What are the 9 traits of borderline personality disorder

Borderline Personality Disorder (BPD) - HelpGuide.org

personality disorders

If you have BPD, everything feels unstable: your relationships, moods, thinking, behavior—even your identity. But there is hope and this guide to symptoms, treatment, and recovery can help.

What is borderline personality disorder (BPD)?

If you have borderline personality disorder (BPD), you probably feel like you're on a rollercoaster—and not just because of your unstable emotions or relationships, but also the wavering sense of who you are. Your self-image, goals, and even your likes and dislikes may change frequently in ways that feel confusing and unclear.

People with BPD tend to be extremely sensitive. Some describe it as like having an exposed nerve ending. Small things can trigger intense reactions. And once upset, you have trouble calming down. It's easy to understand how this emotional volatility and inability to self-soothe leads to relationship turmoil and impulsive—even reckless—behavior.

When you're in the throes of overwhelming emotions, you're unable to think straight or stay grounded. You may say hurtful things or act out in dangerous or inappropriate ways that make you feel guilty or ashamed afterwards. It's a painful cycle that can feel impossible to escape. But it's not. There are effective BPD treatments and coping skills that can help you feel better and back in control of your thoughts, feelings, and actions.

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BPD is treatable

In the past, many mental health professionals found it difficult to treat borderline personality disorder (BPD), so they came to the conclusion that there was little to be done. But we now know that BPD is treatable. In fact, the long-term prognosis for BPD is better than those for depression and bipolar disorder. However, it requires a specialized approach. The bottom line is that most people with BPD can and do get better—and they do so fairly rapidly with the right treatments and support.

[Read: Helping Someone with Borderline Personality Disorder]

Healing is a matter of breaking the dysfunctional patterns of thinking, feeling, and behaving that are causing you distress. It's not easy to change lifelong habits. Choosing to pause, reflect, and then act in new ways will feel unnatural and uncomfortable at first. But with time you'll form new habits that help you maintain your emotional balance and stay in control.

Recognizing borderline personality disorder

Do you identify with the following statements?

• I often feel “empty.”
• My emotions shift very quickly, and I often experience extreme sadness, anger, and anxiety.
• I'm constantly afraid that the people I care about will abandon me or leave me.
• I would describe most of my romantic relationships as intense, but unstable.
• The way I feel about the people in my life can dramatically change from one moment to the next—and I don't always understand why.
• I often do things that I know are dangerous or unhealthy, such as driving recklessly, having unsafe sex, binge drinking, using drugs, or going on spending sprees.
• I've attempted to hurt myself, engaged in self-harm behaviors such as cutting, or threatened suicide.
• When I'm feeling insecure in a relationship, I tend to lash out or make impulsive gestures to keep the other person close.

If you identify with several of the statements, you may suffer from borderline personality disorder. Of course, you need a mental health professional to make an official diagnosis, as BPD can be easily confused with other issues.

[Read: Borderline Personality Disorder Test]

But even without a diagnosis, you may find the self-help tips in this article helpful for calming your inner emotional storm and learning to control self-damaging impulses.

Borderline personality disorder (BPD) manifests in many different ways, but for the purposes of diagnosis, mental health professionals group the symptoms into nine major categories. In order to be diagnosed with BPD, you must show signs of at least five of these symptoms. Furthermore, the symptoms must be long-standing (usually beginning in adolescence) and impact many areas of your life.

The 9 symptoms of BPD

1. Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. Even something as innocuous as a loved one arriving home late from work or going away for the weekend may trigger intense fear. This can prompt frantic efforts to keep the other person close. You may beg, cling, start fights, track your loved one's movements, or even physically block the person from leaving. Unfortunately, this behavior tends to have the opposite effect—driving others away.
2. Unstable relationships. People with BPD tend to have relationships that are intense and short-lived. You may fall in love quickly, believing that each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships either seem perfect or horrible, without any middle ground. Your lovers, friends, or family members may feel like they have emotional whiplash as a result of your rapid swings from idealization to devaluation, anger, and hate.
3. Unclear or shifting self-image. When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don't have a clear idea of who you are or what you want in life. As a result, you may frequently change jobs, friends, lovers, religion, values, goals, or even sexual identity.
4. Impulsive, self-destructive behaviors. If you have BPD, you may engage in harmful, sensation-seeking behaviors, especially when you're upset. You may impulsively spend money you can't afford, binge eat, drive recklessly, shoplift, engage in risky sex, or overdo it with drugs or alcohol. These risky behaviors may help you feel better in the moment, but they hurt you and those around you over the long-term.
5. Self-harm. Suicidal behavior and deliberate self-harm is common in people with BPD. Suicidal behavior includes thinking about suicide, making suicidal gestures or threats, or actually carrying out a suicide attempt. Self-harm encompasses all other attempts to hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.
6. Extreme emotional swings. Unstable emotions and moods are common with BPD. One moment, you may feel happy, and the next, despondent. Little things that other people brush off can send you into an emotional tailspin. These mood swings are intense, but they tend to pass fairly quickly (unlike the emotional swings of depression or bipolar disorder), usually lasting just a few minutes or hours.
7. Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there's a hole or a void inside them. At the extreme, you may feel as if you're “nothing” or “nobody.” This feeling is uncomfortable, so you may try to fill the void with things like drugs, food, or sex. But nothing feels truly satisfying.
8. Explosive anger. If you have BPD, you may struggle with intense anger and a short temper. You may also have trouble controlling yourself once the fuse is lit—yelling, throwing things, or becoming completely consumed by rage. It's important to note that this anger isn't always directed outwards. You may spend a lot of time feeling angry at yourself.
9. Feeling suspicious or out of touch with reality. People with BPD often struggle with paranoia or suspicious thoughts about others' motives. When under stress, you may even lose touch with reality—an experience known as dissociation. You may feel foggy, spaced out, or as if you're outside your own body.

Common co-occurring disorders

Borderline personality disorder is rarely diagnosed on its own. Common co-occurring disorders include:

• depression or bipolar disorder
• substance abuse
• eating disorders
• anxiety disorders

When BPD is successfully treated, the other disorders often get improve, too. But the reverse isn't always true. For example, you may successfully treat symptoms of depression and still struggle with BPD.

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Causes—and hope

Most mental health professionals believe that borderline personality disorder (BPD) is caused by a combination of inherited or internal biological factors and external environmental factors, such as traumatic experiences in childhood.

Brain differences

There are many complex things happening in the BPD brain, and researchers are still untangling what it all means. But in essence, if you have BPD, your brain is on high alert. Things feel more scary and stressful to you than they do to other people. Your fight-or-flight switch is easily tripped, and once it's on, it hijacks your rational brain, triggering primitive survival instincts that aren't always appropriate to the situation at hand.

