Manic like symptoms

What Is It, Causes, Triggers, Symptoms & Treatment

Overview

What is mania?

Mania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level. This highly energized level of physical and mental activity and behavior must be a change from your usual self and be noticeable by others.

What's considered an “abnormal,” extreme change in behavior and what does it look like?

Abnormal manic behavior is behavior that stands out. It’s over-the-top behavior that other people can notice. The behavior could reflect an extreme level of happiness or irritation. For example, you could be extremely excited about an idea for a new healthy snack bar. You believe the snack could make you an instant millionaire but you’ve never cooked a single meal in your life, don’t know a thing about how to develop a business plan and have no money to start a business. Another example might be that you strongly disagree with a website “influencer” and not only write a 2,000 word post but do an exhaustive search to find all the websites connected to the influencer so you can post your letter there too.

Although these examples may sound like they could be normal behavior, a person with mania will expend a great deal of time and energy including many sleepless nights working on projects such as these.

What is a manic episode?

A manic episode is a period of time in which you experience one or more symptoms of mania and meet the criteria for manic episode (see “symptoms” and “diagnosis” sections). In some cases, you may need to be hospitalized.

Can I have a manic episode as its own condition or is it always part of another mental health condition?

Technically if you have a manic episode, you have a mental health condition. Mania can be a part of several mental health conditions including:

Bipolar I disorder (most common condition for mania to occur).
Seasonal affective disorder.
Postpartum psychosis.
Schizoaffective disorder.
Cyclothymia.

What is bipolar I disorder?

Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.

Most people have both episodes of both mania and depression, but you don’t have to have depression to be diagnosed with mania. Many people with a bipolar I disorder diagnosis have recurring, back-to-back manic episodes with very few episodes of depression.

What are the triggers of manic episodes?

Manic episode triggers are unique to each person. You’ll have to become a bit of a detective and monitor your mood (even keeping a “mood diary”) and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.

Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.

Common triggers to be aware of include:

A highly stimulating situation or environment (for example, lots of noise, bright lights or large crowds).
A major life change (such as divorce, marriage or job loss).
Lack of sleep.
Substance use, such as recreational drugs or alcohol.

What happens after a manic episode?

After a manic episode you may:

Feel happy or embarrassed about your behavior.
Feel overwhelmed by all the activities you’ve agreed to take on.
Have only a few or unclear memories of what happened during your manic episode.
Feel very tired and need sleep.
Feel depressed (if your mania is part of bipolar disorder).

Symptoms and Causes

What are the symptoms of mania?

Symptoms of a manic episode

Having an abnormally high level of activity or energy.
Feeling extremely happy or excited — even euphoric.
Not sleeping or only getting a few hours of sleep but still feeling rested.
Having an inflated self-esteem, thinking you’re invincible.
Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
Being easily distracted by unimportant or unrelated things.
Being obsessed with and completely absorbed in an activity.
Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

Psychotic symptoms of a manic episode

Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there. An example is a person hearing the voice of someone and talking to them when they’re not really there.

How long does a manic episode last?

Early signs (called “prodromal symptoms”) that you’re getting ready to have a manic episode can last weeks to months. If you’re not already receiving treatment, episodes of bipolar-related mania can last between three and six months. With effective treatment, a manic episode usually improves within about three months.

What causes mania?

Scientists aren’t completely sure what causes mania. However, there are several factors that are thought to contribute. Causes differ from person to person.

Causes may include:

Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This isn't definite though. You may never develop mania even if other family members have.
A chemical imbalance in the brain.
A side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
A significant change in your life, such as a divorce, house move or death of a loved one.
Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
A high level of stress and an inability to manage it.
A lack of sleep or changes in sleep pattern.
As a side effect of mental health problems including seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.

Diagnosis and Tests

How is mania diagnosed?

Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist

To be diagnosed with mania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Their criteria for manic episode is:

You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least one week and is present most of the day, nearly every day.
You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
The mood disturbance is severe enough to cause significant harm to your social, work or school functioning or there’s a need to hospitalize you to prevent you from harming yourself or others, or you have psychotic features, such as hallucinations or delusions.
The manic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.

Management and Treatment

How is mania treated?

