Borderline Personality Disorder BPD - Mental Health

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Borderline personality disorder (BPD) is a serious mental illness. It is characterised by pervasive instability in behaviour, moods, interpersonal relationships and self-image. Instability in the sufferer's life often disrupts family and work life, relationships, long-term planning and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation.

While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women (USA) There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 Yet, with help, many improve over time and are eventually able to lead productive lives.

People suffering from BPD often have highly unstable patterns of social and personal relationships. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence.

There are two variants of Borderline Personality Disorder:

Impulsive type: The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism.

Borderline type: Several of the characteristics of emotional instability are present and in addition the sufferer's self-image, aims, and internal preferences are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm.

The symptoms of BPD can occur in a variety of combinations, and individuals with the disorder have many, sometimes all, of the following traits:

• fears of abandonment
• extreme mood swings
• difficulty in relationships
• unstable self-image
• difficulty managing emotions
• impulsive behaviour
• self-injuring acts
• suicidal ideation
• transient psychotic episodes

Treatments for BPD have improved markedly in recent years. Group and individual psychotherapy are at least partially effective for a large number of patients. The individual outpatient psychotherapy for the borderline patient usually consists of 2-3 therapy sessions a week over a number of years. The therapist works with the patient to understand the meanings and motives of their behaviour and to strengthen capacity to endure frustration, anger and loneliness without acting impulsively upon those feelings.

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