This may make it sound as if there's nothing you can do. After all, what can you do if your brain is different? But the truth is that you can change your brain. Every time you practice a new coping response or self-soothing technique you are creating new neural pathways. Some treatments, such as mindfulness meditation, can even grow your brain matter. And the more you practice, the stronger and more automatic these pathways will become. So don't give up! With time and dedication, you can change the way you think, feel, and act.

Personality disorders and stigma

When psychologists talk about “personality,” they're referring to the patterns of thinking, feeling, and behaving that make each of us unique. No one acts exactly the same all the time, but we do tend to interact and engage with the world in fairly consistent ways. This is why people are often described as “shy,” “outgoing,” “meticulous,” “fun-loving,” and so on. These are elements of personality.

Because personality is so intrinsically connected to identity, the term “personality disorder” might leave you feeling like there's something fundamentally wrong with who you are. But a personality disorder is not a character judgment. In clinical terms, “personality disorder” means that your pattern of relating to the world is significantly different from the norm. (In other words, you don't act in ways that most people expect). This causes consistent problems for you in many areas of your life, such as your relationships, career, and your feelings about yourself and others. But most importantly, these patterns can be changed!

Self-help tips: 3 keys to coping with BPD

1. Calm the emotional storm
2. Learn to control impulsivity and tolerate distress
3. Improve your interpersonal skills

Self-help tip 1: Calm the emotional storm

As someone with BPD, you've probably spent a lot of time fighting your impulses and emotions, so acceptance can be a tough thing to wrap your mind around. But accepting your emotions doesn't mean approving of them or resigning yourself to suffering. All it means is that you stop trying to fight, avoid, suppress, or deny what you're feeling. Giving yourself permission to have these feelings can take away a lot of their power.

Try to simply experience your feelings without judgment or criticism. Let go of the past and the future and focus exclusively on the present moment. Mindfulness techniques can be very effective in this regard.

• Start by observing your emotions, as if from the outside.
• Watch as they come and go (it may help to think of them as waves).
• Focus on the physical sensations that accompany your emotions.
• Tell yourself that you accept what you're feeling right now.
• Remind yourself that just because you're feeling something doesn't mean it's reality.

[Listen: Eye of the Storm Meditation]

Do something that stimulates one or more of your senses

Engaging your sense is one of the quickest and easiest ways to quickly self-soothe. You will need to experiment to find out which sensory-based stimulation works best for you. You'll also need different strategies for different moods. What may help when you're angry or agitated is very different from what may help when you're numb or depressed. Here are some ideas to get started:

Touch. If you're not feeling enough, try running cold or hot (but not scalding hot) water over your hands; hold a piece of ice; or grip an object or the edge of a piece of furniture as tightly as you can. If you're feeling too much, and need to calm down, try taking a hot bath or shower; snuggling under the bed covers, or cuddling with a pet.

Taste. If you're feeling empty and numb, try sucking on strong-flavored mints or candies, or slowly eat something with an intense flavor, such as salt-and-vinegar chips. If you want to calm down, try something soothing such as hot tea or soup.

Smell. Light a candle, smell the flowers, try aromatherapy, spritz your favorite perfume, or whip up something in the kitchen that smells good. You may find that you respond best to strong smells, such as citrus, spices, and incense.

Sight. Focus on an image that captures your attention. This can be something in your immediate environment (a great view, a beautiful flower arrangement, a favorite painting or photo) or something in your imagination that you visualize.

Sound. Try listening to loud music, ringing a buzzer, or blowing a whistle when you need a jolt. To calm down, turn on soothing music or listen to the soothing sounds of nature, such as wind, birds, or the ocean. A sound machine works well if you can't hear the real thing.

Reduce your emotional vulnerability

You're more likely to experience negative emotions when you're run down and under stress. That's why it's very important to take care of your physical and mental well-being.

Take care of yourself by:

• Avoid mood-altering drugs
• Eating a balanced, nutritious diet
• Getting plenty of quality sleep
• Exercising regularly
• Minimizing stress
• Practicing relaxation techniques

Tip 2: Learn to control impulsivity and tolerate distress

The calming techniques discussed above can help you relax when you're starting to become derailed by stress. But what do you do when you're feeling overwhelmed by difficult feelings? This is where the impulsivity of borderline personality disorder (BPD) comes in. In the heat of the moment, you're so desperate for relief that you'll do anything, including things you know you shouldn't—such as cutting, reckless sex, dangerous driving, and binge drinking. It may even feel like you don't have a choice.

Moving from being out of control of your behavior to being in control

It's important to recognize that these impulsive behaviors serve a purpose. They're coping mechanisms for dealing with distress. They make you feel better, even if just for a brief moment. But the long-term costs are extremely high.

Regaining control of your behavior starts with learning to tolerate distress. It's the key to changing the destructive patterns of BPD. The ability to tolerate distress will help you press pause when you have the urge to act out. Instead of reacting to difficult emotions with self-destructive behaviors, you will learn to ride them out while remaining in control of the experience.

For a step-by-step, self-guided program that will teach you how to ride the “wild horse” of overwhelming feelings, check out our free Emotional Intelligence Toolkit. The toolkit teaches you how to:

• get in touch with your emotions
• live with emotional intensity
• manage unpleasant or threatening feelings
• stay calm and focused even in upsetting situations

The toolkit will teach you how to tolerate distress, but it doesn't stop there. It will also teach you how to move from being emotionally shut down to experiencing your emotions fully. This allows you to experience the full range of positive emotions such as joy, peace, and fulfillment that are also cut off when you attempt to avoid negative feelings.

A grounding exercise to help you pause and regain control

Once the fight-or-flight response is triggered, there is no way to “think yourself” calm. Instead of focusing on your thoughts, focus on what you're feeling in your body. The following grounding exercise is a simple, quick way to put the brakes on impulsivity, calm down, and regain control. It can make a big difference in just a few short minutes.

Find a quiet spot and sit in a comfortable position.

Focus on what you're experiencing in your body. Feel the surface you're sitting on. Feel your feet on the floor. Feel your hands in your lap.

Concentrate on your breathing, taking slow, deep breaths. Breathe in slowly. Pause for a count of three. Then slowly breathe out, once more pausing for a count of three. Continue to do this for several minutes.

