Borderline Personality Disorder
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Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the 'borderline' of psychosis, people with borderline personality disorder suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.Symptoms While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with borderline personality disorder may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with borderline personality disorder view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone. People with borderline personality disorder often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with borderline personality disorder feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. People with borderline personality disorder exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. Borderline personality disorder often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. Treatment Treatments for borderline personality disorder have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat borderline personality disorder, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking. Recent Research Findings Although the cause of borderline personality disorder is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to borderline personality disorder symptoms and traits. Studies show that many, but not all individuals with borderline personality disorder report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles. Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in borderline personality disorder. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.
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Studies from Yale University, Medical Department yield new information about personality disorders
2007 OCT 8 -- "This study compared psychosocial functioning and treatment utilization in 130 participants who were diagnosed with a borderline personality disorder (BPD), a non-BPD personality disorder (OPD), a mood and/or anxiety disorder (MAD), or had no current psychiatric diagnosis and served as a healthy comparison group. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) diagnoses, psychosocial functioning, and treatment utilization were determined by using well-established semistructured research interviews conducted by trained doctoral-level clinicians," scientists writing in the journal Comprehensive Psychiatry report. "Analysis of variance revealed the most severe deficits in functioning characterized the BPD group across areas of global functioning with more moderate impairments in functioning occurring in OPD and MAD groups. The BPD group was characterized by significantly greater psychiatric and nonpsychiatric treatment utilization than the other groups. These findings indicate that BPD as well as other personality disorders are a source of considerable psychologic distress and functional impairment equivalent to, and at times exceeding, the distress found in mood and anxiety disorders," wrote E.B. Ansell and colleagues, Yale University, Medical Department. The researchers concluded: "The public health impact of BPD diagnosis is highlighted by the high rates of psychiatric and nonpsychiatric treatment utilization." Ansell and colleagues published their study in Comprehensive Psychiatry (Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Comprehensive Psychiatry, 2007;48(4):329-336). Additional information can be obtained by contacting E.B. Ansell, Yale University, School Medical, Dept. of Psychiatry, POB 208098, New Haven, CT 06519, USA. The publisher of the journal Comprehensive Psychiatry can be contacted at: W B Saunders Co-Elsevier Inc., 1600 John F Kennedy Boulevard, Ste. 1800, Philadelphia, PA 19103-2899, USA. Keywords: United States, New Haven, Personality Disorders, Anxiety Disorder, Borderline Personality Disorder, Mental Health, Narcissistic Personality Disorder, Psychiatry, Psychosocial, Yale University, Medical Department. This article was prepared by Mental Health Weekly Digest editors from staff and other reports. Copyright 2007, Mental Health Weekly Digest via NewsRx.com.
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