Characteristics of borderline personality disorder, its essence and clinical picture. The main factors that cause this disease. Basic approaches to psychotherapy and drug treatment. Borderline personality disorder is a mental illness characterized by emotional instability, impulsivity, low levels of self-control, and impaired interpersonal relationships. Most often it begins at a young age with blurred symptoms that are very difficult to notice.
Description of borderline personality disorder
Borderline personality disorder is a mixed state in which symptoms of the mental level are recorded, which appear as a kind of psychological defense against changes at the neurotic level. Thus, this pathology is difficult to attribute to any specific diseases, so it was decided to single out a separate category of borderline disorder. The selection of this nosology has been in question for many years. The fact is that some psychiatrists considered it necessary to include borderline personality disorder in international classifications, while others did not see this need. Thus, the study of this disorder has taken a long time and has always developed debate among scientists. The similarity of the symptoms of this disease with other nosologies leads to repeated errors of clinicians who find it difficult to determine the correct diagnosis and often expose depression, bipolar affective or obsessive-compulsive disorder. This distorts the statistics significantly, and the prevalence of the disease is likely to be much higher than the available numbers. Almost 75% of all cases of diagnosis of this disease are observed in women. Among the entire adult population, borderline personality disorder occurs in 3%. This is a very high indicator, which indicates the urgency of this problem and requires close attention of clinicians. Moreover, suicidal behavior, which is often observed in this nosology, leads to suicide. Statistics show that almost one in 10 patients with borderline disorder commits suicide.
The main causes of borderline disorder in humans
Despite the fact that this is a fairly common pathology, there is no consensus on the etiology of the disorder today. Most support the multifactorial theory of the onset of the disease, the essence of which lies in the combined influence of various factors. There are several main hypotheses that explain Borderline Personality Disorder Syndrome:
- Biochemical theory … It is known that human emotional responses are regulated by the ratio of brain neurotransmitters. The main ones are represented by dopamine, norepinephrine and serotonin. So, for example, if there is a lack of serotonin, the mood worsens and the person sinks into a depressive state. Low concentration of dopamine contributes to the fact that a person does not feel "rewards" for their work and life, thus turning it into a waste of time. If the body lacks endorphin, for example, it becomes very difficult for the individual to resist stress and withstand powerful emotional reactions.
- Genetic theory … As with most mental disorders, the presence of such diseases in relatives or in the pedigree matters. Most of the genotype has not yet been deciphered, so it makes sense to assume that the likelihood of developing a disease such as borderline disorder will be laid down at the DNA level. It is believed that an increased chance of getting sick is not only for those whose relatives were sick with the same disease, but also for people whose loved ones have any psychoemotional changes.
- Social theory … It is believed that the disease develops more often in those who grew up in disadvantaged families. The use of alcohol and drugs by parents, as well as their neglect of the child, form an extremely unfavorable background in which a personality with emotional defects develops. Since children tend to subconsciously copy the behavior of their parents and set them as an example, antisocial behavior in a family with a small child can forever leave an imprint on his character. The system of self-esteem and permissiveness is violated, generally accepted frameworks of behavior are not established, and a person cannot fit into society.
- Psychotraumatic theory … Almost any event in a person's life that had a significant impact on his psyche and caused a strong emotional reaction can affect the formation of his personality in the future. Particular importance should be given to mental, physical or sexual abuse experienced at an early age. It is the belittling of one's own value and personality as such that has a powerful effect on a person in the future. There are also some changes in people who lost loved ones in childhood and could not cope with it. This means not only the death of relatives, but also leaving the family, as happens during a divorce.
- Parenting theory … It has long been known that a good and correct upbringing is the key to a full-fledged formed personality. It should be based on both severity and discipline, and love and affection. It is important to maintain a balance between these poles. This is usually achieved with the help of two parents, one of whom sets the framework, and the other provides all kinds of support. If the unhealthy microclimate in the family with the oppressive dictatorial behavior of the parents dominates, then with a high probability the child will develop as a personality with an anxious component. Or, on the contrary, an overly gentle, courteous upbringing with all kinds of rewards without control and restrictions will bring up a demonstrative personality who will not reckon with the general rules and will not be able to adapt in society.
Signs of having borderline personality disorder
The symptoms of BPD can be very different from person to person. This means that there are very few specific symptoms of the disease. This greatly complicates the diagnosis and treatment of the disease. The development of specific symptoms depends on the individual, how they were raised, their worldview, and emotional sensitivity. The environment also plays an important role. A supportive environment and a high quality of life significantly improve the adaptation of people with borderline personality disorder (BPD).
