Borderline personality disorder: the symptoms, its essence, and clinical picture. Main factors that cause this disease. Basic methods of psychotherapy and drug therapy. A borderline personality disorder is a mental illness characterized by emotional instability, impulsivity, low self-control, and impaired interpersonal relationships. It often starts young with vague symptoms that are very difficult to notice.
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Description of borderline personality disorder
A borderline personality disorder is a mixed condition in which symptoms of the mental level are registered, which appear as a kind of psychological defense against changes at the neurological level. Thus, it is difficult to attribute this pathology to any specific diseases, so I decided to single out a particular category of borderline. The choice of this nosology has been controversial for years. The fact is that some psychiatrists found it necessary to have a borderline personality disorder in the international classification, but others did not see this need. Thus, studying this disorder has taken a long time and has continuously developed a debate among scientists. The similarity of the symptoms of this disease with other nervous systems leads to repeated mistakes by doctors who have difficulty determining the correct diagnosis and often reveal depression, bipolar disorder, or obsessive-compulsive disorder. It distorts the statistics significantly, and the prevalence of this disease is likely much higher than the available figures. Almost 75% of all cases of diagnosis of this disease occur in women. In the entire adult population, borderline personality disorder occurs in 3%. It is a very high indicator, which indicates the urgency of this problem and requires the close attention of doctors. In addition, suicidal behavior, which often occurs in this nosology, leads to suicide. Statistics show that almost every ten patients with borderline disorder commit suicide.
Moreover, suicidal behavior, which often occurs in this nosology, leads to suicide. Statistics show that almost every ten patients with borderline disorder commit suicide. In addition, suicidal behavior, which often occurs in this nosology, leads to suicide. Statistics show that almost every ten patients with borderline disorder commit suicide.
What is the biggest symptom of BPD (Borderline personality disorder)?
Even though this is a fairly common pathology, there is no consensus on the causes of the disorder today. Most people support the multifactorial theory of the onset of the disease, the essence of which is the combined effect of various factors.
Several main hypotheses explain Borderline Personality Disorder syndrome:
- Biochemical Theory … Human emotional reactions are known to be controlled by the ratio of neurotransmitters in the brain. The main ones are represented by dopamine, norepinephrine, and serotonin. So, for example, a lack of serotonin worsens the mood, and the person sinks into depression. A low concentration of dopamine contributes to the fact that a person does not feel “rewarded” for his work and life, turning it into a waste of time. Suppose the body lacks endorphins, for example. In that case, it becomes tough for the individual to resist stress and resist strong emotional reactions.
- Genetic theory … As with most mental disorders, the presence of such conditions in relatives or the family tree matters. Most of the genotype has not yet been transcribed, so it is reasonable to assume that the probability of developing a disorder such as borderline disorder will be set at the DNA level. It is believed that not only those whose relatives suffer from the same disease have an increased chance of getting sick, but also people whose loved ones have some psycho-emotional changes.
- Social theory … It is believed that the disease develops more often in those who grew up in low-income families. The parents’ use of alcohol and drugs and their neglect of the child form an extremely unfavorable background in which a personality with an emotional defect develops. Since children tend to unconsciously copy their parents’ behavior and set them as examples, antisocial behavior in a family with a small child can forever leave an impression on his character. The system of self-respect and non-permissiveness is broken, a generally accepted framework of behavior is not established, and a person cannot fit into society.
- Psychotraumatic theory … Almost all events in a person’s life that had a significant impact on his psyche and caused solid emotional reactions can influence the formation of his personality in the future. Particular emphasis should be placed on mental, physical, or sexual abuse experienced early. It is underestimating one’s value and nature as such that has a powerful effect on a person in the future. There are also some changes in people who lost a loved one in childhood and couldn’t deal with it. It means not only the death of a relative but also leaving the family, as happens in divorce.
- Parental theory … It has long been known that proper and correct upbringing is the key to a fully formed personality. It should be based on both seriousness and discipline and love and affection. It is essential to maintain a balance between these poles. It is usually achieved with the help of two parents, one sets the framework, and the other provides support. Suppose the unhealthy microclimate in the family with repressive authoritarian behavior of the parents dominates. In that case, the child will likely develop a personality with an anxiety factor. Or on the contrary, a too gentle, polite upbringing with all kinds of rewards without control and restrictions will raise a visible personality that will not reckon with general rules and will not be able to adjust to society.
