Borderline Personality Disorder (BPD)

1. Borderline Personality Disorder (BPD) Adlyn Perez

2. Prevalence: • 2% of US Population • Women 3 times more likely to have it Definition: • DSM-IV: pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. • Borderline • Refers to people on the border between normal, adaptive functioning and psychological disability • term that refers to the great overlap of symptoms between BPD and other disorders. This makes BPD difficult to diagnose.

4. Symptoms 1 • Poorly regulated emotions • “Emotional Storms” – extreme bouts of emotional upheaval (anxiety, fury, loneliness, emptiness) that can’t be voluntarily controlled easily • Emotions quickly fluctuate between opposing extremes • Uncontrollable emotions make Borderlines more prone to mood disorders (bipolar, major depressive disorder) and often have them also.

5. Symptoms 2 • Impulsivity • Examples: cutting, gambling, promiscuity, drinking, spending, drugs and binge eating. • Parasuicidal acts- threats of suicide made to manipulate, control a situation, or gain attention • Suicide- genuine risk of suicide – greater with Borderlines who are greatly impulsive and have mood disorders in addition to BPD. • Why? Borderlines may do anything to relieve the force of their emotional upheavals by engaging in reckless, exciting, distracting, or comforting behaviors

6. Symptoms 3 • Instability • Unstable sense of self: sense of self depends on the attitudes and behaviors of those they want care from. Borderlines have values and opinions, but the need to be approved of can easily override them, and often does. • Dissociative moments- difficulty recalling what they said or did in a specific moment. • All of these uncontrollable factors foster a persistent and deeply rooted sense of insecurity with themselves and in what goes on around them. This insecurity stems from lack of control over their behaviors and emotions or their environment.

7. Symptoms 4 • Disturbed Relationships: • Idealize Caregivers: believe that the people they are close to are perfect, doing all that they can to ensure they’re caregiver’s well being and thinking that they will make the person feel loved, safe, and alive at all times. • Devaluate Caregivers: once the significant other can’t live up to idealized expectations, borderlines perceive that the person is completely unsupportive, selfish, and uncaring. • Fear of Abandonment: extreme dependence on support and presence of other people • Fear of Closeness: driven by fear of being hurt, fear of loosing fragile independence and sense of self, or a desire to escape the problems of their current relationships • Borderlines fluctuate between these unrealistic perceptions and extremes.

8. Making sense of BPD • Fluctuating, overwhelming emotions & impulses • Unsuccessful attempts to manage/alleviate emotions using mostly self-destructive behaviors • Insecurity • Reliance on others for stability • Demand that others be unrealistically constant in all aspects and at all moments- intolerance for even normal/minor changes in behavior and attitude of others. • Attempts to control other’s behavior via manipulation, or threatening harm to that person (aggression) or themselves (parasuicidal acts).

9. Causes ??? • Neurological abnormalities in centers which regulate emotions – hyperactivity of the amygdala. • Genetic source • Developmental source • Trauma & stress • Verbal, physical, sexual abuse, & neglect (found in approx 70% of Borderlines) • Early separation from parents • Biological predisposition for disorder may be triggered by stress

10. Treatment • Individual psychotherapy + medication • Medication-stabilize emotions, reduce impulsivity, facilitate clear, rational thinking. • Low doses of antipsychotic, antidepressants • Psychotherapy • Enhance interpersonal skills, manage emotions and impulses

11. References • American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: Author. • Friedel, R. O. (2004). Borderline personality disorder demystified: An essential guide for understanding and living with BPD. New York: Marlowe & company. • Gabbard, G. O. (1996). Psychotherapeutic strategies for borderline personality disorders. In Guide to psychiatric disorders. (pp. 119-135). New York: Hatherleigh Press. • Mauchnik, J., Schmahl, C., & Bohus, M. (2005). New findings in the biology of borderline personality disorder [Abstract].Directions in Psychiatry, 25(3), 197-215. • Herpertz, S.C., Dietrich, T.M., Wenning, B., Krings, T., Erberich, S.G., Willmes. K., Thron, A. & Sass, H. (2001). Evidence of abnormal amygdala functioning in borderline personality disorder: A functional MRI study [Abstract]. Biological Psychiatry, 50(4), 292-8.