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Understanding BPD

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 inflexible and do not 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 their environment, the person may be described as having a personality disorder.

What is Borderline Personality Disorder? The DSM-V, which is the manual used to diagnosemental 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 areevil, 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, they 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) or Emotional Intensity Difficulties. 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 EID)? BPD is estimated to affect up to 2-3% of the general population, about 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. A significant number 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. In the last several 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 an evidence-based approach to treatment which allows individuals to see significant progress over a period of a few months. The value of education for family members and professional caregivers is being recognized.

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Helping Someone With BPD

Those who have a family member, significant other, or friend with a severe mental disorder often ask how they can be helpful to that person. Despite their desire to help, family and friends may find themselves experiencing feelings of frustration, helplessness, resentment, and anger. The following suggestions have come from talking with patients about how people in their support system can be helpful.

Be patient! Changing behavior patterns can be a long process and is challenging work. As conditions such as diabetes, many mental disorders are chronic (life-long), and a reasonable goal is improved management, not a cure.

Point out positive qualities. Everyone has things they do well. Having a mental disorder often undermines the Person's confidence, and they may focus their attention on the things they cannot do.

Notice small changes, rather than focusing on how far the person has to go or how much they could do in the past. Make compliment efforts to use new skills and coping strategies or try new medications despite side effects.

Expect setbacks. Managing a chronic illness is hard work, and sometimes the course of the illness is an up and down one. Remember - a lapse is not necessarily a relapse. Setbacks are often expected, temporary, and even helpful as patients recognize the need to continue actively managing their disorder. Don't induce guilt when there is a setback. It is often problematic for persons with a mental illness to accept their limitations, and adding guilt increases feelings of alienation from those who want to help.

Support the Person's decision to seek help and follow treatment recommendations, but give responsibility for treatment to the patient. You cannot force someone to get treatment or stay in treatment, and you cannot control another person's disorder, and you cannot cure it.

Direct your anger at the disorder, not the person with the disorder. The Person who has the disorder hates it more than you do. Don't blame the Person for having a disorder. They did not choose to have a mental disorder. Try to think of the Person as having a disorder, not a disorder.

Don't criticize. Those who have a mental disorder are often highly critical of themselves, and negative comments further lower self-esteem and feelings of worthlessness.

Be informed. Read as much as you can about your loved one's disorder, but do not try to be your family member, friend's therapist, or psychiatrist.

Identify family patterns that may contribute to problems. Try to notice and improve interactions between you that trigger arguments or conflict. Seek family therapy or couple counseling if there has been a long history of communication problems.

Take care of yourself. If a family member has had a mental disorder for many years, family life has often been disrupted, and family members may have given up activities they formerly enjoyed. Family members and friends are entitled to time to pursue enjoyable activities.

Look for support. There are often support groups available for family and concerned friends. If you are not aware of resources in your area, contact local hospitals, mental health centers, or national organizations such as the National Alliance for the Mentally Ill. Numerous resources are now available on the Internet.

– Nancee Blum