Borderline Personality Disorder ( BPD) is not only an aspect of difficulties in close relationships. It is also problems, internal mood swings, unexpected changes in life goals, a sense of emptiness and difficulty finding meaning in life.
A person with borderline personality feels emotions more strongly than the average person and needs more time to calm down. With such vacillation and often lowered self-esteem, people with BPD often have difficulty dealing with their emotions. They often experience crises with regard to mood, behavior or interpersonal relationships. Many of them feel emptiness and boredom. They attach themselves strongly to others, and then express strong anger when they feel they are ignored or mistreated by those on whom they depend.
What is personality?
We can most simply call personality a collection of personality traits. And although it sounds inconspicuous, it is the aforementioned traits that make us…. ourselves. After all, each of us has a different way of being, perceiving the world and expressing emotions. Each has a unique combination of traits of varying intensity. Thus, one of us is more open to new experiences and willing to take risks, while another is less so. The same is true of initiating contact with other people, being conscientious in carrying out assigned duties, or being willing to make compromises.
Personality disorder – what does it mean?
Personality, or the traits we possess, has a major impact on how we think, feel and react. This translates directly into everyday life. It would be good if our traits are conducive to finding ourselves in the surrounding reality. First and foremost, it’s about fitting in with the demands of social life and the ability to establish satisfying relationships. We can then speak of “appropriate adaptation to the environment.”
What when this is not the case at all? What when functioning among people becomes burdensome? What when family and work life suffers?
Personality disorders are a category of mental disorders characterized by fixed, persistent patterns of behavior, thinking and feeling. The patterns impair social, occupational and other major areas of functioning. Childhood and adolescent periods are very important for the onset of personality disorders.
Personality disorders can not only manifest with specific symptoms, but also affect a variety of medical conditions and symptoms. Studies indicate a link between BPD and problems such as eating disorders, substance abuse and suicide attempts among adolescents.
What is borderline personality disorder?
The numbers say that borderline disorder affects between 1.4% and as many as 5.9% of people worldwide. Instability is a key aspect of the disorder, expressed in instability of emotions, relationship building and one’s own identity. Difficulties in these areas usually lead to a strong desire to escape painful emotions through risky behavior.
An emotionally unstable person presents certain clinical features. Specialists mainly rely on two main classification systems: the American DSM(Diagnostic and Statistical Manual of Mental Disorders) and the ICD(International Classification of Diseases) developed by the WHO. According to the more extensive DSM-5, BPD is characterized by:
- obsessive fear of rejection,
- fluctuating relationships with people, moving from idealization to depreciation,
- a distorted self-image,
- tendencies to self-harm and impulsivity,
- rapid emotional changes,
- feelings of emptiness and difficulty controlling anger,
- dissociation, dissociative symptoms
- periodic paranoia, having a psychotic nature.
At least five of the above criteria must be met to diagnose BPD.
Diagnosis – how to diagnose borderline disorder?
Borderline personality disorder can be difficult to diagnose. Accurate assessment usually requires more than one session and should be conducted by a professional with knowledge, training and skills in the assessment and psychological treatment of personality disorders.
People with this disorder sometimes receive a misdiagnosis of bipolar disorder, for example, because sometimes this type of vacillation can seem similar. In reality, the two disorders are very different and require quite different treatment.
Remember, however, that emotionally unstable personality can co-occur with:
- depressive disorder,
- social phobia
- PTSD
- eating disorder,
- anxiety disorder,
- addiction
- schizophrenia.
The co-occurrence of depression with BPD, is quite common, both disorders have some overlapping symptoms that can complicate diagnosis and treatment. Many patients with a BPD diagnosis also experience depressive episodes, especially after a breakup (read: depression after a breakup). Studies indicate that most people with BPD experience what amounts to at least one depressive episode in their lives.
Borderline – symptoms. What is borderline personality?
Borderline, or borderline personality or emotionally unstable personality has distinctive characteristics.
Impulsivity
One of the characteristic features is high impulsivity. This is because a person with borderline disorder acts under the influence of the moment and does not think about the consequences. He makes decisions spontaneously, guided by the emotions he experiences. Later, he often regrets his ill-considered behavior and hastily spoken words.
Propensity for risky behavior
Another distinguishing feature is the search for stimulation and discharge of unpleasant emotions, through risky behavior. Self-injury, reaching for psychoactive drugs, uncontrolled spending, shopaholism, gambling, casual sex and breaking traffic laws are most common here.