In case of emergency, distract yourself

If your attempts to calm down aren't working and you're starting to feel overwhelmed by destructive urges, distracting yourself may help. All you need is something to capture your focus long enough for the negative impulse to go away. Anything that draws your attention can work, but distraction is most effective when the activity is also soothing. In addition to the sensory-based strategies mentioned previously, here are some things you might try:

Watch TV. Choose something that's the opposite of what you're feeling: a comedy, if you're feeling sad, or something relaxing if you're angry or agitated.

Do something you enjoy that keeps you busy. This could be anything: gardening, painting, playing an instrument, knitting, reading a book, playing a computer game, or doing a Sudoku or word puzzle.

Throw yourself into work. You can also distract yourself with chores and errands: cleaning your house, doing yard work, going grocery shopping, grooming your pet, or doing the laundry.

Get active. Vigorous exercise is a healthy way to get your adrenaline pumping and let off steam. If you're feeling stressed, you may want to try more relaxing activities such as yoga or a walk around your neighborhood.

Call a friend. Talking to someone you trust can be a quick and highly effective way to distract yourself, feel better, and gain some perspective.

Tip 3: Improve your interpersonal skills

If you have borderline personality disorder, you've probably struggled with maintaining stable, satisfying relationships with lovers, co-workers, and friends. This is because you have trouble stepping back and seeing things from other people's perspective. You tend to misread the thoughts and feelings of others, misunderstand how others see you, and overlook how they're affected by your behavior. It's not that you don't care, but when it comes to other people, you have a big blind spot. Recognizing your interpersonal blind spot is the first step. When you stop blaming others, you can start taking steps to improve your relationships and your social skills.

Check your assumptions

When you're derailed by stress and negativity, as people with BPD often are, it's easy to misread the intentions of others. If you're aware of this tendency, check your assumptions. Remember, you're not a mind reader! Instead of jumping to (usually negative) conclusions, consider alternative motivations. As an example, let's say that your partner was abrupt with you on the phone and now you're feeling insecure and afraid they've lost interest in you. Before you act on those feelings:

Stop to consider the different possibilities. Maybe your partner is under pressure at work. Maybe he's having a stressful day. Maybe he hasn't had his coffee yet. There are many alternative explanations for his behavior.

Ask the person to clarify their intentions. One of the simplest ways to check your assumptions is to ask the other person what they're thinking or feeling. Double check what they meant by their words or actions. Instead of asking in an accusatory manner, try a softer approach: “I could be wrong, but it feels like…” or “Maybe I'm being overly sensitive, but I get the sense that…“

Put a stop to projection

Do you have a tendency to take your negative feelings and project them on to other people? Do you lash out at others when you're feeling bad about yourself? Does feedback or constructive criticism feel like a personal attack? If so, you may have a problem with projection.

To fight projection, you'll need to learn to apply the brakes—just like you did to curb your impulsive behaviors. Tune in to your emotions and the physical sensations in your body. Take note of signs of stress, such as rapid heart rate, muscle tension, sweating, nausea, or light-headedness. When you're feeling this way, you're likely to go on the attack and say something you'll regret later. Pause and take a few slow deep breaths. Then ask yourself the following three questions:

1. Am I upset with myself?
2. Am I feeling ashamed or afraid?
3. Am I worried about being abandoned?

If the answer is yes, take a conversation break. Tell the other person that you're feeling emotional and would like some time to think before discussing things further.

Take responsibility for your role

Finally, it's important to take responsibility for the role you play in your relationships. Ask yourself how your actions might contribute to problems. How do your words and behaviors make your loved ones feel? Are you falling into the trap of seeing the other person as either all good or all bad? As you make an effort to put yourself in other people's shoes, give them the benefit of the doubt, and reduce your defensiveness, you'll start to notice a difference in the quality of your relationships.

BPD treatment

If you think that you or a loved one may be suffering from BPD, it's best to seek professional help, ideally from someone with experience diagnosing and treating BPD.

The importance of finding the right therapist

The support and guidance of a qualified therapist can make a huge difference in BPD treatment and recovery. Therapy may serve as a safe space where you can start working through your relationship and trust issues and “try on” new coping techniques.

An experienced professional will be familiar with BPD therapies such as dialectical behavior therapy (DBT) and schema-focused therapy. But while these therapies have proven to be helpful, it's not always necessary to follow a specific treatment approach. Many experts believe that weekly therapy involving education about the disorder, family support, and social and emotional skills training can treat most BPD cases.

It's important to take the time to find a therapist you feel safe with—someone who seems to get you and makes you feel accepted and understood. Take your time finding the right person. But once you do, make a commitment to therapy. You may start out thinking that your therapist is going to be your savior, only to become disillusioned and feel like they have nothing to offer. Remember that these swings from idealization to demonization are a symptom of BPD. Try to stick it out with your therapist and allow the relationship to grow. And keep in mind that change, by its very nature, is uncomfortable. If you don't ever feel uncomfortable in therapy, you're probably not progressing.

Don't count on a medication cure

Although many people with BPD take medication, the fact is that there is very little research showing that it is helpful. What's more, in the U.S., the Food and Drug Administration (FDA) has not approved any medications for the treatment of BPD. This doesn't mean that medication is never helpful—especially if you suffer from co-occurring problems such as depression or anxiety—but it is not a cure for BPD itself.

When it comes to BPD, therapy is much more effective. You just have to give it time. However, your doctor may consider medication if:

• You have been diagnosed with both BPD and depression or bipolar disorder.
• You suffer from panic attacks or severe anxiety.
• You begin hallucinating or having bizarre, paranoid thoughts.
• You are feeling suicidal or at risk of hurting yourself or others.

Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D.

• • References

    Personality Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_Disorders

    Choi-Kain, Lois W. , Ellen F. Finch, Sara R. Masland, James A. Jenkins, and Brandon T. Unruh. “What Works in the Treatment of Borderline Personality Disorder.” Current Behavioral Neuroscience Reports 4, no. 1 (March 1, 2017): 21–30. https://doi.org/10.1007/s40473-017-0103-z

    Stoffers-Winterling, Jutta M., Birgit A. Völlm, Gerta Rücker, Antje Timmer, Nick Huband, and Klaus Lieb. “Psychological Therapies for People with Borderline Personality Disorder.” Cochrane Database of Systematic Reviews, no. 8 (2012). https://doi.org/10.1002/14651858.CD005652.pub2

    Kulacaoglu, Filiz, and Samet Kose. “Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe.” Brain Sciences 8, no. 11 (November 18, 2018): 201. https://doi.org/10.3390/brainsci8110201

    Bozzatello, Paola, Silvio Bellino, Marco Bosia, and Paola Rocca. “Early Detection and Outcome in Borderline Personality Disorder.” Frontiers in Psychiatry 10 (2019): 710. https://doi.org/10.3389/fpsyt. 2019.00710

