Borderline personality disorder is a common psychiatric personality disorder characterized by instability in mood, interpersonal relationships, self-image, behavior, and a variety of impulsive behaviors, and is a complex and serious psychiatric disorder. The typical characteristic of borderline personality disorder has been described as “stable instability”, which is often characterized by noncompliance with treatment and is difficult to treat.
Borderline personality disorder is often a disruptive mental state, both for the patient and for those around him or her.
It can be caused by unhealthy childhood experiences or brain dysfunction. A person diagnosed with borderline personality disorder is found to live in a state of inner world calmness and outer madness. They have difficulty regulating their emotions and are often in an up-and-down state. They have a distorted image of themselves, often feeling worthless, simply bad or very bad. And when they crave love, patients with borderline personality disorder often find that their anger, impulsivity, ups and downs, and frequent mood swings push others away.
The diagnostic entity for borderline personality disorder began to enter psychiatric diagnosis in 1948 with the DSM-I, then called “emotionally unstable personality disorder” and was dropped in 1968 with the DSM-II because it overlapped significantly with another diagnosis at the time, cyclothymic personality disorder. The diagnosis of DSM-IV-TR borderline personality disorder has been retained, replacing cyclic personality disorder.
In the last decade, increasing awareness and research is helping to improve the treatment and understanding of borderline personality disorder. At the same time, it remains in a situation that is doubly controversial, especially when female patients far outnumber male patients, questioning gender bias. Despite the lack of definitive data, 1 to 2% of adults in the United States have borderline personality disorder (BPD). This data comes from a statistic that 1 in 33 women have borderline personality disorder, compared to 1 in 100 men, usually in early adulthood.
Patients with this type of personality disorder – mainly women – are unstable in their self-image, state of mind, behavior and interpersonal interactions. The symptoms are apparent in early adulthood but tend to moderate or stabilize with age. Patients believe they feel empty, angry and entitled to affection because they were deprived of adequate care in childhood. They therefore seek care endlessly. This type of personality disorder is most prevalent in psychiatric and other types of health care settings. When borderline personality disorder patients feel cared for by others, they behave as lonely outcasts, seeking help for depression, substance abuse, eating disorders, and past abuse. However, when they fear losing the care of others, their state of mind changes dramatically, often displaying inappropriate, intense anger. This is accompanied by a radical shift in the way they view the world, themselves and others – from black to white, from hate to love. And vice versa. There is never a time for compromise in their perceptions. When they feel abandoned (i.e., completely alone), they isolate themselves or become extremely impulsive. Sometimes, because of their impoverished perception of reality, they exhibit transient fragments of psychotic-like thinking, such as paranoid thoughts and hallucinations. These individuals are more intense and dramatic in their interpersonal relationships than patients in Group A. They have more thought process disorders and turn more aggression on themselves than patients with antisocial personality disorder. They are angrier and more impulsive than patients with dramatic personality disorder, and fall into confusion about identity recognition. They try to evoke a strong, heartfelt caress from their protectors. However, the patient’s recurrent illness, fictitious grievances, and violations of the treatment plan often cause the protector – including the physician – to become frustrated and disappointed, viewing them as refusing help and resentful. Common coping mechanisms are splitting, manifestation, suspicion and projection.
In contrast to the lingering impressions, new evidence suggests that people with borderline personality disorder often recover over time and lead happy, peaceful lives.
I. Signs and symptoms
According to the latest version of the DSM-IV-TR, BPD is defined as Axis II. The main signs and symptoms of borderline personality disorder are as follows.
1. frantic efforts to avoid real or imagined abandonment.
Unstable and tense interpersonal patterns, characterized by shifts between the extremes of over-idealization and denial of its value.
3. Identity disorders: persistent and marked instability of self-image or senseofself.
4. Impulsive behavior that may lead to self-harm in at least two ways.
5. Repeated suicidal behavior, gestures, threats, or self-injurious behavior.
6, Unstable emotional performance due to overly reactive mood.
7, chronic feelings of emptiness.
8.Inappropriate and intense anger, or difficulty controlling anger.
Patients with borderline personality disorder care more about the impression they make on others, their relationship with others, and their performance.
Patients with borderline disorder often feel very uncertain about who they are. As a result, their self-perception or sense of self often changes rapidly. Often they believe they are evil or bad, and sometimes they may feel they do not exist at all. This unstable self-image can lead to frequent changes in jobs, friends, goals, values, and gender awareness.