Mania is treated with medications, talk therapy, self-management and family and friends support.

Medications

If you have mania only, your healthcare provider may prescribe an antipsychotic medication, such as ariprazole (Abilify®), lurasidone (Latuda®), olanzapine (Zyprexa®), quetiapine (Seroquel®) or risperridone (Risperdal®).

If you have mania as part of a mood disorder, your provider may add a mood stabilizer. Some examples include lithium, valproate (Depakote®) and carbamazepine (Tegretol®). (If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant.)

Sometimes antidepressants are also prescribed.

Talk therapy (psychotherapy)

Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who'll help you identify and work through factors that may be triggering your mania and/or depression (if you’re diagnosed with bipolar I disorder).
Cognitive behavioral therapy can be useful in helping you change inaccurate perceptions that you have about yourself and the world around you.
Family therapy is important since it’s very helpful for your family members to understand your behavior and what they can do to help.

Ask your provider for contact information for local support groups. You might find it helpful to talk with other people who have similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.

Other treatments

Electroconvulsant therapy (ECT) may be considered in rare cases in individuals who have severe mania or depression (if bipolar). ECT involves applying brief periods of electric current to your brain.

Prevention

What steps can I take to better cope with or manage my mania?

Although episodes of mania can’t always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.

Some ideas to try during this time include:

Avoid stimulating activities and environment – such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
Stick to routines. Go to bed at a set time, even if you’re not tired. Also, stick to the same times for eating meals, taking medications and exercising.
Limit the number of social contacts to keep you from getting too stimulated and excited.

Postpone making any major life decisions and big purchases.
Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
Consider selecting someone to manage your finances during a manic episode.

If you ever have thoughts of harming yourself, tell family or friends, call you healthcare provider or contact the National Suicide Prevention Lifeline at 800-273-(TALK) (1-800-273-8255). Counselors are available 24/7.

Outlook / Prognosis

What outcome can I expect if I’ve been diagnosed with mania?

If your mania is related to a diagnosis of bipolar I disorder, this is a lifelong disease. Although there’s no cure for mania, medication and talk therapy (psychotherapy) can manage your condition in most cases.

Living With

How can I involve family and friends in understanding my mania?

It’s important to have an honest conversation with your family and closest friends.

Let your family and friends know what you do and don’t find helpful. For example, if you’d appreciate a friendly reminder about taking your daily medications or a question about if you are getting enough sleep, let them know. On the other hand, if you don’t like always being asked if your current state of happiness is a sign you’re having a manic episode, discuss this.
Ask your family and friends if they can help identify your triggers if you can’t. They may be able to spot triggers that you can’t spot yourself. Ask what they’ve noticed or any patterns they may see around the times of your episodes. As soon as you recognize an early sign, make an appointment to see your healthcare provider. You may or may not need a medication adjustment. However, it’s good to be on the alert since your symptoms could rapidly change.
Describe how your symptoms feel to you. Your family and friends will have a better understanding of your condition.
Let family and friends know what type of help you’d like from them and when you’d like it. There may be times when you feel you can cope on your own. Knowing the difference will be helpful for everyone.

Frequently Asked Questions

What is acute mania?

Acute mania is the manic phase of bipolar I disorder. It is defined as an extremely unstable euphoric or irritable mood along with excess activity or energy level, excessively rapid thought and speech, reckless behavior and feeling of invincibility.

What is unipolar mania?

Unipolar mania is a disorder in which only excitement, excess activity or energy level and euphoric symptoms are seen. This is a rare condition.

What’s the difference between mania and hypomania?

Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. The differences between these two conditions is as follows:

	Mania	Hypomania
How long the episode lasts.	At least one week.	At least four consecutive days.
Severity of episode.	Causes severe impact on social or work/school functioning.	Not severe enough to significantly affect social or work/school functioning.
Need for hospitalization.	Possibly.	No.
Psychotic symptoms present (delusions or hallucinations).	Is among possible symptoms.	Can’t be present for a diagnosis of hypomania.

Can my diagnosis change between bipolar I disorder and bipolar II disorder?

No. Once you have a diagnosis of bipolar I disorder — even if you never have another manic episode or a psychotic event (delusions or hallucinations) — your diagnosis can never be changed to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.