    Ripoll, Luis H. “Psychopharmacologic Treatment of Borderline Personality Disorder.” Dialogues in Clinical Neuroscience 15, no. 2 (June 2013): 213–24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811092/

    Angstman, Kurt, and Norman H. Rasmussen. “Personality Disorders: Review and Clinical Application in Daily Practice.” American Family Physician 84, no. 11 (December 1, 2011): 1253–60. https://www.aafp.org/afp/2011/1201/p1253.html

  Borderline Personality Disorder – Overview of symptoms, causes, and treatment. (National Institute of Mental Health)

  Borderline Personality Disorder (BPD) –Explains borderline personality disorder (BPD) including possible causes, how you can access treatment and support, and tips for helping yourself. (Mind)

  What is Dialectical Behavior Therapy (DBT)? – A comprehensive article with ten short videos. (Behavioral Tech)

  Helplines and support

  In the U.S.: Call the NAMI HelpLine at 1-800-950-6264

  UK: Call the the Mind infoline at 0300 123 3393

  Australia: Call the Sane Helpline at 1800 187 263

  Canada: Find Your CMHA for a helpline near you

  India: Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 330

  Last updated: December 15, 2022

  What Are The 9 Symptoms Of Borderline Personality Disorder?

  Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, mental health disorder. It is a serious psychological condition that is characterized by pervasive instability in moods, emotions, behaviors, and interpersonal relationships which interfere with one’s ability to function in everyday life. Although the cause of borderline personality disorder remains unknown, the National Institute of Mental Health (NIH) alludes to research that “suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing a borderline personality disorder.” Teenagers with borderline personality disorder feel prolonged, intense emotions and are unable to return to a neutral emotional baseline after facing an emotionally charged experience in a timely manner. This can affect all areas of one’s life as the duration it takes a young person with BPD to process, integrate, and recover from emotional challenges is elongated. 

  The nine symptoms of borderline personality disorder are highlighted in the diagnostic criteria that are outlined in the DSM-5. According to the DSM-5, to be diagnosed with BPD a young person must experience five or more of the following symptoms in a variety of contexts:

  1. Emotional instability
  2. Feelings of emptiness
  3. Efforts to avoid abandonment
  4. Impulsive behaviors
  5. Identity disturbances
  6. Inappropriate, irrational and/ or intense bouts of anger
  7. Transient paranoid and/ or dissociative symptoms
  8. Unstable interpersonal relationships
  9. Suicidal and/ or self-harming behaviors

  BPD directly affects how one feels about him or herself, one’s behavior as well as how one can relate to others. Hence, teens with a borderline personality disorder often struggle with relationship issues, lack self-esteem, have a poor self-image, and have an inability to appropriately self-regulate. The symptoms that manifest because of borderline personality disorder often mimic those of other mental health disorders such as histrionic personality disorder, narcissistic personality disorder, and bipolar personality disorder. Due to its elusive nature, a borderline personality disorder can be extremely difficult to diagnose. As such, to obtain the most accurate mental health diagnosis it is imperative to undergo a comprehensive evaluation that is conducted by one or more qualified mental health professionals.

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  Seeking help is never easy, but you are not alone! If you or someone you know needs mental health treatment, we strongly encourage you to reach out for help as quickly as possible. It is not uncommon for many mental health difficulties to impact a person’s life, the long term. Pursuing support at the beginning of one’s journey can put the individual in the best position to learn how to manage themselves in a healthy way so they can go on to live happy and fulfilling lives.

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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. nine0003

  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. nine0003

  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. nine0003

  ---

  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. nine0003

  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. nine0003

  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. nine0003

  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. nine0003

  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. nine0003

  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. nine0044
  • 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. nine0003

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

  1. The dominant affect is anger.
  2. Inability to build interpersonal relationships.
  3. Self rejection.
  4. 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. nine0003

  ---

  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. nine0003

  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. nine0044
  • 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: nine0003

  • 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. nine0003

  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. nine0003

  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. nine0044
  • 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:

  1. genetic predisposition.
  2. 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). nine0003

  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. nine0003

  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: nine0003

  1. 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".
  2. 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.
  3. 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. nine0044
  4. 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:

  1. 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. nine0044
  2. 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.
  3. 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. nine0044
  4. 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:

  1. 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. nine0044
  2. 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.
  3. 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. nine0044

  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. nine0003

  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. nine0003

  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; nine0044
  • 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. nine0003

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

  1. 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; nine0044
  • 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; nine0044
• 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.

+7 (495) 121-48-31




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: nine0003

1. 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.
2. 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. nine0044
3. 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.
4. 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.
5. 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. nine0044



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. nine0003

References:

1. McWilliams N., “Psychoanalytic diagnostics. Understanding personality structure in the clinical process”
2. Ushakov G.K. Borderline neuropsychiatric disorders.-2nd edition-M., Medicine
3. Kuzmenok G.F. Collection “Ways of Understanding. Collection of articles for the 15th anniversary of the Society for Psychoanalytic Psychotherapy” - about the combination of therapy and pharmacology.
4. Gert Sauer Siberian Lectures on Analytical Psychology
5. Churkin A.A., Martyushov A.N. Practical Guide to the Application of the ICD-10 in Psychiatry and Addictions
6. Tiganov A.S. Manual of Psychiatry - M. Medicine
7. Ukhanovsky A.O., Kutyavin Yu.A., Litvak M.E. General psychopathology
8. A.V. Snezhnevsky - Clinical Psychiatry

On the Edge: Living with Borderline Personality Disorder

Medical Issues

Text: Masha Pushkina, nine0003

Ekaterina Tarasova

Illustrations: Alena Belyakova

October 31, 2017

Borderline personality disorder affects 3% of people on Earth. It would seem that 3% is not much at all, but we are talking about several hundred million people, and this is twice as much as the entire population of Russia. What is BPD and where does it come from, how can a “border guard” live with himself and what should his relatives do, can he be cured and how can he help himself on his own - all this is in our new large material on disorders. Anna Ushkalova, a psychiatrist at the International Medical Center, assisted us in researching the issue. Special thanks to Katya Novikova for collecting comments from people with BPD. nine0311


Borderline personality disorder ( BPD, Borderline personality disorder ) is a psychiatric disease characteristic of people who are characterized by instability in interpersonal relationships, self-image, emotional instability, impulsivity. These symptoms occur at a young age, appear regularly in many life situations and lead to maladjustment in society.

Unfortunately, in our country little attention is paid to the problems of people with BPD. Incorrect diagnosis often complicates the treatment process itself. nine0003

“People with BPD are often treated incorrectly with medications that only make them worse. But in most cases, “border guards” are unaware of their diagnosis and, accordingly, do not know that their condition can be corrected.