A sense of unfulfillment
Borderline disorder is also a chronic emptiness. A person with the personality disorder doesn’t know what is important to him or what direction he wants to go. He often changes his desires and life goals, abandoning what he used to do. She doesn’t feel fulfilled and fears that she will never be able to find meaning in life.
Personality symptoms characteristic of borderline personality
- taking feverish actions to avoid abandonment, expectation, regular reassurances from the partner about his commitment and love,
- emotional instability, emotional vacillation, volatility of emotions, irritability,
- engaging in impulsive behavior,
- reluctance to engage in activities whose results are seen only after some time,
- variable self-image, own goals and preferences,
- low self-esteem, which positively influences self-aggressive behavior, e.g. self-harm
Causes of borderline – biopsychosocial theory
The biopsychosocial model is a holistic approach to understanding mental health and illness. The model takes into account biological, psychological and social factors that affect people’s health. This model is often used to explain the causes of mental disorders, including borderline personality disorder.
The biopsychosocial model emphasizes that various factors: biological, psychological and social interact and influence each other, ultimately leading to the development of mental disorders. The model distinguishes between:
Biological factors
Genetics. Studies suggest that BPD may have some genetic basis. People who have a first-degree relative bear a higher risk of developing the disorder.
Neurobiology. Some changes in brain structure and function are possible, particularly in areas responsible for emotion regulation and impulsivity.
Neurotransmitter abnormalities. Certain abnormalities in the neurotransmitter system may contribute to BPD symptoms.
Psychological Factors
Trauma. Many BPD patients have experienced traumatic events in childhood, such as physical or sexual abuse, neglect or loss of a caregiver.
Dysfunctional attachment styles. Early relationship problems with caregivers can lead to insecure, anxious or avoidant attachment styles, which can contribute to personality disorders in later life.
Emotional dysregulation. This group of patients often has difficulty regulating their emotions. This is due to both early life experiences and biological predispositions. High emotional reactivity, understood as the tendency to react intensely to emotionally evocative stimuli, which is expressed in high sensitivity and low resilience.
Social Factors
Family environment. A dysfunctional family environment, such as instability, conflict or lack of support, can contribute to the development of abnormal personality structures.
Cultural and social norms. Societal expectations about behavior, emotions and relationships can influence the symptoms of a personality disorder.
Experiences with peers, such as rejection, taunting or bullying, can also influence the development of the disorder.
Borderline in a relationship
A relationship with a person with a borderline disorder is often intense but short-lived. At first, everything seems perfect. However, the fairy tale quickly comes to an end, as possessiveness, fear of betrayal, jealousy, sometimes overstepping boundaries and attempts at control enter the picture. And all of this is caused by the fear that the borderline person will be left alone again.
One can easily imagine how strong a brake on a relationship is the fear of abandonment. When we are convinced that sooner or later the other person will leave us, we think of nothing else. We become suspicious and obsessive. We let fear cloud our relationship, and thus doom it to failure.
“I can’t trust” – the biggest problem of borderline disorder
It’s not that people with borderline don’t want love, they very much want to find a safe haven in the other person, to feel closeness, to live happily. Their main problem is that they can’t trust, they feel a great fear of intimacy. They are afraid that the more they open up, the harder the final breakup will hurt them later. Often deep down they have a belief that they don’t deserve love, which is why the threat of loss is so likely for them.
So they wall themselves off with an invisible wall that is impossible to break through. They themselves do not allow their partner “too” close to them,” but at the same time they demand assurances from him about the constancy and unchangeability of their feelings.
Emotionally unstable, or the road from love to hate
Borderline personality disorder is also a lack of security and stability in a relationship. Being in a close relationship with such a person involves going from one extreme to the other. First there is idealization (“my partner is the most wonderful person in the world”). However, it only takes one argument, a minor delay or cancellation of an appointment for everything to turn 180 degrees.
The dynamics of such a relationship are generally so intense that few people can get used to it. The transitions from excitement to despair and from love to hate are repeated in cycles. Partners feel overwhelmed and tired by this. Such fluctuations in a relationship increase the potential risk of a breakup.
Borderline personality disorder in men
Women are not the only ones who suffer from borderline personality disorder. Although BPD is more commonly diagnosed in women, men can also suffer from the disorder. Men with BPD may have slightly different symptoms than women. Men may be more likely to exhibit symptoms such as impulsivity, anger, aggression control problems and substance abuse. Borderline symptoms in men can be more difficult to diagnose because they can be confused with other disorders, such as ADHD or bipolar disorder.
