Adolph Stern coined the term "borderline" in 1938. In 1980, it was officially recognized as a diagnosis. Since then, the borderline category has become so widely used that it is now assigned to 20% of psychiatric patients and is estimated to affect 3 to 5% of the general population, based on a study carried out by Frances & Widiger in 1986. Females account for roughly two-thirds of those who have a borderline personality disorder. Borderline Personality Disorder is one among ten recognized by the DSM IV. According to Widiger & Weissman, this accounts for approximately 15% of the population in psychiatric settings and about 50% of patients with personality disorders.
Patients on the 'borderline' between neurosis and psychosis were labelled with a borderline personality disorder. However, the symptoms of borderline personality disorder are not as straightforward as this description suggests: rather than signs of neurosis and psychosis, the diagnosis of borderline personality disorder is based on symptoms of emotional instability, feelings of depression and emptiness, and identity and behavioural issues. Even though the definition has changed, the label "borderline" has remained.
People with Borderline Personality Disorder are frequently very intense, ranging from rage to deep depression in seconds. They are characterized by impulsive behaviour. Widiger & Rogers stated that a borderline personality disorder is associated with mood disorders, with 24 percent to 74 percent of patients having major depression and 4 percent to 20 percent having bipolar disorder. Besides, up to 67 percent of people with personality disorders have at least one induced disorder.
Clinical Features of Borderline Personality Disorder
According to the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition), "a person with a borderline personality disorder has labile interpersonal relationships that are characterized by instability." This pattern of interacting with others has usually persisted for years and is closely related to the individual's self-image and early social interactions. The pattern can be found in a variety of settings (not just at work or home), and it is frequently accompanied by a similar lability (fluctuation back and forth, often in a rapid manner) in a person's affect (mood) or feelings. Relationships and a person's affect are frequently described as shallow. A person suffering from this disorder may also engage in impulsive behaviour and exhibit the majority of the following symptoms:
1) Efforts to avoid real or imagined abandonment
2) A pattern of unstable and intense interpersonal relationships is characterized by alternating between extremes of idealization and devaluation.
3) Identity disturbance - markedly and persistently unstable self-image or sense of self.
4) Impulsivity in at least two potentially self-damaging areas, e.g., spending, sex, substance abuse, reckless driving, or binge-eating.
5) Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour.
6) Affective instability due to a marked reactivity of mood, e.g., intense episodic dysphoria, irritability, or anxiety, which usually lasts for between a few hours and several days.
7) Chronic feelings of emptiness
8) Inappropriate, intense anger, or difficulty controlling anger, e.g., frequent displays of temper, constant anger, or recurrent physical fights.
9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
Borderline personality disorder can be diagnosed in anyone with six or more of the traits and symptoms listed above. However, the characteristics must be long-standing (pervasive), and there must be no other explanation, such as physical illness, a different mental illness, or substance abuse. A person suffering from this disorder may appear bright and intelligent and warm, friendly, and competent. They can sometimes maintain this appearance for several years until their defense structure crumbles, usually in the aftermath of a stressful event such as the end of a romantic relationship or the death of a parent.
Causes of Borderline Personality Disorder
Borderline personality disorder (BPD) has no single cause and is most likely caused by various factors.
· Problem with brain chemicals
· Problem with brain development
· Environmental factors
· Several environmental factors appear to be prevalent in people with BPD like: being exposed as a child to long-term fear or distress, being abused emotionally, physically, or sexually,being ignored by one or both parents,growing up with a family member who had a severe mental health condition, such as bipolar disorder or a problem with alcohol or drugs
Treatment of Borderline Personality Disorder
According to the American Psychiatric Association, recent advances in treatment have resulted in an 86 percent remission rate ten years after treatment. In recent years, treatments for borderline personality disorder have improved. For many patients, group and individual psychotherapy are at least partially effective. Within the last 15 years, a new psychosocial treatment known as dialectical behaviour therapy (DBT) has been developed specifically to treat borderline personality disorder.
Cognitive-behavioural therapy (CBT), which focuses on helping people understand how their thoughts and behaviours affect each other, has also been an effective treatment for borderline personality disorder. Interpersonal psychotherapy (IPT) and psychoanalytic therapy are two different psychotherapy approaches that have been used to treat borderline personality disorder. Pharmacological treatments are frequently prescribed in response to specific target symptoms displayed by the individual patient. Antidepressants and mood stabilizers may be beneficial for people who are depressed or have a volatile mood. When there are cognitive distortions, antipsychotic drugs may be used.
Now put on your thinking hats and think about the following questions for a couple of minutes.
How would you explain the term “borderline personality disorder” to your students?
Can you think of some factors that may contribute to borderline personality disorder?
Can you think of the ways to help a friend or relative who is suffering from borderline personality disorder?
Write down your thoughts and discuss them with your students, children and your colleagues. Listen to their views and compare them with your own. As you listen to others, note how similar or different your views are to others’.
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