In Russia, acquaintance with the methods of psychotherapy of borderline disorder common in the West is just beginning, there are only a few experienced specialists. But the first psychotherapeutic communities are already opening up where people with BPD can get help, ”says the Resource Center, an information portal for people suffering from borderline disorder. nine0003

Psychiatry classifies BPD as a personality disorder, a group of diseases that includes various character pathologies, from dissociative disorders to narcissistic disorders.

Despite the similarity of the name, "borderline personality disorder" has nothing to do with "borderline". Psychologists call the borderline state the degree of severity of character traits on the verge of norm and pathology.


Diagnosis

nine0368

To make a diagnosis of BPD, in addition to general symptoms, at least five other signs from the following list must be present:


1. Strong fear of being alone. The tendency to make excessive efforts to avoid the real or imagined fate of being abandoned.

2. A tendency to intense, tense and unstable relationships, in which extremes alternate - idealization and devaluation of the partner.

3. Identity disorder: instability of the image or feeling of the self. Ups and downs of self-esteem. Fuzzy ideas about myself (who am I? what do I like? what do I want?). nine0003

4. Impulsivity, which manifests itself in at least two areas of dangerous behavior, such as spending money, sexual behavior, substance abuse, risky driving, overeating.

5. Recurrent suicidal behavior, suicide threats, repeated acts of self-harm. Masochistic tendencies in behavior and relationships with people.

6. Affective instability, extremely changeable mood. In this case, periods of intense dysphoria, irritability or anxiety are usually short and last from a few minutes to several days. nine0003

7. Constant feeling of emptiness, meaninglessness, boredom.

8. Inappropriate displays of intense anger or difficulty in controlling anger (eg frequent irritability, repeated fights).

9. In conditions of severe stress, paranoid ideas and suspicion, dissociative symptoms, derealization, depersonalization may occur.

10. Violations of mentalization, that is, understanding the motives of one's own and other people's actions, difficulty in understanding the emotions and reactions of other people. nine0003

11. Chaotic interpersonal relationships.

To understand what the world of the "border guard" looks like from the inside, I interviewed more than ten people with a diagnosis of "borderline personality disorder. " They talked about the main symptoms of BPD through the prism of personal and very painful experience.


Features of "border guards"

Psychiatrists call it identity disorder, psychopathy, sluggish schizophrenia - because BPD only exists in the DSM-4 foreign classification of diseases. "Border guards" are so dependent on the attitude of other people towards them and their own emotional outbursts that they hardly understand what they really are and what they want from life. These are solipsists in reverse: they consider the world around them to be a figment of their imagination, while people with BPD often doubt their own reality. nine0170

Who am I?

Anya: “The hardest thing is the complete fragmentation of the world and oneself. Every day or several times a day you are a completely different person, and you are strongly influenced by the people around you and events. Either you are tough and distant, then you are deeply dependent and extremely emotional, then you are straight, then you are lesbian, then you are generally asexual. You can react radically differently to the same thing, depending on which part of your personality you find yourself in at that moment. And each of the states seems to be absolute, you are not able to remember yourself at this moment. nine0003

It's almost a split personality, and your parts are barely connected. The hardest part is the feeling that you don't really exist. It's like you only exist while someone is looking at you and talking to you, while someone else is reflecting you. Sometimes these fluctuations leave you so isolated that you want to go outside and pester passers-by, asking if they see me at all.”

Anastasia, 18 years old, actress in the experimental theater and physics student: “I still do not clearly understand who I am. A feeling of inner emptiness that has been progressing since childhood, an extremely unstable self-esteem. But it's not that disturbing yet. But after I was visited by depersonalization and dissociation, it became not fun at all. And when there was a constant desire to harm myself, I was not the only one who got scared. Poisoning, cuts, blows, blackouts, bulimia - an incomplete list of my adventures.


Existence with such a fragmented self-perception is very painful. The life of a "border guard" during periods of deterioration is a constant fear of being rejected and mental pain; what Freud called the word "Angst". nine0170

Lois , aged 23: “My brain hurts. Every time I experience hell like the first time. During the next episode, it always seems that it has never been worse, now it’s definitely an apocalypse. The memory of what was bad before and then disappeared disappears.

Even answering the question “How are you?” is problematic. Immediately a swarm of questions arises: how are you when? now or today? Or maybe you're hinting with your question that you don't like me? what answer do you want to get? nine0003

Fear sends me into a vicious circle, when all options for action are bad: not talking about what I feel, keeping everything in myself is bad for me. I speak out - people take it personally, even if I clarify that these are just my feelings. Friends get angry and upset, which makes me even worse. And I can talk in a bad state endlessly. The more I talk, the more I regret what I said."


But a few people noted positive aspects in their condition. For example, the ability to empathize (although other people have said the opposite: that obsession with their feelings prevents them from taking the place of another). nine0170

Ksenia, 25 years old, social media manager: “I think I feel everything much brighter and deeper than others. It is very difficult for me to be alone on the streets and especially in the metro, where there are a lot of people. Grandmothers begging, a sad girl, a stray dog, a tired driver - they all give me an uncontrollable pity and a feeling of empathy that is almost impossible to cope with. Crying three times on the way from home to work is a common thing. nine0003

Illness has expanded the boundaries of my perception, growing such a huge range of feelings that it allows me to easily enter into the position of others. My young man says that sometimes he himself does not have time to understand himself and understand some of his inner experiences, as I already feel the slightest changes in him and anticipate events.

It is important to understand that the condition of a border guard is not a continuous series of suffering. There are periods of improvement, and quite long ones. At this time, they can experience "brighter, richer and more interesting feelings, sharpening in perception, the ability to notice and enjoy such things in the world around them that ordinary people simply pass by." nine0003

Max: “During episodes of good mood, you want to communicate with everyone, you become very friendly and there is a lot of energy that is easy to direct to any business, just give it a push. But everything is fine only until something hits the switch. Even one ridiculous thing - say, the death of a dove - can cause the world to abruptly change its tone to black.

Don't leave me - leave immediately!

nine0002 The void needs to be filled with something, and the fragmented consciousness needs to be glued together. Most often - strong feelings and emotions of other people, which the "border guard" needs like air.