Relationships are often in turmoil, and people with borderline personality disorder have often experienced love/hate for others. They may idealize a person at one time and then suddenly turn sharply to anger and hatred that is more than contempt or even misunderstanding. This is due to the unacceptable gray area for such patients – things are only black and white. For example, in the eyes of a person with borderline personality disorder, a person is either good or evil. The same person can be good one day and evil the next.
In addition, patients with borderline personality disorder often engage in impulsive and risk-taking behavior. This behavior often hurts them, whether emotionally, financially, or physically. For example, they may drive recklessly, engage in unsafe sex, use illegal drugs or go on spending or gambling binges. Patients with borderline personality disorder often engage in suicidal behavior or self-harm in order to relax.
II. Clinical manifestations
The clinical manifestations of borderline personality disorder are mainly the following symptoms.
First, disorder of self-identity (Self-identity).
Lack of self-objective and self-worth, low self-esteem, and a sense of “who am I? Who am I?”, “What kind of person am I?” and “Where do I want to go?” There is a lack of reflection and answers to such questions. While this disruption of self-identity often begins during adolescence, patients with borderline personality disorder clearly experience a lag in self-identity, remaining in a confused stage with discontinuous and conflicting self-images. This is reflected in various contradictions and conflicts in their lives.
Second, an unstable and rapidly changing state of mind.
Patients often have intense anxiety and easily oscillate between anger, sadness, shame, panic, fear, and feelings of euphoria and omnipotence. There is often a chronic, pervasive sense of emptiness and loneliness that surrounds them. The state of mind is characterized by rapid and variable changes. Especially when exposed to stressful events, patients are highly susceptible to brief episodes of tension and anxiety, irritability, panic, despair, and anger. However, their mood often lacks the persistent sadness, guilt and infectiousness characteristic of depression, and they do not have biologically characteristic symptoms such as early awakening and weight loss.
Third, there is significant separation anxiety.
They are described as “coming into life with an umbilical cord in their hands, always looking for a place to attach it”. There is a great fear of being alone and abandoned. They are extremely sensitive to abandonment and separation and try to avoid separation scenarios by all means, such as begging or even threats of suicide. Very afraid of loneliness, lack of self-soothing ability, often need to discharge the empty loneliness through a variety of stimulating behaviors and substances such as drinking, promiscuity, drug use, etc.
Fourth, conflict in intimate relationships.
They will swing between two extremes in intimate relationships. On the one hand, they are very dependent on each other, and on the other hand, they are always arguing with people close to them. One will feel that the other party is the best, and then the other party said worthless. Repeated relationship breakdowns, interpersonal relationships in constant conflict. People who get along with them often feel very tired, but can not get out of it.
Fifth, impulsivity (impulsivity).
Impulsive behaviors such as alcoholism, extravagance, gambling, theft, drug abuse, gluttony, and lewdness are common. 50% to 70% of patients have impulsive self-destructive and suicidal behaviors, and 8-10% of patients succeed in committing suicide. It is a disease with a high suicide rate. Sudden outbursts of anger, destruction of objects, brawling, and cursing are also common impulsive behaviors.
Sixth, psychotic symptoms of stress.
In stressful situations, depersonalization (depersonalization), implicated concepts such as transient or situational, illusions or hallucinations that seem to have a basis in reality, etc. are likely to occur. Generally, these symptoms are mild, brief in duration, and can be relieved quickly after the mental stress is lifted, and antipsychotic drugs are effective.
The most authoritative diagnostic criteria for borderline personality disorder is the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). This diagnostic criterion first originated in 1967 when Kernberg introduced the concept of borderline personality structure based on the work of psychoanalysts Stern and Knight. The borderline personality structure encompasses a wide range of severe personality disorders.
On this basis, in 1975, Gunderson & Singer reviewed previous research on clinical observations of borderline personality and proposed several descriptive criteria, including emotional irritability, impulsive behavior, poor interpersonal relationships, psychotic-like perceptions, and social maladjustment. A semi-structured research instrument, the DIB, was also developed.In 1978, Gunderson & Kolb et al. used the DIB to conduct a statistical study of 33 borderline personality patients and identified seven diagnostic criteria.In 1979, Spitzer, Kernberg, Grinker et al. conducted a further study with a large sample and identified eight diagnostic criteria for BPD criteria for use in the DSM-III in 1980. By 1994, more than 300 studies were conducted on the diagnostic criteria of the DSM-III, and the current nine diagnostic criteria for borderline personality disorder BPD were finally identified.
