Borderline Personality Disorder Clinical Manifestations And Treatment

“You can feel like a mental patient, but that doesn’t mean you have to act like one.” — Marsha Linehan, founder of DBT.

Borderline

Borderline , in psychiatry, was thought to be on the border between psychosis and neurosis. Meaning almost but not entirely crazy. The disorder is characterized by  instability in mood, self-image, behavior, and interpersonal relationships. This typically means people suffering from BPD have chronic feelings of emptiness and low self-esteem, suicidal thoughts and gestures (cutting), anger issues, and even bisexual tendencies. Marsha Linehan, an expert on BPD, describes  borderlines as the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create imense suffering.

The term borderline  basically reffers to INSTABILITY as the hallmark characteristic of the disorder. 

The basic  life-style is dominated by crisis:

• Behaviour can become highly unpredictable
• Mood states tend to be extreme and labile
• Persistent feelings of alienation and emotional emptiness

Women with bordeline personality disorder

CLINICAL MANIFESTATIONS:

INTERPERSONAL INSTABILITY is obvious in relationships and interactions with others

SPLITTING reffers to a predictable pattern of alternately devaluing and idealising others.Devaluation appears to be unpredictably triggered by sudden angry responses to perceived  or actual interpersonal loss. Borderline patients are  hypersensitive to behaviors of others towards them.

SELF-HARM and SUICIDAL IDEATION refer to impulsive harmful behaviour towarsd self that vary widely in severity.Self-harm is sometimes intended to elicit a rescue response from others but also may be used to relieve severe feelings of emptiness, numbness,frustration, anger, or interpersonal tension. Common self-harm behaviours include cutting and burning, hitting objects and drug overdose.Suicide thaughts and attempted suicide in response to perceived or actual trauma or crisis characterise severe forms of the disorder.

Borderline Personality Disorder

MANIPULATION refers to relating to others as objects for the purpose of achieving unstated goals. Manipulation may be covert or overt, but the aim almost always is to obtain caretaking responses from others.

ANGER and DYSPHORIA are commonly experienced or chronic negative mood states. Dysplays of negative emotions can vary greatly but can reach levels of intensity that simply overwhelm the affected person.Negative emotions also include loneliness and boredom.Complaints of never experiencing good or happy emotions may not be an overstatement.

DYSPHORIA

DEREALISATION refers to transient experiences in wich nothing seems real.When derealisation also includes depersonalisation, the affected person does not feel real and instead feels like adisembodied observer.

IMPULSIVE AGRESSION may manifest as alarming episodes of substance abuse, promiscuity, fighting, self-harm.

The cause of BPD is unknown, but almost certainly there is a history of childhood trauma. This includes parental abandonment and neglect, poor communication  in the family, and physical and sexual abuse. Clinically, BPD is often wrongly diagnosed  as Bipolar Affective Disorder (BAD) because of the overlap in mood instability symptoms. The main difference between these two is that borderline symptoms are triggered by interpersonal difficulties while bipolar symptoms are autonomous and independent of relationship stres factors . Also medication is  far less effective for treatment of borderline  than bipolar effective disorder .

Medications used to manage symptoms of borderline are ddetermined by the persons immediate treatment needs. Persons with this didorder are at  high risk  for depression, anxiety, stress, panic and substance abuse. In some cases antidepressants prove helpful. Severe impulsive agression may require short term antipsychotic medication(riperidone, olanzepine).Mood stabilization  medications (gabapentin)might improve severe mood instability.

Given the unpredictable mixture of clinical symptoms that can be associated with a diagnosis of borderline personaliy disorder, psychotherapy must be amphasised.

The primary psychotherapeutic goals for the bordeline personality disorder include:

• Crisis prevention
• Management and stabilisation of object relations.

The treatment of choice for BPD is Dialectical Behavioral Therapy  (DBT). It is  a form of talk therapy that helps patients  learn to manage intense emotions to minimize self-destructive behaviors and thus function better in relationships. The goal is to promote acceptance, yet encourage change.

“Pain creates suffering only when you refuse to accept the pain.”- Marsha Linehan

“Acceptance is the only way out of hell.”– Marsha Linehan