A feature that distinguishes all people with BPD is the difficulty in building stable relationships. On the one hand, they strive for dependence and complete merging, but at the same time they are afraid of intimacy, feeling danger in it. After all, if a loved one rejects you, it will be tantamount to losing yourself. Therefore, such people try to leave first, often suddenly and for no apparent reason. nine0003

Xenia: “People with BPD have such a thing as Favorite Person (FP). This is the one who replaces you all and everything. To some extent, this is reminiscent of the relationship between the dog and the owner, when the dog was left at home alone, and he trashed the whole apartment and whined at the door for several hours, waiting for the owner. Most of the time I cannot be alone with myself, I am corroded by emptiness and at the same time a storm of emotions.

Rina, 25 years old, philologist: “I am constantly waiting for rejection. You may not be aware of this, live in peace, and then one of your friends will express himself incorrectly, say, for example, “Let's say goodbye” - and your world will immediately collapse. You start to think that the person doesn't want to see you again. You delve into yourself, trying to figure out what you did wrong, until you plunge into the abyss of sadness and thoughts about death. And a friend just wanted to say that he needs to go home now, we'll meet tomorrow. Always like this". nine0170

Being close to a "border guard" is risky. In his love, idealization is always replaced by depreciation, and the one who yesterday was a “handsome prince”, after a couple of unsuccessful phrases, can turn into a “terrible tyrant”.

N: “Because I am afraid of being left and abandoned, I have always destroyed all relationships. I started seeing a therapist because I was unable to trust the girls I dated. If we didn’t see each other for a day, and sometimes for several hours, I was absolutely sure that she had cheated on me, that everyone around me was deceiving. nine0003

Pain and razor

Many do not believe in the depth and severity of the experiences of BPD sufferers. Their loud suffering from the outside may seem like just a way to attract attention and manipulate. But all these feelings, even if they are objectively inadequate, are completely real in the mind of the patient. Their ignoring and depreciation can end in a real disaster.

Up to 10% of "border guards" die by suicide. These are extreme cases. What happens much more often, at some point in life - with almost everyone, is self-harm, that is, self-harm. Chaos inside and mental pain become so strong that physical pain seems more acceptable. nine0003

My interlocutors named different motives for inflicting physical harm on themselves: it could be a “punishment” for bad behavior, a way to drown out guilt and shame for one’s “abnormality”, and even an attempt to destroy the “monster” inside, which destroys everything around and poisons the lives of loved ones . It can also be a cry for help, a desperate attempt to get support, most often from indifferent parents.

To suppress pain, both alcohol and psychotropic substances are used, so borderline disorder gives rise to addictions and codependencies. nine0003

Xenia: “Many harm themselves spontaneously, thoughtlessly. But there are also those who specially, in a special way, prepare for this: they sharpen a knife, sterilize the skin, prepare bandages. Sometimes it is not enough for such people to inflict a wound on themselves, because it will heal anyway. They pour lemon juice over the cuts and cover them with salt.”

D., 20 years old, student: “At five in the morning, I was standing in the dormitory toilet with a knife in my hand. Blood was splattering down my leg. Back then, self-harm was the only reliable way to deal with emotions without losing performance. Then I carried the knife in my bag, kept it on the table next to the laptop at home and even sometimes slept with it, hiding it under the pillow or under the bed. Only then did I realize that it was a disease.” nine0170

The greatest risk of suicide in BPD is at a young age (13-15 years)

© Berman A.L., 1985; Friedman R.C., 1987

Aggression can be directed not only at oneself, but also at another. Not so long ago, the Internet was bypassed by a video of schoolgirls who beat each other in a wasteland while friends were filming it. The audience was shocked by girlish aggression: they tried to blame her on television, computer games. It seems that no one then thought that this could be a way to overcome mental pain: “Anya (author's note: the heroine's best friend) backhanded me in the face. We fought: we thrashed with our fists and legs, pulled each other by the hair, scratched, tried to knock each other to the ground and beat each other harder. We smashed our noses and cut our lips, ripped our clothes and tried to release our heartache, like in Fight Club. nine0003

Some manage to channel this need for physical pain into more acceptable channels. Among the border guards there are many fans of piercings, tattoos, BDSM.

Not all people with BPD cut themselves and abuse alcohol or other substances: borderline disorder can present with relatively "mild" disorders. In borderline disorder, either impulsivity, suicidal attempts, or violations of direct interpersonal relationships may predominate, when, due to emotional instability, relationships with others become negative. There are more severe violations, as in the case of suicide attempts, when psychiatric consultations are necessary. There are such disorders in which you can improve your life with the help of regular psychotherapy and work on yourself. That is, the gradations of symptoms in the manifestation of BPD are very different! Sometimes people seem to be adapted at first glance, everything “seems to be all right” with them: they work, they live well, but in stressful situations they can show impulsive destructive behavior. One hundred and fifty-one different combinations of symptoms are possible in the clinical picture of patients diagnosed with BPD (and some authors give two hundred and fifty-six as a possible number of combinations of symptoms)! nine0003

Self-help

Borderline disorder is by no means a sentence. Almost all of my interlocutors were able to recognize their problem and find constructive ways to deal with emotional extremes. In order to perceive the world as it is, and not as dictated by a sick imagination, the "border guard" needs to make great efforts.


J: “I have a whole list of self-help methods: meditation, mindfulness exercises, detachment from the situation (I physically interrupt the conversation, leave the apartment, and so on). And, of course, in my head there is always a background process of tracking my thoughts and correcting errors of perception. Regularly do “reality checks”:


1.

in my mind I build a “line of defense” in favor of the person whom I suspect of bad things;

2.

asking a stranger how he would react to the situation;

3.

step back, wait until emotions subside, and only then make a decision;

4.

I try to keep a schedule of work and rest: I am especially unstable during sessions and deadlines, so I try to prepare in advance and always get enough sleep. ”.

nine0002 Daria, 34 years old, psychotherapist: “Psychotherapy helped me understand myself. With the help of a therapist, I learned to understand what my boundaries are. Then I figured out exactly what I feel, what I want at that moment and what to do with it. I learned to console myself. A person with BPD mourns the lost love of his parents, and this grief is hidden under a huge layer of rage, because the family was not allowed to grieve. Then I had to learn to take responsibility for my own needs and not take revenge on my relatives for the sins of my parents. nine0003

N: “The therapist gave me an exercise based on meditation: in an inner voice that expresses self-care, acknowledge my feelings, acknowledge that right now it hurts and is unpleasant, and then imagine a gesture that would express self-care ( like a big hug). It helps a lot. It became incredibly easier for me to live when I realized what was happening, that all these things (a change in the meaning of life every ten minutes, breakdowns and tantrums) are not really me, but my disease.

Lois: “Adequate view from the outside is extremely important to us. A friend recently told me what my “borderline” part looks like. And that was the most helpful information I've received in months. She helped me finish a difficult episode. Without a friend, I would never have guessed what it looks like.


