Disorders and Treatment
- Mental Illness
- Bipolar Disorder
- Mood Disorders
- Borderline Personality
- Mental Health Diagnosis
- Mental Health Treatments
- Alternative Meds
- Case Studies
Of the 10 different personality disorders listed in the DSM, there is one that stands out from all the others when it comes to frequenting therapists’ offices, doctors’ offices, mental health clinics, and hospital emergency rooms.
Individuals with Borderline Personality Disorder (BPD) struggle with intense negative emotions, frequent personal crises, suicidal thoughts, and self-mutilation – all of which cause them to be high users of the mental health system.
The term "borderline" stems from the early belief that individuals with BPD teetered on the "border line" between neurosis and psychosis. A more appropriate name for this particular personality disorder would be "emotional regulation disorder". Attempts to get the name changed have been unsuccessful thus far.
Individuals with BPD are not hard to spot. Their complicated lives are marked by telltale symptoms. These symptoms not only make their own lives very difficult, but also have a significant negative impact on those around them. The symptoms of BPD include:
Personality disorders, by their very nature, are inflexible and deeply ingrained. This makes them very difficult to treat and lends to a poor prognosis as a general rule. However, compared to other types of personality disorders, some individuals with BPD respond fairly well to appropriate treatment. This is why BPD is the one personality disorder diagnosis that some health insurance plans do cover. Treatment options include psychotherapy, medication, and hospitalization.
Psychotherapy is the best overall treatment for BPD. In recent years, a specific, highly structured type of therapy called "dialectical behavioral therapy" has proven to be quite effective in treating BPD. DBT focuses on helping BPD individuals with emotional regulation, interpersonal relationships, and stress management.
Medication has very limited effectiveness in treating BPD symptoms. However, since many individuals with BPD often struggle with depression or anxiety, medication may be prescribed to treat symptoms of those disorders.
Inpatient psychiatric treatment is sometimes required for individuals with BPD, with the primary goal being safety. Inpatient treatment typically occurs when the individual is actively suicidal or engaging in dangerous self-mutilation (e.g. deep cutting versus superficial cutting). Approximately 1 in 5 psychiatric inpatients have BPD.
It’s not uncommon for individuals with BPD to be misdiagnosed with Bipolar Disorder, and vice versa, even though the two disorders are quite distinct. Although both disorders involve "mood swings", individuals with BPD experience mood changes very frequently – such as every few hours or even several times a day. These changes are reactive in nature, with the negative moods in BPD often triggered by feelings of abandonment. Also, individuals with BPD don’t have the distinct periods of mania or hypomania that occur in Bipolar Disorder.*
Impulsive behavior is another overlapping symptom. In Bipolar Disorder, this typically occurs during a manic or hypomanic episode, whereas in BPD impulsivity is not mood-dependent.
*It is possible for someone to have both BPD and Bipolar Disorder, in which case a history of symptoms to adequately warrant both diagnoses would be present. An accurate diagnosis is important, especially since the treatment for these two disorders is quite different.
Individuals with BPD often have more than one psychiatric disorder. Common co-occurring disorders include substance-related disorders, major depressive disorder, PTSD, ADHD, and bulimia nervosa. Individuals with BPD may have another personality disorder as well.
It’s estimated that 2% of the U.S. adult population has Borderline Personality Disorder. As individuals with BPD reach middle-age and beyond, it’s not uncommon for their symptoms to gradually become less intense.Image: detail from "Borderline" by Katrin Alvarez
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