Signs of having a borderline personality disorder
The symptoms of BPD can vary significantly from person to person. It means that there are very few specific symptoms of the disease. It greatly complicates the diagnosis and treatment of the disease. The development of particular symptoms depends on the individual, their upbringing, worldview, and emotional sensitivity. The environment also plays an important role. A supportive environment and high quality of life significantly improve the adjustment of people with borderline personality disorder (BPD).
There are 6 main components of the clinical picture with this disease:
Human relationships… Communication with other people always requires a specific emotional involvement and response. Those who develop BPD are characterized by instability in their feelings and emotions. Their mood is volatile and fluctuates very often. Moreover, these personalities are sensitive to the slightest emotional changes in the outside world. For example, a sentence or a comment from the outside, said just like that, which most people would ignore, such persons will notice.
- Moreover, it will constantly disturb them. People with BPD react to such insignificant factors with great harshness and often change the pole of their vibrant color. For example, one minute, they are pleased with a specific person, and a moment after the “leaning” look from his side, they interpret him as the most potent offense. Such emotional fluctuations do not provide rest for the patients or their loved ones.
Classification… The feelings of such persons, as mentioned above, are compassionate. Their balance is easily disturbed by small things that usually don’t matter much. They tend to perceive everything in this world as either good or bad. The other person cannot be neutral towards them. He is either their good friend or an enemy who hates them. Individuals with BPD do not distinguish between black and white colors, so they are always categorical in their decisions. It also applies to self-esteem.
- In some cases, it goes out of scale, as the motivation from outside can lift it very high. In other instances, self-esteem drops, and the likelihood of depression increases. It is associated with a high rate of suicide among individuals with BPD. If they decide to risk their lives, they will be very strict about this,
- Fear of loneliness… It depends on other personality traits, and this phobia can manifest differently. In some cases, this is aggressive and even dictatorial behavior aimed at keeping close people close to him. Sometimes the fear of loneliness manifests itself in excessive tears and weakness where people are manipulated, so they are not abandoned. Loneliness, in their understanding, does not only mean long-term separation. Even if a loved one is gone for a few hours, it is considerable stress for a person with BPD. Being exceptionally emotionally unstable, they try to have a constant range of positive emotions close to them, including a loved one. Panic attacks, anger attacks, or aggressive behavior often appear against this background. But in fact, they all aim to keep loved ones close.
- Self-destruction … is an essential characteristic of people with BPD. Due to the same emotional instability, they tend to perform any action that leads to the destruction of their own body or poor health. It sometimes manifests itself as risky behavior, bordering on danger. Most of the time, self-destructive behavior is hidden under fast driving, a tendency to abuse alcohol and drugs, and binge eating. Some experts claim that the desire to be constantly updated with the help of tattoos also belongs to this group. The data suggests that about 80% of those who get a tattoo and are dissatisfied with the result but still go back to another probably have a borderline personality disorder. This behavior often leads to accidents that cannot be interpreted as suicide but are also caused by the disease.
- Impairment of self-perception … Identifying oneself as a separate person with character and feelings and determining the characteristics and mood of a particular period is challenging for people with BPD. That is, they do not perceive themselves as a distinct characterological type. For example, some people describe themselves as risky and extreme, while others are more inclined to be domestic and caring. For people with BPD, there is no concept of nature or description. They have periods when they feel one thing at a time. Then the character changes completely, and it is impossible to predict different behavior. The problem is that it is difficult for them to identify their feelings and behavior, break it down into parts and evaluate whether it is good or bad.
- Loss of control … Virtually all manifestations of BPD are random and not controlled by the individual. All emotional responses to events develop independently of actual feelings and beliefs. Aggressive behavior, tantrums, and panic occur without the individual’s intervention. Moreover, they cause trouble for themselves and those around them because they do not deserve such treatment. The value and evaluation system has been violated. At one moment, a person admires and is fascinated by something. At another, he feels disgusted and even aggressive towards it. It negatively affects personal relationships and undermines the authority of the person with BPD in the eyes of others.
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In reality, each case of borderline personality disorder is individual and slightly different from the classic description.
Already in the 21st century, it was possible to identify several different soul types:
- Phobic form … In borderline personality disorder, the symptoms are colored by fear that dominates the person’s thoughts. In practice, this manifests as an anxiety-phobic background that leaves a mark on all emotions and actions. Such people often avoid responsibility, get attached to someone, and find it difficult to understand. They tend to exaggerate minor problems.
