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Borderline Personality Disorder

 

Borderline Personality Disorder is one of ten personality disorders recognised by the DSM IV.

A personality disorder is a type of mental illness and to be diagnosed particular criteria must be met. With personality disorders, the symptoms have usually been present for a long time. These symptoms have an overall negative affect on the sufferer’s life.

One of the core signs and symptoms in BPD is the proneness to impulsive behaviour. This impulsiveness can manifest itself in negative ways. For example, self-harm is common among individuals with BPD and in many instances, this is an impulsive act. Sufferers of BPD can also be prone to angry outbursts and possibly criminal offences (mainly in male sufferers) as a result of impulsive urges.

Another common feature of BPD is affective lability. This means that sufferers have trouble stabilising moods and as a result, mood changes can become erratic. Other characteristics of this condition include reality distortion, tendency to see things in ‘black and white’ terms, excessive behaviour such as gambling or sexual promiscuity, and proneness to depression.
(To learn more about symptoms and diagnostic criteria please go to the section on diagnostic criteria.)

These traits can sometimes make it very difficult for a person to maintain a relationship with someone with BPD as their behaviour and actions can be difficult to tolerate and hard to understand. It is important for persons close to a BPD sufferer to educate themselves on the condition so they can empathise with what the sufferer is going through and how they are feeling.

BPD is not usually diagnosed before adolescence. It has been suggested that BPD symptoms can sometimes improve as time goes on or even disappear all together. This is not always the case however as BPD can continue to affect sufferers well into later life.

Traits from other mental illnesses and psychological conditions from the DSM IV can often co-exist in BPD patients. These are usually anxiety disorders, eating disorders, obsessive-compulsive disorder (OCD) and bipolar disorder (also known as manic depression).

Is borderline personality disorder a mental illness?

Yes! A mental illness is an illness that affects a person’s behaviour primarily rather than their physical well-being. BPD is considered by medical practitioners to be a severe psychiatric disorder. It is recognised as such by the DSM IV.

Mental illness is often not taken as seriously as physiological illness even though it is very common and can be very debilitating. It is often viewed as moodiness, craziness or a weakness when it is in fact a genuine illness that can be caused by physiological factors. People have as much control over developing a mental illness as they do over catching a cold. Like physical illness, mental illness needs treatment and is not something that someone can just will to go away.

Why the name borderline?

The name borderline was coined by Adolph Stern in 1938. This name was used to describe patients who were on a ‘borderline’ between neurosis and psychosis. However, the symptoms of BPD are not so simplistic as to be defined in terms of neurotic and psychotic. The diagnosis of BPD is based upon signs of emotional instability, feelings of depression and emptiness, identity and behavioural issues rather than signs of neurosis and psychosis. However, the name Borderline has remained even though the definition has changed. Throughout Europe, the same disorder has been given the more appropriate and less misleading title of ‘Emotionally Unstable Personality Disorder.’



Relationships

A complicated and challenging problem often faced by those with BPD is how to create and maintain ‘normal’ relationships with others. Not only is this a problem in itself, with the sufferer finding it hard to communicate with those around them, but it can also make it difficult and painful to seek comfort regarding various other symptoms of BPD that they might be affected by. While someone with BPD may desperately want help from a friend, the latter might find their behaviour antisocial – the BPD-sufferer may seem spiky and dismissive in spite of attempts to comfort them. This kind of situation is common, and such problems require a great deal of understanding on the part of friends, family and helpers in order for them to be dealt with sensitively and effectively. Most of all, it is important for all to understand that, while struggles with interpersonal relationships - and other symptoms of BPD - can be eased and lessened, there is never a magical ‘cure’ with which to end them.


How BPD sufferers can help themselves

Although your problems may seem insurmountable, thoughtful and careful attention to your mental health can help make BPD less difficult to cope with. Help available can range from individual psychotherapy to group therapy, where you can share your experiences with others who will understand. The different methods of treatment available ensure that help is at hand for anyone suffering with BPD, no matter what sort of communication they find easiest. Furthermore, within the field of psychotherapy, plenty of helpful research has taken place to find the best ways of treating BPD. Although the variety of different treatments may seem intimidating at first, each has its own distinct way of helping – for example, Dialectical behaviour Therapy (DBT) provides a mix of individual and group psychotherapy, while cognitive therapy takes a more individual approach, and can help those with BPD to get to the root of the problem.