A pattern of behavior that manifests as instability in interpersonal relationships, self-image, and affect, along with marked impulsivity, begins in early adulthood and appears in a variety of situations with at least five of the following.
1. frantic efforts to avoid real or imagined abandonment (not including suicide or self-injury in item 5)
2. an unstable and tense pattern of interpersonal relationships characterized by variations between the two extremes of idealization and devaluation
3. A disruption of identity (identification): a marked and persistent instability of self-image or sense of self. (Note: Excluding uncertainty during normal adolescence). Impulsivity in at least two potentially damaging aspects of self (e.g., spending money, sex, substance abuse, reckless driving, overeating). (Excluding suicidal or self-injurious behaviors in item 5)
4. Repeated suicidal behavior, suicidal gestures or threats of suicide, or self-injurious behavior.
5. Significant mood reactions causing emotional instability (e.g., severe episodes of irritability, irritability, or anxiety, usually lasting several hours and rarely more than a few days)
Chronic feelings of emptiness
Inappropriately strong anger, or difficulty controlling anger (e.g., frequent tantrums, constant anger, repeated fights)
Transient, stress-related paranoid notions or severe dissociative symptoms.
III. Screening and diagnosis
The diagnosis of personality disorder is based on signs and symptoms and a complete psychological assessment. Individuals diagnosed with borderline personality disorder must meet the characteristics articulated in the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM). This manual is published and distributed by the American Psychiatric Association and is used by mental health professionals to diagnose psychological conditions and by insurance companies to reimburse for treatment.
The Diagnostic and Statistical Manual of Mental Disorders explains that people with borderline personality disorder have unstable relationship situations, self-impressions and emotions, and also impulsive behaviors. These tend to arise in the early adult years.
For patients diagnosed with borderline personality disorder, at least five of the following signs and symptoms must be present.
Intense fear of abandonment.
Unstable relationship situations.
Unstable self-image.
Impulsive behavior and self-destructive behavior.
Suicidal behavior or self-harm.
Emotional ups and downs.
Prolonged emotional emptiness.
Intense anger.
Temporal paranoia and loss of contact with reality.
The diagnosis of borderline personality disorder is usually oriented toward adults, not children or adolescents. This is because borderline personality disorder presents with signs and symptoms that are associated with maturity.
IV. Comorbidities
Borderline personality disorder can disrupt many aspects of a person’s life. Relationships, work, school, social activities, self-image – all can be negatively affected. Frequent job losses and marital breakups are not uncommon. Self-injury, such as cutting a vein or burning, can lead to scarring and frequent medical visits. The rate of suicide among people with borderline personality disorder is high, reaching 10%.
In addition, people with borderline personality disorder may have other mental health problems, including
Depression.
Substance abuse.
Anxiety disorders.
Eating disorders.
Bipolar disorder.
Other personality disorders.
Because of their risk-taking, impulsive behavior, people with borderline personality disorder are also more likely to have unwanted pregnancies, contract STDs, have motor vehicle accidents and get into fights. They may also be involved in abusive relationships, becoming either the abuser or the abused.
V. Treatment
Treatment of borderline personality disorder has improved in recent years through specialized techniques for patients with this disorder. Treatment includes
Psychotherapy. This is the core treatment for borderline personality disorder. Dialectical Behavioral Therapy (DBT) is designed to treat disorders of the disorder. Usually conducted in individual, group, and telephone counseling, DBT is based on teaching people how to regulate their emotions, tolerate pain, and improve relationships.
Medication. Medications cannot cure borderline personality disorder, but they can help with related problems such as depression, impulsivity and anxiety. Medications can include antidepressants, antipsychotics and anxiolytics.
Inpatient treatment. Sometimes, people with borderline personality disorder may need more intense treatment in a psychiatric hospital or clinic. Inpatient treatment can also save them from self-harm.
Because treatment can be intensive and long-term, people face their best chance for success when they find an experienced mental health counselor who treats them for borderline personality disorder.