She (my border side):


1.

requires constant attention;

2.

she needs to explain everything;

3.

her thoughts must be guessed;

4.

she acts like a child.

I am learning to catch and unravel "borderline" thoughts, make them absurd, I try to share them with loved ones in order to jointly refute them. It's a very useful practice."


Polina: “I am a perfectionist and have always strived to be the best. But if I've learned anything during my illness, it's that the world and the people around you are already demanding enough, so it's important to be kind and gentle with yourself. Now I just allow myself to be weak. I allow myself to listen to sad music, cry and whine. I allow myself to take breaks from work. Because I know that if you do not allow yourself weakness, it will be even worse. nine0003

Alexander , poet, journalist: “I am always looking for new, constructive ways. For example, the People Skills To Go app for people with BPD. In times of crisis, without psychotherapists and psychiatrists, I would not have coped. Sometimes people get tired of me and stop talking, but many people stay in relationships for many years, and I think that love overcomes pain.


Many BPD sufferers have a desire for creativity, self-expression through it. And this is also a form of therapy. nine0170

Anastasia: “The theater saves me. If there are no rehearsals, I dance, merge with the music. If there is no physical strength, then I lie on the floor and listen to cello and piano recordings.

Xenia: “The Telegram channel saved me, I wrote everything I felt there, trying to spit out all the lines in a beam between my eyes. The letters floated in front of me, blocking out the pain for a while. A round dance of unspoken words that flew like canvases to the Internet to thousands of people. nine0170

Relationships

Many people with BPD are quite happy with their social and personal lives, but this is exactly the case when you cannot rely on feelings and the will of fate alone. A lot of work is needed on oneself and relationships, and on both sides. The “border guard” needs to be aware and pronounce every conflict moment, and, most importantly, learn to express their feelings without aggression. Partner, respectively - to support him and calmly answer even the strangest questions. nine0003

The popular advice for dealing with "tantrums" - to go away and wait until she calms down - is not applicable in any case, because everything can end very badly.

Daria: “I used to have more friends, but it was codependency based on the principle ‘eat my mental waste and I will sing yours in return’. Now I redefine the concept of friendship for myself.

It was hard for my second husband, whom we met at the height of my treatment. He says that he had to calm me down two or three times a day. I was stormy at the sudden appearance of a valuable person whom I tried to simultaneously idealize and completely appropriate, and completely devalue - that is, forever banish from the horror of intimacy. Now, three years later, when I sometimes start to stagger from fatigue and overstrain, I “hang” on my husband - I describe my feelings to him, he gently tells that in reality everything is not so, but much better, and it becomes easier for me. nine0003

Rina: “My friends know my diagnosis. Friends and colleagues consider me an interesting and very eccentric person. I studied so much literature about PHR that I learned how to lecture my friends about what was happening to me. Now they almost see me better when I am carried, and can insure in time.

Polina: “I do not hide my condition from anyone: not so long ago I published a long post on Facebook explaining my diagnosis in detail, and received a lot of support. Many relatives are also aware, but not everyone understands how to behave correctly. Even my father, when I told him about BPD, joked: “Go to the village to milk the cows at five in the morning.” Not a very good joke, I think. nine0003

I think it's pointless to hide, because sooner or later my condition will become public - I'm not made of iron. So I try to avoid rumors, discussions behind my back and accusations of a bad temper. I'm really lucky that they accept me, because, perhaps, I myself would not want to be my own friend.

Lois: “Before I couldn't tell when something was going on, now I can say to a new acquaintance, 'Sometimes I react illogically to what's going on around me. If I ask: Are you sure you don't hate me now? “It means that I’m really afraid to hear: yes, I hate you and don’t want to see you ever.” nine0170

Diagnostics in Russia

The cases described above are the exception rather than the rule. Most people with borderline disorder do not know their diagnosis and do not receive any treatment.

Because BPD has almost no obvious psychiatric manifestations such as hallucinations and psychosis, it does not occur to the patient or his relatives to see a doctor. Self-harm - the most obvious manifestation of BPD - patients carefully hide. nine0003

Acquaintances consider such a person to be hysterical, self-centered, capricious, with a bad temper and do not believe that he can be changed. He himself, due to the specifics of the disease, is not able to analyze and evaluate his condition, and in his problems he sincerely considers others or external circumstances to be guilty.

Anna Ushkalova, psychiatrist: “Difficulties in diagnosing BPD — like other personality disorders — lie in the fact that, historically, the mental health care system in Russia has focused on inpatient treatment with an emphasis on acute and emergency conditions. Russian psychiatry paid insufficient attention to personality disorders in general. In addition, psychotherapeutic education in our country is not included in the basic course of psychiatry. Nevertheless, interest in this problem is growing, as is the number of specialists with skills and experience in working with such disorders. nine0350

The situation is complicated by the fact that in the International Classification of Diseases (ICD-10) adopted in Russia, the diagnosis of "borderline personality disorder" does not exist at all. There is a concept close, but not identical to it - "emotionally unstable personality disorder" (disease code - F60.3).

Daria: “I realized what was happening to me when I was about twenty-five years old, when people started writing about BPD on the Internet. I realized that I am not a lazy, inconsistent, irresponsible hysteric, but that what is happening in my body and head has objective reasons. nine0170

Up to a third of all completed suicides are committed by people with BPD

© Kullgren G. et al., 1986; Runesson B. et al., 1991; Links, 2003

Unfortunately, often those with BPD do not see a doctor for the first time until after a suicide attempt. If it does not reach such an extreme, the diagnosis can turn into a whole investigation.


Polina: “The prerequisites were in early childhood, and alarm bells began to be heard in high school, when I unexpectedly started cutting myself, then starving myself and depriving myself of sleep. It took me a long time to figure out what was wrong with me. At first she turned to a private psychotherapist, but she suspected a charlatan in her. Long trips to the doctors began. They didn’t tell me anything worthwhile, they advised me to drink glycine. In the meantime, I suspected that I had bipolar disorder, it seemed to me that I was wasting time with doctors - in general, it was so. The mother of a friend once told me that she was successfully treated in the Clinic of Neurosis. Already at home, in St. Petersburg, a neurologist in the district clinic wrote me a referral. At the clinic, I was first diagnosed with “bipolar disorder”, but it was not confirmed. The psychiatrist started calling me ‘border guard’.” nine0170

Some of the symptoms of borderline disorder are indeed similar to those of bipolar disorder (mood swings, alternations of agitation and depression, depression), and misdiagnosis is not uncommon.