Treatment for BPD in men is similar to that in women and can include individual therapy, group therapy and pharmacotherapy.
Borderline personality – a disease or disorder?
Borderline personality disorder cannot be likened to the common cold and given measures to remove all unwanted symptoms. Borderline is a personality disorder, and even despite the sincerest intentions, it is impossible to completely change the individual traits of the human personality.
However, this does not mean that nothing can be done. The implementation of appropriate methods carries a good chance of improving the quality of life. In other words, the symptoms of borderline disorder cannot be completely eliminated, but they can be minimized.
Emotional patient, or the labeling of people with borderline
Labeling(stigmatization) refers to the process by which a person or group is defined by a certain trait, or attribute, that is perceived as negative or undesirable by society. Labeling can lead to prejudice, discrimination and isolation of the individual. Labeling negatively affects the healing and recovery process.
People with borderline don’t just exhibit mood swings and angry outbursts. They are often wonderful people who simply cannot manage themselves and their lives. Many people with this type of difficulty have many positive qualities:
- People with borderline often feel emotions deeply and intensely. This can lead to deep empathy, compassion and the ability to make deep emotional connections with other people.
- Creativity, they often exhibit exceptional creativity, which can manifest itself in art, writing, music or other forms of expression.
- Passion, when a person engages in an activity that is important to them, they do so with full commitment and passion.
- High sensitivity, while this trait can sometimes be difficult to manage, it can also lead to a deeper understanding of others, as well as a greater awareness of one’s own feelings and needs.
- Flexibility of thought, people with BPD may be more open to new ideas and perspectives, which can make them more flexible in their thinking.
- Resilience. Despite the difficulties they face, many people with BPD have an uncanny ability to survive and adapt in the face of adversity.
Borderline personality – test
Remember, an online test will never bring a definite answer and cannot equal a specialized diagnosis. However, it can be a small help that will make us think about how we function.
Read the following questions carefully and answer each one: “Yes” or “No.”
- Are your relationships intense and turbulent?
- Do you often experience mood swings?
- Do you have a panicky fear of being spurned and abandoned by loved ones?
- When experiencing strong emotions, do you feel you are losing touch with reality?
- Have you self-harmed or threatened someone to do so?
- Do you have the feeling that you don’t know who you actually are, what you expect from life and what you are interested in?
- Do you often engage in risky or harmful behavior (for example, reaching for psychoactive substances, breaking traffic laws, falling into a whirlpool of uncontrolled shopping)?
If most of your answers turned out to be affirmative and you suspect borderline in yourself, it is worth consulting a professional – online psychotherapy.
To be sure of your suspicions, it is essential to go to a specialist. During the visit, he will evaluate in detail the symptoms present, the patient’s life history. In doing so, he will use the applicable diagnostic criteria: DSM-5 or ICD-11.
Borderline – how to live?
We go to the specialist, a diagnosis is carried out. Finally we hear: “borderline”. Now what?
Now comes the time to give ourselves attention and understanding. Time to implement appropriate Remember borderline is not a sentence, we do not have to be doomed to suffer. The most important thing is to take action. You yourself need to take that first step and get on the path to self-acceptance, understanding your needs and working through what is most difficult for you.
“Where did borderline come from for me?”
After receiving a diagnosis, we may wonder why we developed borderline disorder in the first place. Were we at fault in something? Could we have prevented it? However, it is worth realizing that the formation of personality depends on many factors, often beyond our control. Genetics and the environment in which we grow up play an important role. So it’s not worth the trouble of asking questions and blaming ourselves for the fact that we have borderline. It is not your fault.
Borderline treatment methods
Treating borderline personality disorder (BPD) can be a lengthy process that requires a personalized approach and integrated care. Here are some commonly used treatment strategies and methods:
- Individual therapy
Dialectical-behavioral therapy (DBT). This is a specialized form of therapy focused on teaching coping skills to deal with strong emotions, tension and impulsivity.
Schema therapy. Focuses on identifying and changing unhealthy schemas (deeply ingrained beliefs and behaviors).
- Group therapy
Support groups. Can offer group support and teach coping skills. DBT skills groups focus on teaching specific skills, such as those related to emotion regulation.
- Medications
Although there are no medications to treat borderline, pharmacotherapy is sometimes implemented to alleviate specific symptoms or co-occurring disorders. A psychiatrist may introduce treatment aimed at pharmacological stabilization of mood, reduction of depressive symptoms, control of impulsivity or reduction of anxiety symptoms. The most common medications used for this purpose are:
- Antidepressants (SSRIs, SNRIs). They can be used to treat depressive symptoms that often co-occur with BPD. Examples include fluoxetine (Prozac), paroxetine (Paxil) or venlafaxine (Effexor XR).
