggression or mood swings, then it is likely that he is diagnosed with borderline disorder.

It is also important to listen to close people who note changes in the usual state of a person.

Many people with a violation try to cope on their own, as soon as they notice the first signs of a disorder in themselves, but only a professional can provide competent help.

Diagnosis of disorder

How to define borderline disorder? To do this, the doctor fully examines the history and identifies the criteria for BPD:

a devastating feeling of loneliness;
sudden impulsivity;
affective instability and sudden reactions to stressful situations;
emerging paranoia or severe dissociative symptoms;
inadequate, unjustified anger, inability to cope with it;
suicidal thoughts, threats, desire to harm oneself;
unstable interpersonal relationships;
violation of one's own identity.

A psychiatrist uses an interview to diagnose borderline personality disorder. It would be useful to conduct an external examination - if scars or scars are found on the skin, then the person is already in the severe stage of BPD.

The generally accepted criteria for making a diagnosis are those set by the American Psychiatric Association.

Violations that manifest themselves:

in social functioning - close relationships become unstable, conflicts appear. A person with BPD considers himself abandoned and useless - this leaves an imprint on interaction with people. On the other hand, empathy appears: patients with this disorder are very sensitive and also relate to others, they express sincere sympathy in difficult situations;
in a personal conflict - a person is characterized by excessive self-criticism, a feeling of instability and constant loneliness. There are no clear goals in life, the patient cannot focus on aspirations, he is removed from career plans.

Pathology of personal qualities:

hostility to the outside world appears - the patient is irritated, experiences unreasonable anger;
all emotions are colored negatively - a person is afraid of being rejected, constantly feels anxiety;
a person is prone to impulsiveness, ready to take risks, and the patient does not think about the consequences of actions.

Expression in the manifestation of emotions persists for a long time.

For a person of this age and gender category, all violations are not normal.

The patient is not under the influence of any drugs and his behavior is not due to their intake.

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BPD treatment

The treatment of borderline disorder primarily takes into account the needs of the person with BPD, to a lesser extent, the doctor relies on generally accepted standards. If the patient has a tendency to depression or increased anxiety, then they resort to drug treatment.

The psychiatric community is more inclined towards outpatient treatment than hospitalization - it has not proven itself as a rational approach to solving this problem.

Currently, there are several approaches to the treatment of borderline disorder, the appropriateness of which in a particular case is determined by the psychotherapist:

Transfer analysis. This is a type of psychotherapy for which a step-by-step recommendation has been developed that is used in the treatment of BPD.
Scheme therapy. It combines Gestalt therapy, cognitive behavioral therapy, attachment theory and psychoanalysis. This type of psychotherapy for borderline personality disorder takes into account the patient's childhood, an analysis of the likelihood of traumatic events and abuse. The doctor in this case focuses on the source of experiences, teaches to find ways out and cope with anxiety.
Dialectical-behavioral therapy. This is a long process that is used to relieve the symptoms of the disease, to save the patient from thoughts of suicide.
mentalization. Can be done individually or as part of a group. In this technique, the main focus is the level of meaningfulness - a person learns to find the meaning of life, control their emotions and prioritize needs.
Pharmacotherapy. Studies have proven that there are no effective medications for the treatment of BPD. There are no drugs that can relieve the feeling of emptiness. But the authors of scientific papers came to the conclusion that some drugs can act directionally, that is, get rid of the main symptoms of the disease. Among these drugs, Haloperidol (reduces aggression), Aripiprazole (relieves excessive impulsivity), Valproic acid salts (relieve manifestations of a depressive state) showed the greatest effectiveness.

Disease prevention

It is believed that you can get rid of the violation if you follow all the clinical recommendations for borderline personality disorder. It is not uncommon for patients to completely get rid of all the signs of BPD under the strict guidance of the attending physician.

To date, there are no ways that can prevent this mental disorder. Therefore, it is so important to take all measures to track the disease at an early stage and contact specialists.

References:

McWilliams N., “Psychoanalytic diagnostics. Understanding personality structure in the clinical process”
Ushakov G.K. Borderline neuropsychiatric disorders.-2nd edition-M., Medicine
Kuzmenok G.F. Collection “Ways of Understanding.
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