Borderline personality disorder not as hopeless as once thought

Borderline personality disorder (BPD) is one of the most difficult psychiatric disorders to deal with – and many family physicians and psychiatrists do their best to avoid it at all costs. Until recently, this condition has been considered almost untreatable.

BPD usually develops early in life, affects about two percent of the population and is an extremely disruptive disorder with many symptoms.

People with BPD typically have a long history of intense, unstable relationships and an extreme fear of being abandoned by people. They tend to evaluate people as either all good or all bad and evaluations can change from one extreme to the other very quickly.

Almost always, borderline patients have a poor sense of identity, which is easily influenced by their surroundings and relationships.

Borderlines exhibit anger that is inappropriate and difficult to control. They have a history of impulsive, reckless behaviour in sex, spending, drug use, stealing or eating, In addition to these behaviours, individuals with this disorder experience chronic depression, anxiety, feelings of emptiness and mood states that may last only hours.

Social adaptation is another problem that plagues people with BPD. Those with the disorder tend not to know or understand the rules regarding performance in job or academic settings. This often leads to frequent job changes and a string of unfinished educational pursuits.

Self-mutilation and suicidal thoughts and gestures are also common among individuals with BPD – another reason why it is so important for good, effective treatment to be found and used.

A recent study at Harvard University followed 290 borderline patients over a 10 year period and found hope in regular clinical treatment. Study participants all received in-patient care and outpatient follow-up and experienced a sharp decline in 12 of the 24 main symptoms over the study period. At the last assessment only 15 percent of patients reported any of those 12 symptoms.

The other 12 symptoms also showed patterns of substantial, but less dramatic decline over the follow-up period. Symptoms of impulsivity including self-mutilation and suicidal thoughts as well as interpersonal problems such as being demanding and feelings of entitlement resolved the most quickly.

Mood symptoms such as depression, anger and loneliness as well as fears of abandonment and dependency issues remained the most stable over the course of the study.

Although this was not a study comparing different treatment approaches, it did show that regular clinical treatment of varying types seemed to result in dramatically fewer symptoms over time.

Dialectical behaviour therapy is one of the best-researched treatments for BPD. This therapy works from the theory that BPD occurs as a result of a negative and invalidating childhood environment as well as a biological predisposition. Many individuals with this disorder have been physically or sexually abused as children. They become over-sensitized to emotional stimuli and react more quickly and severely than most. Therapy teaches coping skills and helps borderline patients to deal more effectively with surges of emotion.

Specifically, therapy attempts to reduce suicidal or self-destructive behaviour and inappropriate responses that may interfere with the patient’s quality of life.

However, clinical experience suggests the more chronic symptoms such as anger and undue dependency may seriously impair psychosocial functioning. No psychosocial treatment has yet been developed to effectively treat these more chronic temperamental symptoms in BPD.

Attempts are often made to treat the more tenacious symptoms pharmacologically with antidepressants, mood stabilizers and anti-psychotic medications. These can help but are not a perfect solution as they were not designed for use in BPD.

In any case, although there is still room for improvement of available treatments there is also good, evidence-based reason, to give our patients with Borderline Personality Disorder reason to be hopeful about their future.

Another important aspect to the treatment of BPD is fostering the education and support of the patient’s loved ones. Because borderline patients are often unpredictable and volatile, they can be difficult people to live with.

Loved ones need to offer support, avoid overreacting to upsetting behaviour, encourage treatment, set boundaries and be consistent with their loved one. All of these steps can help a borderline patient get through this difficult disorder. Keeping a positive attitude is also important for friends and family when dealing with a loved one suffering from borderline personality disorder.

If you think you or a loved one are experiencing BPD, speak with your doctor about getting treatment.


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