There are 6 main aspects of the clinical picture with this disease:
- Interpersonal relationships … Interacting with other people always requires a certain amount of emotional involvement and response. Those who develop BPD are characterized by instability in their feelings and emotions. Their mood is extremely unstable and fluctuates very often. Moreover, these personalities are sensitive to the slightest emotional changes in the outside world. For example, a phrase or remark from the outside, said just like that, which most people would ignore, such persons will definitely notice. Moreover, it will disturb them constantly. People with BPD react extremely sharply to such insignificant factors and often change the pole of their emotional color. For example, one minute they are extremely happy with a certain person, and a moment after the "slanting" look from his side they interpret him as the strongest offense. Such emotional fluctuations do not give rest to the patients themselves, or to their loved ones. They are constantly on the verge of feelings and perceive this world a little differently.
- Categorical … The feelings of such individuals, as mentioned above, are very fragile. Their balance is easily disturbed by any little things that usually do not matter much. They tend to perceive everything in this world either good or bad. The other person cannot be neutral for them. He is either a good friend of theirs or an enemy who hates them. Individuals with BPD do not distinguish colors between black and white, thus, they are always categorical in their decisions. This also applies to self-esteem. In some cases, it goes off scale, since the encouragement from the outside can lift it up very high. In other cases, self-esteem falls and the likelihood of developing a depressive state increases. Associated with this is the high frequency of completed suicides among individuals with BPD. If they decide to end their lives, they will be very categorical in this matter, even if the reasons are insignificant and do not explain such a depressed state.
- Fear of loneliness … Depending on other personality traits, this phobia can manifest itself in different ways. In some cases, this is aggressive and even dictatorial behavior, which is aimed at keeping loved ones around. Sometimes the fear of loneliness manifests itself in excessive tearfulness and weakness, through which people are manipulated so that they are not abandoned. Loneliness in their understanding does not only mean a long-term separation. Even if a loved one is away for several hours, it is a huge stress for a person with BPD. Since they are extremely emotionally unstable, they try to keep a constant field of positive emotions near them, including a loved one. Against this background, panic attacks, bouts of anger or aggressive behavior are often observed. But in fact, all of them are aimed at keeping a loved one near them. This can reach a level of absurdity where people with SPD are reluctant to part with others, even for a few hours.
- Self destruction … This is a very important characteristic of people with BPD. Due to the same emotional instability, they tend to perform any actions that lead to the destruction of their own body or poor health. This sometimes manifests itself as risky behavior, bordering on danger. Most often, self-destructive behavior is hidden under the manner of fast driving, a tendency to abuse alcohol and drugs, and bulimia. Some experts argue that the desire to be constantly updated with the help of tattoos also belongs to this group. The data shows that about 80% of people who get a tattoo and are unhappy with the result, but still return for another, are most likely suffering from borderline personality disorder. This behavior often leads to accidents that cannot be interpreted as suicide, but in fact they are also caused by the disease.
- Self-perception impairment … The ability to correctly identify oneself as a separate person with character and feelings, as well as to determine one's qualities and mood in a particular period of time is very difficult for people with BPD. That is, they do not perceive themselves as a specific characterological type. For example, some people describe themselves as risky and extreme, while others are more inclined to be domestic and caring. For people with BPD, there is no concept of character or description. They have periods in which they feel one at a time, and then the character completely changes and further behavior cannot be predicted. The problem is that it is difficult for them to identify their feelings and behavior, break it down into parts and assess whether it is good or bad.
- Loss of control … Virtually all manifestations of BPD are coincidental and not controlled by the individual. That is, all emotional reactions to events unfold regardless of true feelings and opinions. Aggressive behavior, outbursts of anger and panic occur without the intervention of the person himself. Moreover, they cause trouble both to himself and to those around him that they did not deserve such treatment. The system of values and assessments has been violated. At one moment a person admires something and is carried away, and at another he feels disgust and even aggression towards it. This negatively affects personal relationships and undermines the authority of the person with BPD in the eyes of others.
What are the forms of borderline disorders in humans?
In fact, each individual case of borderline personality disorder is individual and slightly different from the classical description. Already in the XXI century, it was possible to identify several psychotypes that differentiate among themselves:
- Phobic form … In borderline personality disorder, symptoms are colored by fears that dominate the person's thoughts. In practice, this manifests itself as an anxious-phobic background that leaves an imprint on all emotions and actions. Most often, such people avoid responsibility, become attached to someone and have a hard time parting. They tend to exaggerate small problems.
- Hysterical form … It is characterized by dramatic and pretentious behavior. All actions are aimed at meeting their own needs. They tend to manipulate others and over-express their feelings. Strong affective reactions or, conversely, emotional emptiness are characteristic. It also includes self-harming behaviors with suicidal thoughts.
