Borderline Personality Disorder

Borderline personality disorder is a disorder that is characterized by a growing and spreading instability of the mood, which also affects interpersonal relationships, self-image, and general behavior. Family and work life, long-term planning ability, and the individual's sense of self-identity can all be adversely affected by this disorder. In the past, this disorder was considered borderline psychosis; People with BPD actually have a disorder in the regulation of emotions. BPD is less well known than schizophrenia and bipolar disorder (manic-depressive disorder), but it is more common: it occurs in 2% of adults, and especially in young women. Among those who suffer from it there is a high rate of self-harm with no suicidal intent. However there is also a significant rate of suicide attempts, as well as of suicides carried out in severe cases. Sufferers typically require extensive mental health services, making up 20% of those hospitalized in psychiatric wards. However, the condition of many of them improves following professional assistance, and over time they come to the ability to lead a fruitful life.

While a person suffering from depression or bipolar disorder is usually in the same mood for a few weeks, a BPD sufferer may experience acute tantrums, depressive feelings and anxiety attacks that last only a few hours, or at most a day. These are sometimes associated with episodes of impulsive aggression, self-harm, and drug and alcohol abuse. Distortions in perception of reality and self-esteem can lead to frequent changes in long-term goals, that is, in that person's plans for career, work, friendships, and values. Sometimes people with BPD see themselves as inherently bad and worthless. They may feel incomprehensible, or imagine in their minds that those around them are treating them unfairly without any justification. Other feelings that may arise in them are boredom, emptiness, and blurring of the sense of self-identity. These symptoms worsen when the person with BPD feels isolated and lacks social support, and it is also possible that for this reason every effort will be made to avoid loneliness. In people with BPD, a very unstable pattern of social relationships can often be noticed. These people are capable of forming intense but turbulent relationships. Their attitude toward family, friends, and other loved ones may suddenly turn from an attitude of idealization — immense admiration and love — to an attitude of contempt, much anger, and rejection. Thus they can create immediate closeness and believe that the other is wonderful and uplifting, but when a small breakup occurs or when a conflict arises, they abruptly move on to the other extreme and blame the other for not caring about them at all. They are very susceptible to abandonment even by family members, and respond with anger and pressure to a moderate breakup such as a vacation, business trip or unexpected change of plans. These abandonment anxieties are probably due to their difficulty in feeling emotionally connected to the significant people in their lives during physical absence. This difficulty therefore leaves the BPD sufferer with a sense of loss and self-worthlessness. Threats of suicide (and its realization) may be accompanied by the rage bubbling up in them in the face of the possibility of abandonment or disappointment. Another characteristic of BPD is impulsive behavior. This may include excessive wastefulness, binge eating, and dangerous permissive behavior in the interpersonal realm. BPD is often accompanied by other psychiatric problems, especially bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Over the past few years, BPD treatment options have improved. Individual and group psychotherapy is found to be at least partially effective in many cases. Over the past 15 years, an innovative psychological treatment known as dialectical behavior therapy (DBT) has been developed specifically for the treatment of these patients, and this technique has been found to be promising in studies conducted on the subject. Experts often recommend pharmacological treatments based on specific target symptoms, which are observed in the particular patient. Antidepressants and mood stabilizers may benefit those suffering from depressive and / or unstable moods. Antipsychotic medications may also be helpful in case the patient has thought distortions.

The cause of BPD is unknown. It seems that environmental factors as well as genetic factors have a part in the predisposition to this disorder. Studies show that most - but not all - people with BPD report a history of abuse, neglect, or separation in early childhood. Between 71% and 40% of BPD patients report sexual abuse, usually not from the person who treated them. Researchers believe that BPD is the result of a combination of personal vulnerability to environmental stress, neglect or abuse in early childhood, and a series of life events that act as a kind of 'trigger' - triggers - for the onset of the disorder in early adulthood. Even adults with BPD have typically been victims of violence, including rape and other crimes. BPD may therefore result from a harmful environment combined with impulsivity as well as poor judgment regarding spouse choice and lifestyle. Studies in the field of brain neurology find that brain mechanisms are the basis of impulsivity, mood instability, aggression, anger, and negative emotions expressed in people with BPD. The researchers believe that people with a predisposition to aggression have limited ability to regulate the neural circuits in the brain. The function of these circles is to moderate the emotions. Deep in the brain there is a small almond-like structure called the amygdala, which is an important component in the circle due to being the regulator of negative emotions. In response to signs (signals) from various centers in the brain, indicating a possible threat, it produces feelings of fear and arousal. These feelings may be more pronounced under the influence of drugs or alcohol, and also under the influence of stress. Certain areas in the front of the brain act to inhibit and weaken the activity of the circuit. Recent brain imaging studies point to differences between different people in terms of the ability to activate the forebrain area, which is thought to be related to inhibitory activity. This ability may predict an individual's ability to dispel and get rid of negative emotions. Serotonin, norepinephrine and acetylcholine are, among others, the chemical 'messengers' in these circuits. They play a role in regulating emotions, including sadness, anger, anxiety and nervousness. Drugs that enrich the action of serotonin in the brain may reduce the severity of BPD symptoms. Also, mood stabilizers known to enable better activity of GABA, the neurotransmitter (transmitter of neurotransmitters) the main inhibitor, may benefit people experiencing BPD mood swings. In general, tendencies that depend on brain activity such as this disorder can be managed with the help of behavioral interventions and with the help of medication, largely as people deal with a predisposition to diabetes or high blood pressure.

Studies that translate findings related to mental temperament and mood regulation into neurological terms, i.e., terms of neural activity in the brain, allow relevant clinical conclusions to be drawn that have a direct impact on BPD, and they occupy an increasing research space. There are also studies examining the effectiveness of combining medication with behavioral therapy such as DBT, as well as examining the effect of abuse and other stressful situations in childhood in people with BPD on brain hormones. Data from an ongoing long-term study of BPD, dating back to the early 1990s, should reveal how treatment affects the course of the disease. The study will also accurately point to specific environmental factors and character traits that predict a more positive therapeutic outcome.