- Hysterical form … is characterized by dramatic and pretentious behavior. All actions are aimed at meeting their needs. They tend to manipulate others and express their feelings too much. Emotional solid reactions or, conversely, emotional emptiness are characteristic. It also includes self-injurious behavior with suicidal thoughts.
- Pseudo-depressive form … It is a set of depressive symptoms that differ from the classic version. Due to the inability to evaluate oneself correctly, one runs away from the ideal of oneself in the worst form of one’s personality. Such swings often cause suicidal thoughts and can manifest as automatic aggression.
- Obsessional form … A person realizes his emotional instability with the help of various exaggerated ideas. I am trying to plan for some events or things to do. It reduces internal tension, and accordingly, emotional instability is covered by obsession.
- Psychic form … It appears in the form of somatic symptoms arising from the gastrointestinal or cardiovascular system. A person’s psychological experience does not manifest itself in the form of somatic pathology. On examination, no specific morphological changes are observed.
- The psychotic form … is the most severe variant and manifests with various productive psychotic symptoms, such as hallucinations or paranoia. A person directs his fears and experiences in a specific direction and emphasizes psychic signs. At this time, self-destructive behaviors are used to distract one from them, to return to reality.
Treatment considerations for borderline personality disorder
The severity and specificity of the symptoms of this disease predetermine the breadth of the spectrum of therapeutic drugs and thus their low success. Evidence-based medicine attests to the ineffectiveness of typical psychotropic medications prescribed on a symptomatic basis. It is what explains polypharmacy, a common tendency to treat with multiple drugs at the same time. In addition to drug therapy, psychological treatment methods are also used, which can also be effective in some cases.
A specialist has prescribed individual therapy for a personality disorder on Earth. Must choose each drug for a specific case and adapt to any medications a person is already taking. The importance of this nuance can hardly be overstated.
In general, the treatment of borderline diseases is characteristic. Drugs are selected for the existing signs of the disease and eliminated. Correction of dosages and selection of a specific representative of a particular pharmacological group should be handled only by a physician.
Consider drugs for borderline personality disorder:
- Antidepressants … The most common symptom of PLR is depression, caused by the emotional instability of the human psyche. Thus he plunges into characteristic depression. Of the antidepressant medications for borderline personality disorder, selective serotonin reuptake inhibitors are preferred. On a biochemical level, they balance neurotransmitters and correct a person’s mood as needed. The prominent representatives of this group are Fluoxetine, Sertraline, and Paroxetine. Considering that these drugs in the proper doses can have different effects is essential. The impact of these funds comes quite late – after 2-5 weeks, which requires long-term treatment under the supervision of a doctor.
- Antipsychotics … The use of antipsychotics is associated with several psychotic symptoms that may appear as part of the clinical picture of borderline personality disorder. First-generation antipsychotics (Chlorpromazine, Haloperidol) have little effect on symptoms. The next generations proved to be more effective in this regard – Olanzapine, Aripiprazole, Risperidone. The use of these resources is necessary to control impulses. They give the best effect together with several methods of psychotherapy.
- Normotimics … This group of drugs controls mood and eliminates anxiety. Studies have shown the drug’s high efficacy, valproate, in contrast to other members of this group. It is advisable to prescribe these funds for a personality disorder on the ground from the first days after diagnosis. Some sources claim that valproate is the first choice for this condition.
Important! Benzodiazepines are contraindicated in borderline personality disorder.
Psychological support from family and friends and a course in psychotherapy will be the best option for treating borderline personality disorder.
The doctor must choose a specific technique after examination and conversation with the patient:
- Dialectical behavioral therapy … Has the most success in this disease. Its essence is to identify negative behavior patterns and replace them with positive ones. It is used in the presence of self-destructive symptoms in the clinical picture. Helps relieve unhealthy habits and other signs of BPD.
- Cognitive analytic therapy … is also very often used for this pathology. Its essence lies in creating a specific model of psychological behavior determined by the disease. It is necessary to highlight all the essential points that need to be eliminated. Having such an idea about their condition, a person will be more critical of the symptoms and even be able to fight against them on their own.
- Psychoeducation in the family is used to rehabilitate patients after mental disorders. Its distinctive feature is the involvement of the individual’s family and friends in the process. They participate in psychotherapy together, sharing the problem’s seriousness with them.
A borderline personality disorder is a widespread mental illness that is unfortunately underdiagnosed. Its symptoms cause significant difficulties in a person’s everyday life, create problems in personal relationships, and significantly reduce the quality of life. Therefore, treatment for a borderline personality disorder must be comprehensive and, most importantly, timely.