Borderline Personality Disorder (BPD) is a serious mental illness that can cause a lot of suffering, carries a risk of suicide and needs an accurate diagnosis along with targeted treatment.
But there is hope. With appropriate treatment many sufferers show improvement in one year. Over time, 80% of BPD sufferers reduce their symptoms.
It is an often-misunderstood condition that has many challenging aspects, including intense and stormy relationships, low self-esteem, self-sabotaging acts, mood fluctuations and impulsivity.
The hallmark of BPD is emotional dysregulation (severe difficulty regulating emotions), perhaps due to an inability to soothe oneself in times of stress.
These symptoms can make it difficult in personal, social and employment relationships. BPD is estimated to affect about 1-2 percent of Australians. Although BPD is said to be more common in women, this is probably because it is recognised less frequently in men, who may be less likely to seek treatment.
BPD is a relative newcomer to the psychiatric world—it was officially recognized by the American Psychiatric Association (APA) for the first time in 1980. Related areas of research, medication, treatment options and family support programs followed suit.
The course of BPD depends on many factors. New research and treatment ideas have improved the outlook for people living with BPD, particularly if they are engaged in treatment. Often, the teens and early twenties are the hardest years, with frequent hospitalisations, suicide attempts and self-injury (like cutting) crises being common.
Recent studies have suggested the majority of those with borderline personality disorder do well over time, with most experiencing sustained relief from symptoms, and around half being completely free of symptoms and able to function well in life. Pursuing treatment and learning about the condition and ways to manage it often pay off. In this way, BPD may be a high-risk condition but it has a good outlook.
The causes of BPD are unclear. Historically BPD was seen as having ‘abuse’ as central to the cause. Most experts agree there is not one single cause of borderline personality disorder. As with most conditions, BPD appears to be the result of a combination of genetic and environmental factors. Genetic factors may include inheriting certain genes or personality traits, and there are a number of environmental factors that may play a role. The most severe may be various forms of abuse: emotional, physical and sexual. Loss and neglect may also be contributing factors.
However, some people with no history of abuse at all also develop BPD. The current theory is that some people may have a higher biological or genetic vulnerability to this condition, and adverse childhood conditions can increase the risk of eventually developing the disorder. The experiences of people living with BPD who have no history of experiencing abuse also indicate that there can be a very strong biological component to the condition. It is important to remember that due to biological differences, some children need much more support, emotional coaching and interpersonal validation than others. The emphasis of many treatments is to focus on the present-day realities and strategies to cope while respecting the role of the past in the person's life.
Clinical criteria as published by the American Psychiatric Association in the Diagnostic and Statistical Manual (DSM) IV used to make a diagnosis of BPD are:
A pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning in early adulthood and presenting in a variety of contexts as indicated by five or more of the following:
1) frantic efforts to avoid real or imagined abandonment;
2) a pattern of unstable and intense interpersonal relationships;
3) identity disturbance;
4) impulsivity in at least two areas that are self–damaging;
5) recurrent suicidal behavior, suicidal gestures, threats or self-mutilating behavior;
6) affective [mood] instability;
7) chronic feelings of emptiness;
8) inappropriate, intense anger; and
9) transient stress-related paranoid ideation or severe dissociative symptoms.