Have you a sneaking suspicion that you, or someone you care about may have something wrong with them which feels a little more serious than an anger management/anxiety/impulsive behaviour problem? Are concerned that your loved one may have a psychiatric disorder?
If you have any concerns at all that you, or someone you know has a serious psychiatric condition, you should always consult your doctor in the first instance, but we’re going to discuss a less well-known disorder here that is often missed when sufferers present for examination by their general practitioner.
Borderline Personality Disorder (BPD), also referred to and classified as Emotionally Unstable Personality Disorder (Borderline Type) is a condition which is easily missed or misdiagnosed because its symptoms are diverse, episodic and often invisible to others. It is often mistreated because it is only relatively recently that treatment plans have been developed specifically for managing the disorder. Many physicians, psychologists and psychotherapists have yet to bring their training in this area up-to-date.
It is believed that 1-2% of adults in North America and Europe are living with Borderline Personality Disorder, a disorder which is easily misdiagnosed and mistreated. A condition which causes extreme and often disturbing changes in behaviour, when untreated, it can have a pervasive effect on all aspects of the life of not only the sufferer, but those of others around them as well.
What Are The Symptoms of Borderline Personality Disorder?
One of the reasons why BPD is so often missed initially is because its symptoms are so wide ranging.
The DSM IV (an internationally used diagnostic manual) identifies that in order to be diagnosed as suffering from BPD, a patient must present with at least five of the following symptoms:
- Frantic efforts to avoid real or imagined abandonment. Sufferers characteristically devote a great deal of time and energy to trying to secure a strong attachment figure in their lives, but are invariably unable to accept the security of that relationship, even when it does exist.
- Chronic feelings of emptiness. Described by many sufferers as a black hole or discontented nothingness. The fear of abandonment as described above is often one of the few feelings to permeate this seemingly unbearable state. If left untreated, this emotional state becomes stable and constant as a defensive response to the inner pain, anger, and distress. Chronic feelings of emptiness. Described by many sufferers as a black hole or discontented nothingness. The fear of abandonment as described above is often one of the few feelings to permeate this seemingly unbearable state. If left untreated, this emotional state becomes stable and constant as a defensive response to the inner pain, anger, and distress.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. It is both the search for an end to the emptiness and the fear of abandonment that lead to this unstable pattern. The desperate need to fill the gap leads to idealization, while the paranoid belief that she is about to be abandoned (usually because the idealized object cannot ever meet the depth of need in reality) inevitably produces the devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self. Sufferers may have great difficulty in maintaining an image of self which bears any relationship to reality. Variations include difficulty tolerating the physical self; a feeling of being alternately “bad” or “good”; confusion about sexual orientation; difficulty in holding on to an image of the self.
- Impulsive behaviour in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). These behaviours usually serve as an attempt to erase feelings of emptiness and may be compulsive or obsessive in nature.
- Recurrent suicidal behaviour, gestures, threats or self-injuring behaviour such as beating or banging self against walls, cutting, interfering with the healing of scars or picking at oneself. These behaviours serve as an alternative to living with the emotional emptiness, or to punish the hated part of the self.
- Rapid mood changes (e.g., intense, but episodic depression, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). This apparent poor impulse control stems from a sensitivity to perceived criticism and the tendency to view the internal self as a victim of others’ neglect, failure, disrespect or malevolent acts.
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms. When stressed (often a frequent state), a sufferer can lose fleetingly lose touch with reality, believing that otherwise benign or disinterested protagonists have malevolent intent towards them.
How Is Borderline Personality Disorder Treated?
There are several treatments of choice specifically for BPD. Two are variations of cognitive behavioural therapy, following a psycho-educational model which teaches sufferers skills to manage the condition:
- STEPPS (Systems Training for Emotional Predictability and Problem Solving)
- Dialectical Behavioural Therapy
Both of these approaches are taught in groups, although DBT also has an individual therapy component. The approaches are similar in that the focus is on skills rather than healing – program participants are taught to recognise their destructive or negative feelings rather than fight or succumb to them.
This psychodynamic-based treatment focuses on patient’s the present state and how it remains influenced by events of the past. Group therapy is alternated with individual work.
While they desperately want help and attention, people with BPD typically fight shy of the group experience which is part and parcel of treatment for the condition. Individual therapy often provides a bridge readiness for group therapy, which is an important part of management and recovery.
Several of the therapists at The Therapy Hour have specific training for the management of BPD and are able to work with diagnosed and undiagnosed sufferers both on and off-line, subject to clients being prepared to work within set boundaries for contact.