WHAT IS WRONG WITH YOU!!!?

You may never have heard of borderline personality disorder (BPD). But by the time you finish reading this article, you may recognize yourself or someone you know in the description of this serious emotional disturbance. Some experts believe that it is the most common personality disorder and that it may affect as many as 2 percent to 3 percent of the U.S. population. About 75 percent of those affected are women.

BPD is characterized by disappointing and unstable relationships, fears of abandonment - real or imagined - intense anger and feelings of emptiness.
"People with BPD have an enormous need for love and a terrible fear of closeness," says Lloyd A. Wells, M.D., a psychiatrist at Mayo Clinic in Rochester, Minn.

Inside BPD
People with BPD have disturbed thinking and are constantly in a state of emotional turmoil. They're calm and rational at times but may explode into inappropriate anger or rage at some perceived rejection or criticism.
Affected people are terrified of being alone yet push others away with their erratic behavior. "People with this disorder often get into repetitive, rather predictable crises often related to the fear of abandonment," says Dr. Wells. " Yet their behaviors often do lead to abandonment."
Common occurrences, such as a spouse being a few minutes late, may prompt sudden fury or despair. People with BPD are likely to believe this "abandonment" implies that their partners don't love them anymore or that they're "bad." When a loved one is perceived as uncaring, a person with BPD may react with extreme sarcasm, lingering bitterness or verbal abuse. These outbursts may be followed by feelings of guilt.
Affected people may idealize a new lover and demand lots of time together. This switches quickly to devaluing that person and feeling that he or she doesn't care enough or isn't dependable. As a result, relationships are stormy and unstable.
"People with BPD are immensely demanding and tend to see other people in black or white ways - their worlds are full of good guys and bad guys, rescuers and tormentors," says Dr. Wells.
They often view themselves as victims of circumstance and take little responsibility for themselves or their problems. In their frantic efforts to avoid abandonment, they may demonstrate actions such as self-mutilation or suicidal tendencies. They may also gamble excessively, spend money irresponsibly, binge eat and abuse substances.
Affected people may also experience sudden and dramatic shifts in their self-image, which can be expressed in a shift of their goals and values. They may quickly change their opinions and plans about their career, sexual identity and types of friends.
"People with BPD also may have brief periods in which they are out of contact with reality," says Dr. Wells. "They may 'space out' quite often."

Likely instigators
Doctors don't know for sure what causes BPD, but there are clues. Most likely, no single factor explains its development. Instead, it may be a combination of:
Hereditary predisposition - You may be at five times the risk for BPD if a close family member (mother, father or sibling) has it.
Childhood abuse - Some studies have suggested that as many as half or more of all people with BPD may have been physically or sexually abused as children.
Neglect - Many with BPD describe severe deprivation, neglect and abandonment during childhood.
Neurologic injury in early childhood - Some studies have found an unusually high prevalence of childhood head injuries in people with BPD.

Nailing down the diagnosis
Doctors look for at least five of the following signs to determine if a person has BPD:
Intense fears of abandonment
A pattern of unstable relationships
A precarious self-image
Impulsive and self-damaging behaviors such as overspending and substance abuse
A tendency toward suicide or self-mutilation
Wide mood swings
Chronic feelings of emptiness
Intense anger, violent outbursts
Periods of paranoia and loss of contact with reality
A diagnosis of BPD in adolescents is premature, according to Dr. Wells. "Borderline behaviors are based, in part, on defenses and adaptive mechanisms," he says. "These are relatively fixed in adults, but not in kids, and borderline features in kids often disappear. They often do very well in adult life."

Treatment strategies

Treatment for BPD can be difficult and long-term, lasting years in many cases. People who have the best chance for success seek out treatment for themselves and find a therapist experienced in BPD. Success depends on the affected person sticking to the therapy and taking responsibility for his or her problems.

Treatment for BPD usually involves a combination of:
Psychotherapy - The most effective types of counseling appear to be psychodynamic therapy and dialectical behavior therapy (DBT). Psychodynamic therapy focuses on internal experiences, relationships and self-destructive behaviors. DBT focuses on coping skills - learning how to take better control of behaviors and emotions.
Medications - Antidepressants, antipsychotics and antianxiety drugs may be used at times during treatment to take the edge off symptoms. They're not cure-alls or intended to take the place of psychotherapy.

Getting better
Doctors concede there's no one path to recovery from BPD. The condition appears to be worse in young adulthood and may gradually diminish with age. The majority of people with BPD attain greater stability in their lives during their 30s and 40s.
Although many still believe that affected people can never recover from BPD, that's not true. Today, psychotherapy combined with medications can be effective at reducing or eliminating many of the most troublesome symptoms of BPD. Many people once in psychic misery now feel good about themselves and are able to sustain loving relationships and enjoy meaningful careers.