Meanwhile, it is important for anyone with BPD to make sure that they are taking good physical care of themselves. Emotional and physical health are closely linked, and so plenty of exercise and a healthy diet can help lift your mood and keep negative thoughts at bay. It is also important, of course, to get a good amount of sleep, as the more worn out we are, the harder we find it to deal with stress.

Details of the help that BPDWORLD can provide are available in the ‘Resources’ section, and we will be glad for you to contact us through the ‘General Enquiries’ section if you need help in finding a counsellor, or any related problems.

How friends, family and carers can help

In order to understand how difficult it can be for BPD sufferers to establish and enjoy lasting, affectionate friendships and relationships, it is important to bear in mind the other symptoms that may be affecting them. For example, the ‘difficult’ or ‘unpredictable’ behaviour of those with BPD is often rooted in an emptiness felt deep inside: none of us would find it easy to cope with an overwhelming need for love and attention, coupled with dramatic mood swings and fears of being abandoned by those close to us.Those with BPD will often feel confused and overwhelmed by a variety of feelings and emotions, and it is important that those close to them understand that it is not always simple for them to explain how they feel or what it is that is troubling them. Someone with BPD might find that their feelings and actions often work in spite of themselves; for example, if they are disappointed to find that a friend they have phoned for reassurance and comfort is unavailable, their general impression of their friend might change drastically – they may go from being a much-loved and trusted friend, to being seen as inconsiderate and selfish. Although this sort of ‘swing’ is not intentional, it may make future contact with the friend difficult or even impossible; however, if the friend is able to understand that behaviour like this is not wilful, but rather a symptom of BPD, it may after all be possible for them to offer the affection and understanding that was being sought.

In order to help someone suffering with BPD, it is important to realise the trouble they might have in grasping and keeping in mind the needs of those around them. If this can be kept in mind, and hurtful or careless behaviour understood as a symptom, rather than a malicious or spiteful act, then family, friends and carers can provide important and valued companionship and help to BPD sufferers. At the same time, it is important that those attempting to enjoy an understanding and caring relationship with someone suffering from BPD take care of their own feelings and needs: you might understand perfectly well how a friend who has BPD is unable to see your point of view on things, and that this is not their fault, but it is important that you don’t lose objectivity altogether. What is more, if you are taken into the confidence of someone with BPD, you may find yourself suddenly on the end of a lot of demands and pressure – the difficulty those with BPD have in grasping other people’s needs and privacy may mean you receive late-night phone calls, inappropriately public displays of affection or attempts to play you off against other friends. It is crucial to make sure that you state your own wants and needs, and to stick by them.

As well as keeping a close eye on one’s own emotional wellbeing, it is also important to feel physically safe. Often those with BPD direct physical abuse towards themselves (see the section on Self-Harm), but BPD sufferers’ frequently fiery temperaments can lead to physical confrontations with others, too. Make sure that you always feel safe, and are able to maintain some distance between yourself and a BPD friend. Also make sure that you have other friends or family who are aware of the relationship. Most importantly, remember that you are free to walk away from relationships if you feel unsafe; just because someone has a disorder, it does not mean that you have to put yourself at risk in order to offer them your support and friendship.

Helping to carry the burden of someone else’s problems, no matter how fond we might be of them, is never easy. However, there is help at hand not only for those who suffer from BPD, but also for those who help and support them. As well as finding advice on the BPDWORLD website (see the ‘Resources’ section), you can also contact us for more information on organisations that can provide further support (see ‘General Enquiries’).

 

Flash Movies

flash-movies

Please make sure you have the latest Flash Plug-in: Click here to download it.

BPDWORLD has created the below flash movies to increase awareness & to make the delivery of information a little less boring. Please note that the below movies may trigger & are to be viewed at your own risk.

Borderline personality disorder

This movie describes BPD & its effects; it is great for those who would like to know more about it.

Click Here to watch the movie

 

Self Harm - Suicide

Describes the various forms of self harm & provides a general overview.

Click Here to watch the movie

 

Child Abuse

This is a subject of close relevancy to many with mental ill health problems & was made to increase awareness & provide information.

Click Here to watch the movie

 

What is Borderline Personality Disorder?

Borderline Personality Disorder is one of ten personality disorders recognised by the DSM IV.

