Borderline Personality Disorder (BPD)

Dr. Ali Khwajapresents a simple but practical understanding of this very troublesome disorder

Lately BPD has been in the news more than before, and many people are being diagnosed with this disorder by psychiatrists.  The following details are meant to help those who are facing possible trauma, and is not a medical analysis.  BPD can be confirmed only by qualified mental health professionals. Though its roots may go back into early years of life, it is often fully identified only in adults who behave very unreasonably causing immense agony and distress to those who are close to them.

Overall indicatorsinclude difficulty in processing or managing emotions, self-image issues, varying moods, and behavioral changes. In addition, it can cause a sense of instability and insecurity.  These symptoms can cause a person to engage in impulsive behaviors and develop strained relationships with family members, significant others, friends, and acquaintances. Other possible symptoms are:

 

1.      Mood swings, including verbally or physically attacking near and dear without or with minimal provocation

2.      Deeply liking or deeply hating individual people

3.      Suspicious nature, irrational fear of others’ behavior or intentions

4.      Low self-image, doubts about oneself, self-pity and loneliness

5.      Thoughts or actual acts of self-harm or anxiety

6.      Often take impulsive decisions or risky behavior, and then back-track

7.      Difficulty in maintaining intimate relationships, with unreal fear of abandonment, at times leading to impulsively forming new relationships

8.      Resorting to unhealthy coping mechanisms such as alcohol or drugs

9.      Anger issues, which can include irrational, intense anger or issues with controlling outbursts or violence.

 

More than half of the above to a reasonable extent and for a period of time exceeding 3-6 months can be fairly good indicator that the person needs professional help.

 

Most of such people have had some bad experiences in life which eventually resulted in BPD.You can check out if the person has:

·         Childhood trauma, abuse, sexual molestation, or growing up in a dysfunctional family

·         Been cheated, abandoned or let down by trusted person(s), particularly in early life

·         Been allowed to freely vent out strong emotions without anyone controlling or guiding

·         Is currently facing high stress, at work or at home

·         Is in a position of authority in office or in family, due to which he does not face much confrontation or resistance

·         Had a family member who also had BPD symptoms

What causes BPD?Exact causes have still not been confirmed, but genetic predisposition combined with environmental factors may be involved. It could also be due to changes in brain chemistry. Confrontation and challenges to his views and behavior can aggravate symptoms.

 

Treatment

If a person is accepting his unreasonable behavior and is willing to change, he can:

·         Learn about borderline personality disorder and accept the above symptoms

·         Focus on your current ability to function and where there are hurdles

·         Learn to manage emotions that feel uncomfortable

·         Reduce impulsiveness by observing and analyzing feelings rather than acting on them

·         Work on improving relationships by being aware of your feelings and those of others

 

Psycho-therapyis the prime and most effective way of healing.  Types of psychotherapy that have been found to be effective include:

·         The most popular one, especially in developed countries isDialectical behavior therapy (DBT), which uses a skills-based approach to teach how to manage emotions, tolerate distress and improve relationships.

·         Cognitive behavioral therapy (CBT), which helps identify and change unhealthy beliefs, behaviors, and inaccurate perceptions the person may have about himself or others. It teaches better ways to react when the individual feels angry, insecure, anxious, or has suicidal thoughts.

·         Schema-focused therapy which helps identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life.

·         Mentalization-based therapy (MBT) which helps identify own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting.

·         Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.

 

Medications

Although no drugs have been approved or specifically identified for treatment of BPD, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics in extreme cases, or mood-stabilizing drugs./

 

Therapy for family members

 

Living with a person with BPD is very traumatic for the immediate family members, and they may require constant emotional support, understanding of the behaviors and abuse by the person, and to cope with the very negative environment that is created by him. In some cases marriages may break up, children may grow up with wrong values and attitudes (resulting in their becoming prone to BPD in adult life). Family members may need to be taught to reduce stress, prevent burnout, insulate themselves emotionally, and work on other relationships.

 

When pushed to the wall, family members may start reacting negatively, and throwing the following accusations to the individual:  “You’re so emotionally unstable.”  “Why can’t you hold down a relationship?”  “You don’t need to get so angry all the time.”  “Pull yourself together!”   “It’s like you have two completely different personalities.”  “Do you ever think first about your actions?”  “I can’t cope with you and your mood swings!”  “Be more positive!”

Such statements, though made after lot of tolerating and in frustration, only aggravate the situation and make the person more defensive and aggressive. Avoiding such confrontations, family members need to practice as much of the following as possible:

·         Carrot and stick policy – be very nice to him when he is calm, and be cold when he starts becoming aggressive.

·         Learn most suitable techniques of stress relief, including meditation, mindfulness, engaging in joyful and distracting activities, music, or even rigorous workout, jogging, punching a bag, tearing newspapers to shreds, etc.

·         Build strong bonds with all other members of the family, if possible connect to extended family, and feel the joy of being bonded, loved and cared.

·         As far as possible, avoid confrontation or even applying logic to the issue on hand, or about his behavior. In fact, remaining aloof and not showing any emotional dependency would help.

·         Do not try to hide his negative behavior from others or give excuses on his behalf.

·         Avoid being alone with him, have people around you and continue with routine regardless of his non-cooperation or criticism.

·         If and when he shows a desire to bring about a change, keep a list of therapists ready and give him the choice which professional he would like to take help from.

Recovery takes time

 

The time required for change and improvement depends a lot on the individual’s acceptance that he has a disorder and his willingness to help himself. As long as he is in denial it is very difficult to bring about a change.  Even when he is willing, learning to manage emotions, thoughts and behavior takes time. Most people who put in sincere efforts doimprove over a period of time, but they may always struggle with some left-over symptoms of borderline personality disorder. There may experience when symptoms are better or worse. But treatment can, with consistency and persistence, make the individual much more functional, feel better about himself, and rebuild close relationships.

 

Note:BPD is not a severe psychotic disorder such as schizophrenia or Bipolar Disorder, though it is often confused with them. There are people with BPD who are productive members of society, sometimes even commanding a respectable and authoritative position, but they lead a form of double life, being very aggressive with selected few. Hence it may be difficult to get support from others who may not agree that he has a disorder. Do not be disheartened if others are unwilling or incapable of understanding the situation, but do work on overcoming extreme symptoms before they lead to a burnout or permanent damage. It is very rare that the symptoms come down by themselves.