A note from Cleveland Clinic

Problems can develop in your social life, work/school functioning and home life when you have symptoms of mania, which include mood swings and an abnormal level of energy and activity. You may require hospitalization if you have severe hallucinations or delusions, or to prevent you from harming yourself or others. It’s important to have a good understanding of mania, mania symptoms, your particular triggers and ways to better manage your manic episodes. Medications, talk therapy and support groups as well as support from your family and friends can help manage your mania. Stay in close contact with all your healthcare providers, especially during times of manic episodes. Your provider will want to see you and may need changes to your medications or dose.

What Is It, Causes, Triggers, Symptoms & Treatment

Overview

What is mania?

What's considered an “abnormal,” extreme change in behavior and what does it look like?

What is a manic episode?

Can I have a manic episode as its own condition or is it always part of another mental health condition?

Technically if you have a manic episode, you have a mental health condition. Mania can be a part of several mental health conditions including:

Bipolar I disorder (most common condition for mania to occur).
Seasonal affective disorder.
Postpartum psychosis.
Schizoaffective disorder.
Cyclothymia.

What is bipolar I disorder?

What are the triggers of manic episodes?

Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.

Common triggers to be aware of include:

A highly stimulating situation or environment (for example, lots of noise, bright lights or large crowds).
A major life change (such as divorce, marriage or job loss).
Lack of sleep.
Substance use, such as recreational drugs or alcohol.

What happens after a manic episode?

After a manic episode you may:

Feel happy or embarrassed about your behavior.
Feel overwhelmed by all the activities you’ve agreed to take on.
Have only a few or unclear memories of what happened during your manic episode.
Feel very tired and need sleep.
Feel depressed (if your mania is part of bipolar disorder).

Symptoms and Causes

What are the symptoms of mania?

Symptoms of a manic episode

Having an abnormally high level of activity or energy.
Feeling extremely happy or excited — even euphoric.
Not sleeping or only getting a few hours of sleep but still feeling rested.
Having an inflated self-esteem, thinking you’re invincible.
Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
Being easily distracted by unimportant or unrelated things.
Being obsessed with and completely absorbed in an activity.
Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

Psychotic symptoms of a manic episode

Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there. An example is a person hearing the voice of someone and talking to them when they’re not really there.

How long does a manic episode last?

What causes mania?

Scientists aren’t completely sure what causes mania. However, there are several factors that are thought to contribute. Causes differ from person to person.

Causes may include:

Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This isn't definite though. You may never develop mania even if other family members have.
A chemical imbalance in the brain.
A side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
A significant change in your life, such as a divorce, house move or death of a loved one.
Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
A high level of stress and an inability to manage it.
A lack of sleep or changes in sleep pattern.
As a side effect of mental health problems including seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.

Diagnosis and Tests

How is mania diagnosed?

You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least one week and is present most of the day, nearly every day.
You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
The mood disturbance is severe enough to cause significant harm to your social, work or school functioning or there’s a need to hospitalize you to prevent you from harming yourself or others, or you have psychotic features, such as hallucinations or delusions.
The manic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.

Management and Treatment

How is mania treated?

Mania is treated with medications, talk therapy, self-management and family and friends support.

Medications

Sometimes antidepressants are also prescribed.

Talk therapy (psychotherapy)

Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who'll help you identify and work through factors that may be triggering your mania and/or depression (if you’re diagnosed with bipolar I disorder).
Cognitive behavioral therapy can be useful in helping you change inaccurate perceptions that you have about yourself and the world around you.
Family therapy is important since it’s very helpful for your family members to understand your behavior and what they can do to help.

Other treatments

Electroconvulsant therapy (ECT) may be considered in rare cases in individuals who have severe mania or depression (if bipolar). ECT involves applying brief periods of electric current to your brain.

Prevention

What steps can I take to better cope with or manage my mania?

Although episodes of mania can’t always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.

Some ideas to try during this time include:

Avoid stimulating activities and environment – such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
Stick to routines. Go to bed at a set time, even if you’re not tired. Also, stick to the same times for eating meals, taking medications and exercising.
Limit the number of social contacts to keep you from getting too stimulated and excited.
Postpone making any major life decisions and big purchases.
Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
Consider selecting someone to manage your finances during a manic episode.

