| BORDERLINE PERSONALITY DISORDER |
| According to DSM-IV Borderline Personality Disorder (BPD) is a "pervasive pattern of instability of interpersonal relationships, self-image, and affects, and a marked impulsivity that begins in early adulthood and is present in a variety of contexts." People with BPD make frantic efforts to avoid real or imagine abandonment, they have a unstable and intense relationships (often are very demanding of others and may switch suddenly from idealizing someone to devaluing them), may have an identity disturbance (e.g. unstable self-image), they are impulsive in two areas (reckless spending, gambling, binge eating, substance abuse, unsafe sex, reckless driving, they display recurrent suicidal or self-mutilating behaviour, their mood is unstable (e.g. intense dysphoria, irritability or anxiety which lasts only a short time), they have a basic dysphoric mood which is interrupted with brief periods of anger/panic/despair, are troubled by chronic feelings of emptiness and are easily bored, they have frequent displays of intense anger and often have trouble controlling their anger, and sometimes in periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g. depersonalisation) may occur. People with BPD may undermine themselves just before a goal is about to be achieved (e.g. dropping out of school just before they graduate), regress severely after being told how well therapy is going or end a relationships that is showing some potential of lasting. Premature death from suicide may occur with people with BPD especially in those who also suffer from mood-disorders or substance-related diorders. It is not uncommon for people with BPD to have physical handicaps from self-harm or attempted suicide. The childhood of people with BPD is often traumatic with physical and sexual abuse, neglect, conflict and parental loss/separation common features. BPD is diagnosed predominantly in females, around 75%, and is estimated to affect around 2% of the population. It is five times more common amongst those with relatives with the disorder and there is also an increased family risk for substance-related disorders, anti-social personality disorder, and mood disorders. There is treatment available for BPD either talking therapies or medication. It is advisable that there is some psychological input in the treatment of people with BPD because it is not a chemical condition and through talking therapy people with BPD are able to learn to change their patterns of behaviour. Treatment can take a long time but research shows that after fifteen years 75% of people diagnosed with BPD no longer meet the criteria. There are three types of therapy commonly used for the treatment of BPD: One-to-One or Group Psychotherapy Patients are able to discuss present difficulties and past experiences in a safe environment with someone who is empathetic and non-judgemental. The therapy has to be consistent and the patient should be encouraged to talk about their feelings. Different therapists will use different approaches depending on their specialised school of thought. Cognitive Analytical Therapy Cognitive Analytical Therapy (CAT) is about step-by-step planning and measurement of change, and teaching patients to observe their own moods, thoughts and symptoms. CAT aims to help the patient revise old patterns of behaviour that are no longer effective, identify problems, naming sequences and patterns of thinking that limit our choices, setting realistic targets and goals for challenging and changing sequences, and finding ways to keep hold of this change. Dialectical Behaviour Therapy This is a relatively new concept developed in the US for people with BPD. It uses cognitive and behavioural principles and has two main components - one-to-one and group therapy. The one-to-one therapy looks at how the individual copes with emotional turmoil by analysing recent difficulties and then exploring alternative ways of coping. The group sessions focuses on coping strategies/mechanisms, skills training, and identifying and utilising personal skills/attributes to cope with problems that arise. Often therapy is supplemented by medication, e.g. anti-depressants or anti-psychotics, to help ease the symptoms of BPD such as depressed mood, anxiety and impulsiveness. Two common medications that are used are Carbamazapine and Flupenthixol Decanoate. Please see the section on medications for more information. Many people still refuse to believe that there is such a thing as a personality disorder and see them as being untreatable but they are listed in DSM-IV and ICD-10. It is difficult to diagnose and treat personality disorders but it doesn't mean they don't exist. Please see the links page for details of other websites which look at borderline personality disorder |
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