Diagnosing Borderline Personality Disorder

By Jane Farrell

Borderline personality disorder, a serious mental illness, affects six to ten million Americans, according to statistics from New York-Presbyterian Hospital. That’s more than twice the number of people affected by bipolar disorder or schizophrenia. And up to 90 percent of those diagnosed are women; while that may be because women seek treatment more often than men, it’s still a substantial number. Despite its prevalence, borderline personality disorder less widely known than other conditions such as depression. Here, from the experts at the National Institue of Mental Health, is what you should know about the illness:

Symptoms

Most people who suffer from BPD have:

Problems with regulating emotions and thoughts

Impulsive and reckless behavior

Unstable relationships with other people.

People with BPD also have high rates of other disorders, such as depression, anxiety, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD strongly suggest that the illness is inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Signs & Symptoms

According to the NIMH, to be diagnosed with BPD, a person must show a persistent pattern of behavior that includes at least five of these symptoms:

Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived

A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike and anger

Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, or the direction of plans and goals for the future

Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating

Recurring suicidal behaviors or threats of self-harming behavior, such as cutting

Intense and highly changeable moods, with each episode lasting from a few hours to a few days

Chronic feelings of emptiness and/or boredom

Inappropriate, intense anger or problems controlling anger

Having stress-related paranoid thoughts or severe “dissociative symptoms,” such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide And Self-Harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may harm themselves to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other causes of symptoms.

In some cases, simultaneously occurring mental illnesses may have symptoms that overlap with BPD, making a diagnosis of BPD more difficult. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many patients improve over time.

BPD can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.

Medications

Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some could be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

How to Help Others

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing

With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members

Never ignore comments about someone's intent or plan to harm himself or herself or someone else. Report such comments to the person's therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How to Help Yourself

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

Talk to your doctor about treatment options and stick with treatment

Try to maintain a stable schedule of meals and sleep times

Engage in mild activity or exercise to help reduce stress

Set realistic goals for yourself

Break up large tasks into small ones, set some priorities, and do what you can, as you can

Try to spend time with other people and confide in a trusted friend or family member

Tell others about events or situations that may trigger symptoms

Expect your symptoms to improve gradually, not immediately

Identify and seek out comforting situations, places, and people

Continue to educate yourself about this disorder

For more information about BPD and other mental health issues, click here to visit the NIMH website.