A personality disorder is a type of mental illness and to be diagnosed particular criteria must be met. With personality disorders, the symptoms have usually been present for a long time. These symptoms have an overall negative affect on the sufferer’s life.

One of the core signs and symptoms in BPD is the proneness to impulsive behaviour. This impulsiveness can manifest itself in negative ways. For example, self-harm is common among individuals with BPD and in many instances, this is an impulsive act. Sufferers of BPD can also be prone to angry outbursts and possibly criminal offences (mainly in male sufferers) as a result of impulsive urges.

Another common feature of BPD is affective lability. This means that sufferers have trouble stabilising moods and as a result, mood changes can become erratic. Other characteristics of this condition include reality distortion, tendency to see things in ‘black and white’ terms, excessive behaviour such as gambling or sexual promiscuity, and proneness to depression.
(To learn more about symptoms and diagnostic criteria please go to the section on diagnostic criteria.)

These traits can sometimes make it very difficult for a person to maintain a relationship with someone with BPD as their behaviour and actions can be difficult to tolerate and hard to understand. It is important for persons close to a BPD sufferer to educate themselves on the condition so they can empathise with what the sufferer is going through and how they are feeling.

BPD is not usually diagnosed before adolescence. It has been suggested that BPD symptoms can sometimes improve as time goes on or even disappear all together. This is not always the case however as BPD can continue to affect sufferers well into later life.

Traits from other mental illnesses and psychological conditions from the DSM IV can often co-exist in BPD patients. These are usually anxiety disorders, eating disorders, obsessive-compulsive disorder (OCD) and bipolar disorder (also known as manic depression).

Is Borderline Personality Disorder a mental illness?

Yes! A mental illness is an illness that affects a person’s behaviour primarily rather than their physical well-being. BPD is considered by medical practitioners to be a severe psychiatric disorder. It is recognised as such by the DSM IV.

Mental illness is often not taken as seriously as physiological illness even though it is very common and can be very debilitating. It is often viewed as moodiness, craziness or a weakness when it is in fact a genuine illness that can be caused by physiological factors. People have as much control over developing a mental illness as they do over catching a cold. Like physical illness, mental illness needs treatment and is not something that someone can just will to go away.

Why the name Borderline?

The name borderline was coined by Adolph Stern in 1938. This name was used to describe patients who were on a ‘borderline’ between neurosis and psychosis. However, the symptoms of BPD are not so simplistic as to be defined in terms of neurotic and psychotic. The diagnosis of BPD is based upon signs of emotional instability, feelings of depression and emptiness, identity and behavioural issues rather than signs of neurosis and psychosis. However, the name Borderline has remained even though the definition has changed. Throughout Europe, the same disorder has been given the more appropriate and less misleading title of ‘Emotionally Unstable Personality Disorder.’

 

Self Harm

A common and distressing symptom of BPD is self-harm. People with BPD often act very impulsively – be it through alcohol or drug abuse, gambling and over-spending, or promiscuous behaviour and self-harm is one of the most excruciating expressions of this need for instant gratification. To those untroubled by mental complexities such as BPD, the idea of self-harm might seem excruciating, bizarre or even pointless; However, to many who feel overwhelmed it can seem like a logical and effective way to momentarily relieve the pain that they feel inside. In reality, however, self-harm only adds to and deepens existing problems; Unfortunately, the need to deal with the immediate physical threat posed by self-harming behaviour can distract from the complex problems behind it.

Many may simply think of cutting when they think of self-harm; However, sufferers look to achieve a similar effect in a number of different ways, including self-inflicted burns, hair-pulling, or simply not taking care to avoid accidents. Whatever method a BPD-sufferer chooses to use, a number of common causes are identifiable:

- For someone who feels unloved and ignored, self-harm can be a symbolic way of communicating the pain they feel inside. This method of gaining people’s attention may seem simpler and more direct than trying to talk to someone to make them understand. Unfortunately, many potentially helpful people may, understandably, be scared off by this sort of behaviour. For so many disorders, unless people are informed and aware of the symptoms, causes and results it may lead to misunderstanding and confusion. Whether dealing with BPD-sufferers, people with ADHD or anyone who self harms, it is vital that others surrounding the sufferer understand what the sufferer is going through and how the disorder might manifest itself, to promote the acceptance and compassion that is necessary to help deal with it.