It is important to remember the differences: in BPD, unlike bipolar affective disorder, mood swings are instantaneous and can occur dozens of times a day, and are most often caused by external events rather than internal processes.

But there are also patients in whom these two diseases are combined: according to a number of studies, such cases are more than 10%. nine0003

Anna Ushkalova, psychiatrist: “In the new, eleventh edition of the International Classification of Diseases, a transition to completely different criteria for all personality disorders, including BPD, is planned. First of all, the degree of maladjustment of a person will be taken into account. If a doctor in the public care system can even determine the very presence of the disorder and send the patient to a psychotherapist, this will be a breakthrough in treatment.”

Making a diagnosis, no matter how hard it may sound, changes the lives of patients for the better. Understanding what exactly is happening to you, and that you can influence it, gives a sense of control that people with borderline disorder lack so much. nine0170

Xenia: “Before, I constantly thought that other people just didn’t want to understand me, that I didn’t try hard enough, that I should become like everyone else, or vice versa, everyone should become like me. Until the age of twenty-four, I had full confidence that I was special, that I had a completely unique set of qualities, that I did things that were peculiar to me. And then I read an article about BPD and realized that I had lived my whole life as if by a textbook. ”


nine0365

Causes of borderline disorder

There is no clear understanding of the causes of borderline disorder.

As with most mental illnesses, both innate predisposition and early trauma seem to play a role. In almost every case history there is an emotional shock: the loss of a very close person, physical or sexual abuse, generally inappropriate behavior of parents.

If in due time the child is not taught to value himself as a person and to understand where the boundary lies between his interests and the interests of others, he will not be able to trust either others or himself in the future. nine0003

Anna Ushkalova, psychiatrist: “Currently, the biosocial model has received the greatest recognition. The pathogenesis of BPD can be represented as follows: against the background of a genetic predisposition, there is a “vulnerability” of individual biological structures (hyperactivity of the limbic system, a decrease in the regulatory function of the prefrontal cortex). This leads to increased excitation and slower inhibition in response to stress. The combination of these factors with adverse conditions, especially in childhood (such as sexual or physical abuse, neglect) leads to the fact that the patient develops a dysfunctional pattern of emotional response and behavior. nine0350

Psychological reasons

The most common cause of borderline disorder is considered direct child abuse in the family and chronic childhood trauma.


Xenia: “When I was four years old, I was sexually abused by an elderly man. This situation haunts me to this day and clearly had a great influence on the formation of my personality. Specifically, it blew the roof off me at thirteen or fifteen: alcohol, drugs, the wrong company, fights, hooliganism, running away from home, uncontrolled sexual behavior. nine0003

Lois: “When I was twelve, my stepfather confessed his 'love' to me. The first "kiss" was with him. At that time, I did not understand so much what was happening that I froze physically, disconnected from all emotions and did not talk to anyone for another two days. Then there was a series of cases of psychological and physical violence, and he constantly said that he loved me and suffered because of such a difficult situation. In addition, he followed all my actions, read correspondence with my friends, communicated with them if he did not like something. I didn’t understand what was going on at all, but he threatened me and I haven’t told my parents anything until now.” nine0170

However, more often than not, an unfavorable emotional situation is enough: often “borderliness” is brought up by parents with their own mental disorders.


Anya: “Mom has a mental disorder, although she has never seen a psychiatrist. Her contact with reality was clearly broken, she always lived in imaginary worlds, and from my early childhood I was left to myself, there was practically no communication within the family.

Daria: “The family was middle-income, no one beat or raped me, and for a long time I could not understand what had destroyed me so much. My brother and I had cold, anxious, aggressive, demanding parents, a depressed mother, and a combination of borderline and narcissistic father. It looked like this: something rolled over one of the parents, and they began to bombard my brother and me with demands, accusations, claims against each other - “your neglected mother” and “your crazy father”. It was quite difficult to predict when and whom it would close, so we grew up in an atmosphere of complete chaos, which we attributed not to our parents, but to ourselves. As a result of such an upbringing, I considered myself practically crazy and honestly thought that I would end my life in the garbage, where I belong. nine0170

Some people described their families as outwardly quite normal and, in the opinion of others, prosperous. Often the violence is purely emotional and goes unnoticed by outsiders.


Rina: “All through my childhood, I diligently fulfilled the function entrusted to me — reconciling my parents when they made scandals.”

V., IT specialist: “There was a conflict in the family. I was a very late child and... I don't know how to explain it - this is a huge gap between the parents' view of life, the way it should be, and the views of other people. I was “that weird kid” who was dressed the wrong way and treated the wrong way. As a result, at the age of eighteen, he ended up in a therapeutic department of psychiatry with hysteria. nine0003

Polina: “My earliest childhood was almost perfect. But in elementary school, my father lost his business and fell into a deep depression. So that I would not see this, I was sent to live with my grandmother. Grandmother is a church-going person, which she instilled in me as well. This had a rather strong influence: I treat each of my mistakes as a terrible sin, I feel guilty about everything. At confession, you pronounce your sins to the priest, and he lets them go for you. My “sins” never let me go, I didn’t feel forgiven by anyone.” nine0170

Biological causes

Physicians have discovered abnormalities in the functioning of the brain of people with borderline disorder.

Tendency to depression, anxiety and fear of being abandoned were explained by disturbances in the functioning of serotonin receptors. Due to childhood stress, these receptors become less sensitive to stimuli. That is, impulsiveness, weak will and self-control are not the result of promiscuity: it has specific biological causes. nine0003

Using brain mapping techniques, researchers have identified key reasons for the inability of BPD patients to regulate their aggression. BPD sufferers have a strong activation of the amygdala, which is responsible for emotions, which can cause errors in perceiving other people's neutral facial expressions when they appear unfriendly. Moreover, doctors note that distortions in the mental world can be not only a consequence, but also the cause of impaired activity in the amygdala. In addition, patients with BPD produce more of the stress hormone cortisol, so they are in a constant state of hyper-alertness. The prefrontal cortex, which is responsible for self-control, on the contrary, is too weakly activated in such patients: this prevents them from evaluating their actions from the outside. Also, many “border guards” found a decrease in the volume of the hippocampus, which is responsible for memory: it is suggested that this makes it difficult to comprehend the history of relationships with other people. The hormone dopamine, which causes us to enjoy pleasant things and encourages us to seek these pleasures, is often produced in BPD sufferers from relationships that bring negative emotions - hence the desire to repeat unpleasant relationship patterns. nine0003

Useful resources about BPD

In 2017, the first Russian Resource Center was opened - an information portal for people suffering from borderline personality disorder, created on the basis of the experience of colleagues from the USA and Australia.

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