- Pseudo-depressive form … It is a set of depressive symptoms that differ from the classic version. Due to the inability to evaluate himself correctly, a person rushes from the ideal of himself to the worst form of his own person. Such swings often cause suicidal thoughts and can manifest as auto-aggression.
- Obsessive form … A person realizes his emotional instability with the help of various overvalued ideas. Tries to plan ahead for some events or things to be done. Through this, internal tension is reduced and, accordingly, emotional instability is covered by obsessions.
- Psychosomatic form … It manifests itself in the form of somatic symptoms that are observed from the gastrointestinal tract or cardiovascular system. A person's psychological experiences do not come out and manifest themselves in the form of somatic pathology. When diagnosing, no specific morphological changes are observed.
- Psychotic form … It is the most severe variant and manifests itself with various productive psychotic symptoms, such as hallucinations or paranoid delusions. A person directs their fears and experiences in a specific direction and focuses on psychotic signs. At this time, self-destructive behavior is used in order to distract oneself from them, to return to reality.
Treatment considerations for borderline personality disorder
The erosion and individuality of the symptoms of this disease predetermines the breadth of the spectrum of therapeutic agents, and with this their low effectiveness. Evidence-based medicine testifies to the non-pronounced effect of typical psychotropic drugs, which are prescribed symptomatically. This is what explains polypharmacy, a common tendency to be treated with multiple drugs at the same time. In addition to pharmacotherapy, psychotherapeutic methods of treatment are also used, which can also be effective in some cases.
Drug therapy
Therapy for borderline personality disorder is prescribed on an individual basis by a specialist. Each drug must be selected for a specific case, and also adapted to all medications that a person is already taking. The importance of this nuance can hardly be overestimated.
In general, treatment for borderline disorder is symptomatic. That is, drugs are selected for the existing signs of the disease and eliminate them. Correction of dosages and the choice of a specific representative of a particular pharmacological group should be dealt with exclusively by a doctor.
Consider medications for treating borderline personality disorder:
- Antidepressants … The most common symptom of PLR is a depressed state, which is caused by the emotional instability of the human psyche. Thus, he plunges into a characteristic depression. Of the antidepressant arsenal for borderline personality disorder, selective serotonin reuptake inhibitors are best used. At the biochemical level, they equalize the balance of neurotransmitters and correct a person's mood as needed. The main representatives of this group are: Fluoxetine, Sertraline and Paroxetine. It is important to take into account that these drugs in the right dosages can have different effects. The effect of these funds comes quite late - after 2-5 weeks, which necessitates long-term therapy under the supervision of a doctor.
- Antipsychotics … The use of antipsychotics is associated with several psychotic symptoms that may appear as part of the clinical picture of borderline personality disorder. First generation antipsychotics (Chlorpromazine, Haloperidol) have little effect on symptoms. The next generations turned out to be more effective in this regard - Olanzapine, Aripiprazole, Risperidone. The use of these funds is necessary to control impulsivity. They give the best effect in combination with some methods of psychotherapy.
- Normotimics … This is a group of drugs that control mood levels and eliminate anxiety. Studies have shown the high effectiveness of drugs, valproate, in contrast to other members of this group. It is advisable to prescribe these funds for borderline personality disorder from the first days after diagnosis. Some sources claim that valproate is the first choice for this condition.
Important! Benzodiazepine drugs are absolutely contraindicated in borderline personality disorder.
Psychotherapeutic assistance
Psychological support of family and friends, as well as a course of psychotherapeutic treatment will be the best choice in the treatment of borderline personality disorder. The choice of a specific technique should be made by the doctor after examination and conversation with the patient:
- Dialectical Behavioral Therapy … Has the greatest effectiveness in this disease. Its essence is in identifying negative patterns in behavior and replacing them with positive patterns. It is used in the presence of self-destructive symptoms in the clinical picture. Helps relieve unhealthy habits and other symptoms of BPD.
- Cognitive Analytical Therapy … It is also very often used for this pathology. Its essence lies in the creation of a specific model of psychological behavior that is dictated by the disease. It is necessary to highlight all the important points that need to be eliminated. Having such an idea about their disease, a person will be more critical of the symptoms and will even be able to fight them on their own.
- Family psychoeducation … It is a method that is used in the rehabilitation of patients after mental disorders. Its peculiarity is the involvement of a person's family and friends in the process. They participate in psychotherapy together, thereby sharing the severity of the problem with themselves.
What is borderline personality disorder - watch the video:
Borderline personality disorder is a very common mental illness that, unfortunately, is underdiagnosed. Its symptoms cause significant difficulties in a person's ordinary life, create problems in personal relationships and significantly impair the quality of life. That is why treatment for borderline personality disorder must be comprehensive and, most importantly, timely.