Outlook / Prognosis

What outcome can I expect if I’ve been diagnosed with mania?

Living With

How can I involve family and friends in understanding my mania?

It’s important to have an honest conversation with your family and closest friends.

Let your family and friends know what you do and don’t find helpful. For example, if you’d appreciate a friendly reminder about taking your daily medications or a question about if you are getting enough sleep, let them know. On the other hand, if you don’t like always being asked if your current state of happiness is a sign you’re having a manic episode, discuss this.
Ask your family and friends if they can help identify your triggers if you can’t. They may be able to spot triggers that you can’t spot yourself. Ask what they’ve noticed or any patterns they may see around the times of your episodes. As soon as you recognize an early sign, make an appointment to see your healthcare provider. You may or may not need a medication adjustment. However, it’s good to be on the alert since your symptoms could rapidly change.
Describe how your symptoms feel to you. Your family and friends will have a better understanding of your condition.
Let family and friends know what type of help you’d like from them and when you’d like it. There may be times when you feel you can cope on your own. Knowing the difference will be helpful for everyone.

Frequently Asked Questions

What is acute mania?

What is unipolar mania?

Unipolar mania is a disorder in which only excitement, excess activity or energy level and euphoric symptoms are seen. This is a rare condition.

What’s the difference between mania and hypomania?

	Mania	Hypomania
How long the episode lasts.	At least one week.	At least four consecutive days.
Severity of episode.	Causes severe impact on social or work/school functioning.	Not severe enough to significantly affect social or work/school functioning.
Need for hospitalization.	Possibly.	No.
Psychotic symptoms present (delusions or hallucinations).	Is among possible symptoms.	Can’t be present for a diagnosis of hypomania.

Can my diagnosis change between bipolar I disorder and bipolar II disorder?

A note from Cleveland Clinic

Manic syndrome - good mood or mania?

Inadequately elevated mood is a state that is exactly the opposite of depression. If it haunts a person for a sufficiently long time and is accompanied by other inadequate or illogical manifestations, then it is considered a mental disorder. This condition is referred to as manic and requires special treatment. Depending on the severity of the symptoms, consultation with a psychotherapist or psychiatrist may be required.

Features of the development of mania

In some cases, a tendency to mania can be a character trait, as well as a tendency to apathy. Increased activity, constant mental agitation, inappropriately high spirits, outbursts of anger or aggression are all symptoms of a manic syndrome. This is the name for a whole group of conditions that have different causes and sometimes different symptoms.

Both various life situations and incidents and uncorrected pathological character traits lead to the development of mania. A person prone to manic behavior is very often obsessed with an idea, he strives to realize it, even if it is unrealistic. Often patients are driven by theories that have political, religious or scientific justifications. Quite often, patients show a tendency to active social and social activities.

A significant proportion of manic patients have so-called overvalued thoughts and ideas. Sometimes they can be global, sometimes they are ideas of the household level. From the outside, the behavior of patients talking about their ideas sometimes looks quite comical. If the overvalued thought is of a global nature, the patient, on the contrary, seems thoughtful and enthusiastic to those around him. Especially if he has enough education and erudition to justify his beliefs.

This condition is not always a pathology, it can be individual mental characteristics. Treatment is necessary if overvalued thoughts and ideas get out of control and absorb the entire life of the patient, in other words, they prevent him or others from living.

When do you need medical attention?

Manic syndrome is already a deviation from the norm, which is characterized by a number of symptoms that are more unpleasant for others than for the patient himself. This disease is manifested by disturbances in mental activity and the emotional sphere.

Usually the behavior of a manic patient is incomprehensible to others and looks at least strange.

