What is a personality disorder? Differences in personality style add color and variety to relationships with
others. However, sometimes those differences can become too extreme, so that individuals are not able to be
flexible and deal with people and problems constructively. When personality patterns become very rigid and the
person is not able to adapt to the changing demands of his or her environment, the person may be described as
having a personality disorder.
What is Borderline Personality Disorder? The DSM-IV, which is the manual used to diagnose mental
disorders, describes Borderline Personality Disorder (BPD) as including at least five of the following::
• worry about abandonment and going to extremes to keep someone from leaving
• unstable, stormy relationships with major shifts in thinking about another person, such as believing
someone is a loyal friend to believing the person is untrustworthy or hurtful
• unstable self-image, shifting from feeling confident about who you are to feeling like you are evil, or
don’t even exist
• self-damaging, impulsive behaviors, such as substance abuse, binge eating, reckless spending, or other
behaviors that can lead to serious consequences
• frequent suicidal thoughts, threats, attempts, or self-hurting behaviors such as cutting
• rapidly changing, intense moods
• feelings of emptiness
• intense anger that may lead to physical fights or destruction of property
• during times of stress, he or she may believe others are intentionally trying to make life difficult for them;
at other times, they may feel like they are losing touch with reality
Another way to think about BPD is that it is a disorder of emotional regulation. Those who suffer from this
disorder experience very intense emotions and have difficulty regulating them. Some people have suggested
that we call this disorder Emotional Intensity Disorder (EID). This disorder is extremely painful for the persons
who have it and for those who live with and care about them.
How common is BPD (or Emotional Intensity Disorder)? BPD is estimated to affect 2-3% of the general
population, but affects 11% of patients seen in outpatient clinics, and as many as 20% of hospitalized
psychiatric patients. Those who suffer from BPD are heavy users of mental health services because of frequent
hospitalizations and emergency room visits due to suicidal thoughts and attempts. About 8-10% of people with
this disorder die by suicide. The presence of this disorder complicates the treatment of other disorders such as
Major Depression, Bipolar (Manic-Depressive) Disorder, Eating Disorders, and Substance Abuse.
What factors contribute to the development of BPD? As with other mental disorders, it is believed that
BPD may be the result of a combination of factors, including a biologic or genetic vulnerability that interacts with
stressful events in the early family environment. There may be other family members who have BPD, mood
disorders such as Major Depression or Bipolar Illness, or problems with substance abuse.
How is BPD treated? Medications may play a role in reducing the symptoms of depression, anxiety,
irritability, and paranoid thoughts. Traditionally psychotherapy has been a very long-term process with
uncertain results. Patients with BPD and their therapist often become frustrated with the stress of maintaining a
close working alliance long enough for the psychotherapy to work. Managed care programs have been
reluctant to pay for services for this diagnosis. In the past few years, research studies have demonstrated the
effectiveness of cognitive-behavioral therapies that teach emotion regulation skills and improved lifestyle
behaviors to patients with this disorder. A combination of careful medication management and cognitive-
behavioral therapy that includes emotion regulation skills training is viewed as a promising treatment which
may allow the patient to see significant progress over a period of a few months. The value of education for
family members and professional caregivers is being recognized.
What is being done to further research into BPD? There are now some organizations promoting research
on Borderline Personality Disorder. The Treatment and Research Advancements Association for Personality
Disorder (TARA APD) may be found at: www.tara4bpd.org/dyn/index.php.Another is the National
Education Alliance for Borderline Personality Disorder: http://www.borderlinepersonalitydisorder.com/
(See our LINKS page fordirect links to these organizations)
– Nancee Blum
Bruce Pfohl
© 1997