Borderline personality disorder ~ Part III ~ Overview

Change of plans again, today I had written that I would cover some general topics related to borderline personality disorder, but instead I revised Part III and this is the result which is much more readable. It no longer sounds like I'm trying to write a thesis...that was horrible, but I'm glad I noticed it early in the day and pulled it. Here is Part III revised...

According to the DSM-IV-TR (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders), the essential feature of Borderline Personality Disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.

Most of the information in this article was gathered from http://www.psychcentral.com/, http://www.mentalhealth.com/, and http://www.mayoclinic.com/ unless otherwise specified.

The prevalence of BPD is about 2% of the general population. It is seen in 10% of psychiatric outpatients, and 20% of psychiatric inpatients. This disorder is more frequent in females (about 75%) than males. Emotional instability and impulsivity are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this emotional instability and impulsivity persists and intensifies into adulthood; thus they become diagnosed with this disorder. As with other mental disorders, the causes of borderline personality disorder are complex.

The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But, that view doesn't reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.

Meanwhile, the cause of borderline personality disorder remains under investigation, and there's no known way to prevent it. Possible causes include:

• Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
• Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
• Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Personality forms during childhood. It's shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase your risk of developing borderline personality disorder. These include:

• Hereditary predisposition. You may be at a higher risk if a close family member — a mother, father or sibling — has the disorder.
• Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
• Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.

Marsha Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings.

I also agree with A.J. Mahari's theory that compliment Linehan. Mahari states, "It is the core wound of abandonment in those who have been diagnosed with Borderline Personality Disorder (BPD) that is the source of insecure or non-existent attachment that leads to the toxic and unhealthy ruptured relationships that have at their centre emotional enmeshment and an insatiable need for love. These broken relationships, often rupture under the weight of the child-like behaviour and needs of the borderline still searching for the much-needed unconditional acceptance, validation and love of a parent as the result of unmet early childhood developmental needs.

Most, if not all, borderline behaviour is driven directly or indirectly by fear of abandonment and the fear of re-experiencing the intolerable pain of your original core wound of abandonment. What feels like it keeps happening to you, is in fact, a triggered, dissociative, regressed re-experiencing of what initially happened to you in the very early and formative developmental years of your life." (A.J. Mahari has a fantastic blog entitled Borderline Personality Disorder Inside Out: A.J. Mahari unravels the mysteries of Borderline Personality Disorder)
With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships.

Individuals with BPD seem to have a much higher stigma than individuals with other disorders even within the mental health community and there is debate as to whether or not they are treatable. Many professionals will not treat people with BPD or must limit the number of patients. In order for treatment to be successful, it requires a significant commitment from the therapist and patient. My personal belief is that people with BPD can be treated. I, for one, have been receiving treatment and am near a point where I will no longer meet the criteria.

But, it has been a long time of much tumultuous and extremely painful hard work for both my therapist and I. There were times when I think both of us wanted to quit. Persons with BPD are often described, by the DSM as deliberately manipulative and difficult with extreme inner pain and turmoil, powerlessness and defensive reactions with extremely limited coping and communication skills. My translation, they take tremendous energy, extra attention, consistent limit-setting, terminate treatment prematurely and may return, and have a love/hate relationship with the therapist. But, there is hope.

The course of this disorder is quite variable. The most common pattern is one of chronic instability in early adulthood. This disorder is usually worse in the young-adult years and it gradually decreases with age. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and vocational functioning. After about 10 years, about half of individuals with this disorder no longer meet the full criteria for Borderline Personality Disorder.

Increasing awareness and research are helping improve the treatment and understanding of borderline personality disorder. Emerging evidence indicates that people with borderline personality disorder often get better over time and that they can live happy, peaceful lives.

And, I, for one, am getting there; however, it has taken a very long time and much commitment and painful work. I can see why people "give up" treatment. But, the reward for sticking it out is priceless. Well, really not priceless...therapy and medication is expensive, but that is a whole other issue. Don't even get me started. So, tomorrow will be the last of this series and will cover some basic areas that I wanted to highlight and will contain personal examples...again I'm offering cookies, chocolate and coffee.