- Mood stabilizers. They can help control rapid mood changes and impulsivity. Examples include lamotrigine (Lamictal) or sodium valproate (Depakote).
- Antipsychotic medications. Can be used to control symptoms such as paranoia, irritability or impulsivity. Examples include quetiapine (Seroquel), olanzapine (Zyprexa) or aripiprazole (Abilify).
Schema therapy in the treatment of BPD
Schema therapy is effective in treating personality disorders. It is an integrative approach that combines cognitive therapy, attachment theory, The techniques used include: identifying one’s own needs, recognizing major schemas and modes, identifying major coping styles.
The first step in schema therapy, according to Jacob and colleagues (2019), is to understand the source of our negative feelings in the context of the past. Once these are identified, the therapist uses a variety of techniques to change unfavorable cognitive but also emotional patterns. In addition to using cognitive and behavioral elements, the therapist works on the patient’s processing of difficult emotions. The main role is played by experiential methods, such as imaginal rescripting and chair-to-chair dialogue. In schema therapy, emotion-based methods have an additional purpose. For people with BPD, avoidance is often the most common strategy, especially avoidance of difficult feelings. Using experience-based methods helps patients learn to accept emotions.
Borderline treatment – the emotional dimension and regaining hope
As we already know, the borderline personality struggles to build healthy relationships with others. Meanwhile, the effectiveness of psychotherapy depends largely precisely on the relationship between patient and therapist.
Why does this play such an important role? Because we feel better talking to someone we trust. When a sense of security accompanies us during a session, we express our thoughts more freely and share experiences, even painful ones that we would rather forget.
Psychotherapy is a deep search for the causes of our behavior. It’s also talking about the emotions and fears that accompany us. It’s not as if we are thrown into deep water at the very first session. It takes time, readiness and the formation of the aforementioned relationship with the psychotherapist to bring up more difficult topics. Without this, we will not be able to move forward and discover what is hidden deep in our psyche.
Borderline – treatment. How does schema therapy help people with borderline?
In therapy for people with BPD, the priority is to reduce self-aggressive behavior. Once the most risky behaviors are brought under control, the therapist can proceed to work more deeply to improve the patient’s quality of life. Based on the work of Anoud Arntz (2016), the main areas of therapeutic intervention include:
- Reducing symptoms characteristic of borderline personality disorder, such as relational problems, fear of abandonment or emotional instability.
- Supporting the patient to feel secure, to experience and express emotions, and to establish deep relationships.
- Helping the patient achieve personal and social satisfaction.
In therapeutic work, patients learn skills, related to:
- Emotion regulation. People with BPD often struggle with intense and unstable feelings. Patients learn how to tolerate difficult emotions and not react impulsively to them.
- Interpersonal skills. People with BPD often have trust issues. Therapy should help them establish healthy relationships based on the therapist’s model behavior.
- Increase sense of identity. Patients with borderline may struggle with an unstable self-image. One of the most important goals of therapy is to help them build a more coherent and positive sense of self.
- Tolerating discomfort. Patients learn how to accept themselves and their feelings without wanting to change the reality around them.
- Patients should develop skills that will help them control their own thoughts, behaviors and emotions, building a higher level of adequacy and fit with environmental demands.
Therapy is a process that requires commitment and patience from both patient and therapist. Choosing the right therapeutic methods is crucial for effective therapeutic treatment. Remember, borderline disorder can be effectively treated.
Bibliography:
Cierpiałkowska L. (2009). Psychopathology. Scholar Publishing House, Warsaw.
Krzysztof-Świderska A., Małek D. (2022). Borderline personality in ICD-11 and DSM-5 – relational nature of the criteria of the disorder. Psychiatry and Clinical Psychology 22 (3), pp. 175-179.
Mandal E., Kocur D. (2013). Machiavellianism and manipulation tactics undertaken by patients with borderline personality disorder in everyday life and during therapy. Psychiatria Polska 13 (4), pp. 667-678.
Strelau J., Doliński D. (2008). Psychology. Volume 1. Gdańskie Wydawnictwo Psychologiczne, Sopot.
Arntz A. (2019). Schema therapy in practice. Working with schema modes. Gdańskie Wydawnictwo Psychologiczne, Sopot.