Borderline Personality Disorder

What is borderline personality disorder?

People with borderline personality disorder (BPD) have stormy and unpredictable ways of relating to other people. These ways of thinking, feeling, and behaving cause many problems at work, in school, and socially.

What is the cause?

Experts believe that BPD may be caused by differences in the brain or nervous system. It might also be related to problems in the family such as abuse, financial stresses, death of loved ones, or mental illness. It usually begins in adolescence or early adulthood. It is estimated that from 1% to 14% of people are affected. It affects more women than men.

How is it diagnosed?

There are no blood tests, physical exams, or imaging studies that can diagnose BPD. Your healthcare provider or mental health therapist will ask about symptoms such as:

• unstable personal relationships that switch back and forth between hate and love
• frantic efforts to avoid being abandoned
• an unstable sense of self
• acting without thinking, doing things on impulse that could be harmful to yourself like reckless driving, drug or alcohol abuse, and careless sexual behavior
• self-harm, such as cutting or burning yourself
• attempting suicide
• intense ups and downs in mood
• feeling empty much of the time
• trouble controlling anger
• distrust of others, paranoia, and feeling separate from yourself

What are the symptoms?

People who have this disorder may see the world in terms of extremes: good/bad; love/hate; or your fault/my fault. There is no middle ground. Other symptoms include:

• feeling hopeless, powerless, anxious, and depressed
• not being able to have pleasure without feeling guilty about it
• having some sexual problems. They may be unsure about which sex they are attracted to, or in some cases, even be confused about their own gender. They may have no sexual feelings at all, or may need to fill an inner sense of emptiness by having a lot of sex.
• having intense relationships that swing quickly between the other person seeming wonderful and then seeming to be the worst person they know
• having a hard time understanding what others are feeling. They may often worry that others don't like or respect them. They have a lot of trouble trusting others.
• feeling as if they are different, damaged, or flawed in some way
• struggling with very strong anger or rage at others
• having a hard time taking care of themselves in basic ways such as eating, bathing, and sleeping when under a lot of stress
• fearing that their only hope of getting needs met is to manipulate others
• losing touch with reality. They may hear voices at times or feel paranoid. These symptoms usually aren't permanent but come and go depending on stress levels.

How is it treated?

This is a difficult disorder to treat, but the following can help reduce symptoms such as impulsive behavior and unstable relationships:

• medicines, especially for symptoms of anxiety, panic, depression, or mood swings
• short-term, structured time in the hospital if you are hurting yourself, such as self-cutting, self-burning, or attempting suicide
• day treatment programs, including structured activities and group therapy every day
• therapy that helps you feel cared about and understood
• learning different ways to deal with stress
• treatment for any alcohol or drug abuse problems

Dialectic behavior therapy is now being used to treat BPD. This type of therapy helps you learn to manage stress, your emotions, and the way that you relate to other people.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others.

How long do the effects last?

People with this disorder may need lifelong treatment with medicine, therapy, or both.

For more information, contact

• Depression and Bipolar Support Alliance (DBSA)
  1-800-826-3632
  Web site: http://www.dbsalliance.org
• National Alliance for the Mentally Ill (NAMI)
  Phone: 1-800-950-NAM
  Web site: http://www.nami.org
• Mental Health America
  Phone: 1-800-969-6642
  Web site: http://www.mentalhealthamerica.net