- When constantly overwhelmed by emotional pain or anxiety, the act of cutting oneself or pulling one’s hair may seem like a welcome distraction. Additionally, self-harm can result in the release of endorphins into the body, which act as natural pain killers. Oddly, then, causing oneself pain can be seen to help relieve it; In reality, of course, much more harm is done than good.

- A BPD sufferer whose life is blighted by the symptoms of their illness, and who finds relationships difficult, will often be wracked by feelings of inadequacy and guilt. As well as beating themselves up mentally for their apparent shortcomings, many sufferers choose to punish themselves by hurting their own bodies. Sometimes however, self-harm can also be inflicted in order to punish someone else; For example, a self-harmer may hurt themselves in order to demonstrate the effect that a friend’s inattentiveness is having on them.

- As many BPD sufferers’ problems are rooted in abuse suffered at an earlier age, self-harm can sometimes be seen as a way to continue this pattern. Someone with BPD may feel that they deserve abuse – Even when free from harm, they decide to carry it on.

Clearly, self-harm is a complex problem; There is no simple explanation for the motives behind it. Any one case of self-harming will have a unique group of motivations underlying it. For this reason, it is important not to make assumptions about why any individual chooses to self-harm, or to over-simplify the problem. Fortunately, there are a variety of different ways in which you can help stop yourself from continuing such behaviour:

- Thinking things through – When you are aware that you are feeling the impulse to hurt yourself, take time to reflect on the reasons why, and to think about what will actually come about as a result.

- Putting self-harm off – Instead of diving straight into an act that will cause you harm, make a concerted effort to spend five minutes debating the idea first. The next time you find yourself in the same situation, you could try to wait ten minutes, and so on. Over time, you might find that this period of self-reflection helps distract you from what would usually be an impulsive and immediate decision.

- Doing something else instead – Everyone has perfectly harmless activities that they enjoy doing, and so instead of harming yourself, perhaps try going for a walk or watching a film instead. You may find that this "much safer" activity gives you positive feelings that self-harm wouldn’t have provided.

These are just some of the techniques that might help you to overcome, or at least reduce your self-harming. Just as different people provide different accounts of why they self-harm, different people respond to different techniques for stopping self-harming. It is also important to remember that help is available. As well as providing support through the ‘Resources’ section of this website, BPDWORLD can provide help by responding to your messages through the ‘General Enquiries’ section.

 

 

Facts

 

  • ·         Three-quarters of people with BPD are female, and usually within childbearing age.

    ·         Between 70% and 80 % of patients meeting the diagnostic criteria for BPD self-mutilate or self-harm.

    ·         1/10 BPD sufferers successfully completes a suicide attempt.

    ·         BPD patients are recognised as responding poorly to treatment.

    ·         BPD patients are generally thought to have a long-term, poor quality of life.

    ·         BPD has been associated with other conditions such as schizophrenia, several types of psychosis, other affective disorders, and epilepsy.

    ·         Very little research has been conducted to investigate BPD in men.

    ·         BPD sufferers are reported to be very frequent users of mental health resources.

    ·         When compared with men suffering from other personality disorders, men with BPD have shown more evidence of dissociation, image distortion, frequency of childhood sexual abuse experiences, longer experiences of physical abuse, and experiences of loss at an early age.

    ·         Research suggests that male BPD patients are more regularly diagnosed with substance abuse problems than female BPD patients are.

    ·         Only two personality disorders are associated with self-harm behaviour. One is BPD and the other is antisocial behaviour disorder.

    ·         People who have BPD are more likely to self-harm for two reasons: a) as a response to impulsive urges, and b) as part of a suicidal gesture.

    ·         Research suggests that people with BPD frequently suffer from identity and interpersonal issues.

    ·         At least 50% of BPD sufferers also suffer from major depressive disorder, dysthymia, or sometimes both.

    ·         It is very difficult to say whether a person with BPD's condition will change over time. Research has suggested that some people’s symptoms improve, some get worse and some remain unchanged.

    ·         11% of diagnosed BPD patients are treated in outpatient clinics.

    ·         20% of BPD patients spend time in psychiatric hospital.

    ·         Between 40% and 70% of BPD patients report having been sexually abused, often by a non-care giver.

    ·         Clinicians are often wrongly-educated or under-educated about BPD and BPD treatments.

    ·         Approximately 2% of the population are affected by BPD.

 
 
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