There are certain symptoms that indicate the need for medical attention:

Extremely high spirits, up to constant mental excitement and euphoria.
Inappropriate optimism, the patient does not notice real problems and is not inclined to experience a bad mood appropriate to the occasion.
Accelerated speech, accelerated thinking, lack of concentration on objects and phenomena that the patient is not interested in. Therefore, in mania, learning is often difficult when you have to pay attention to rather boring things.
Increased mobility, active gestures and hyperbolic facial expressions.
Extravagance, pathological generosity. The patient can spend all the savings in a minute, not realizing the responsibility for his actions.
Insufficient control over behavior. The patient does not realize that his high spirits are not appropriate everywhere.
Hypersexuality, often with promiscuity (for example, a person who has never been prone to cheating before suddenly begins to flirt “indiscriminately”, enters into close relationships that he would never have dared to before, to the point that he starts several novels in parallel or embarks on a series of "short non-committal relationships", about which later, after the episode of mania has passed, he will repent and feel shame and even disgust, sincerely not understanding "how this could happen").

Treatment is complicated by the fact that the patient himself often does not recognize himself as ill. He considers his condition normal, subjectively pleasant and does not understand why others do not like his behavior: after all, he feels good, like never before. It is difficult to send such a patient to see a doctor and persuade him to therapy.

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Symptoms and signs of the disease

In addition to the above signs, there are several characteristic symptoms that unite almost all manic states:

A tendency to thoughtlessly waste money.
Tendency to unprofitable transactions, gambling.
Frequent violation of the law.
Tendency to provoke fights and conflicts.
Excessive consumption of alcohol or addiction to other bad habits.
Promiscuous sexual behavior.
Pathological sociability - the patient often meets strange, suspicious personalities and spends time in a variety of companies.

If these signs get out of hand, seek medical attention. It is important to understand that such behavior is not promiscuity, but symptoms of a disease that needs to be treated. Appeal to common sense is useless.

In some cases, the patient has a specific mania - for example, a mania for a specific purpose. Then the patient is sincerely confident in his special mission and tries to fulfill it with all his might, despite the skepticism of those around him.

Varieties of manic states

There are several classifications according to the manifestations of mania and according to their content.

According to the content, the following types are distinguished:

Mania of persecution - accompanied by paranoia. The patient is convinced that he is being persecuted, anyone can act as a persecutor - from relatives and friends to special services.
Mania for a special purpose - the patient is sure that he needs to create a new religion, make a scientific discovery, save humanity.
Megalomania - similar to the previous one. The main difference is that the patient does not have a goal, he simply considers himself the chosen one - the most intelligent, beautiful, rich.
Mania of guilt, politeness, self-destruction, nihilistic - more rare situations. In patients prone to alcohol abuse, jealousy mania is often noted.

According to the emotional state, manic syndrome can be:

Joyful mania - excitement, unreasonably elevated mood.
Angry - irascibility, tendency to create conflict situations.
Paranoid - manifested by paranoia of persecution, paranoia of relationships.
Oneiroid - accompanied by hallucinations.
Manic-depressive syndrome is characterized by alternating mania and depression.

In manic-depressive disorder, intervals may alternate at equal intervals, or one type of behavior predominates. Sometimes the next phase may not come for years.

Treatment of manic states

Diagnosed mania is a condition that requires mandatory treatment. It is customary to carry out complex therapy: pharmacological and psychotherapeutic. Pharmaceutical preparations are selected to relieve symptoms: for example, a patient with increased excitability will receive a prescription for sedatives, antipsychotics help to relieve concomitant symptoms, and to prevent the development of the next phase - normotimics.

With regard to psychotherapeutic treatment, usually work with a specialist goes in the direction of cognitive and cognitive-behavioral therapy, as well as psychoeducation (targeted informing the patient about the disease and learning to recognize early signs (“markers”) of the phase change and respond quickly to them in order to prevent the development of the next full-fledged depression or mania). In the course of psychotherapy, it is possible to find and eliminate the cause of the disease, correct the behavior and way of thinking of the patient. On average, treatment takes about a year, but after improvement, dynamic monitoring is required, since the manic syndrome can recur.

If the patient is in serious condition, hospitalization is recommended. Usually it is prescribed in order to protect others and the patient himself.

Regardless of the patient's condition, it is important to start treatment as soon as symptoms appear. Psychotherapists of the CELT clinic also work with manic states. Thanks to their serious experience and high qualifications, they will help restore mental health.

Manic disorder - Mania signs, classification, treatment

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 experts.

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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