Borderline personality disorder: everything there is to know!

What is borderline personality disorder? 

Borderline personality disorder is a complex psychiatric disease. Its manifestations vary greatly from one person to another.

In general, patients with borderline personality disorder show significant emotional instability. They have difficulty managing their emotions and can lose their temper easily and unpredictably, and behave impulsively. They regularly experience mood swings or feelings of emptiness.

This disorder is often ignored by the patients themselves. The manifestations of borderline personality disorder are difficult to identify but are always related to emotions: borderline states are halfway between psychosis and neurosis.

Patients suffering with borderline personality disorder have a sickly fear of rejection and abandonment. The disorder is characterized by pervasive and persistent patterns of thought that cause intense suffering.

They cannot stand being alone and may resort to self-harm to cope with or avoid loneliness. Suicide attempts are common and are often used as a "test" for those around them to communicate their distress and to get them to care.

The symptoms that characterize borderline personality disorder are numerous and differ from patient to patient. Some symptoms are visible: irritability, anxiety, mood swings and sometimes depression. In addition, there is a great lack of self-confidence and real difficulties with interpersonal relationships. All these symptoms are extremely destabilizing for those around the patient.

Young people and women (3 out of 4 cases) are the ones most affected by borderline personality disorder. However, symptoms tend to diminish over time in most people.

What are the causes of borderline personality disorder? 

Genetic, environmental and chemical factors (disruption of serotonin production) may contribute to the development of borderline personality disorder.

Some patients may have a genetic predisposition to negative reactions to day-to-day stress, making them more likely to develop borderline personality disorder as well as other psychological disorders.

This condition tends to run in families, suggesting that it may be hereditary. Indeed, first-degree relatives of an affected person are five times more likely to develop the disorder than the general population.

In addition, significant stress in early childhood may contribute to the development of the disease. Many patients have been physically and/or sexually abused, have been separated from their caregivers, or have lost a parent as a child.

How is borderline personality disorder diagnosed?

A psychiatrist can diagnose borderline personality disorder when the patient shows one main symptom associated with other symptoms. The most prominent symptoms are emotional instability and impulsivity.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), borderline personality disorder is defined by at least 5 of the following criteria:

• Emotional instability,
  
• Significant impulsivity,
  
• Excessive behavior,
  
• Risk-taking in at least two areas (sex life, substance abuse, driving, gambling, binge eating, etc.),
  
• Hyperemotionality with frequent displays of anger, often for no apparent reason,
  
• Suicidal threats and/or self-harm,
  
• Identity disorders,
  
• A feeling of boredom and emptiness,
  
• A great fear of abandonment,
  
• Disproportionate reactions to stress,
  
• Temporary paranoid thoughts or severe dissociative symptoms triggered by stress.
  

These symptoms appear in early adulthood (or in adolescence).

How can borderline personality disorder be treated? 

Drug treatments 

Psychotropic medications are sometimes necessary to relieve the symptoms of borderline personality disorder. These include anxiolytics and antidepressants. However, treatments cannot cure borderline personality disorder.

Psychological support and psychotherapy 

The support of close family and friends is essential, but it is also necessary to seek help from a psychiatrist or psychologist.

Indeed, certain types of psychotherapy have been found to be effective in improving the symptoms of this disorder. The most effective therapies include: behavioral and dialectical therapy, schema therapy and psychoanalysis.

The benefits of psychotherapy are numerous: gaining better emotional management, correcting dysfunctional thought patterns and finding a healthier way of dealing with life.

Hospitalization 

Severe forms of borderline personality disorder require hospital stays, sometimes repeated. These stays have a soothing effect on patients thanks to the hospital setting and the presence of a care team; during hospitalization patients start or maintain their therapy sessions at a necessary pace, and benefit from a thorough follow-up care.

In other words, the best treatment for patients with borderline personality disorder is long-term psychotherapy with regular sessions.