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Borderline Personality Disorder - BPD

Borderline Personality Disorder (BPD) is often diagnosed during childhood years. This Borderline Personality Disorder article discusses the risk factors of BPD as well as the symptoms and treatment options available to treat borderline personality disorder, or BPD.

Borderline Personality Disorder has become a controversial diagnosis. It has been suggested that the name is problematic—the ICD-10 now calls it “Emotionally Unstable Personality Disorder”—and that the description and placement in the DSM-IV does not properly show its etiology, placing it among personality disorders rather than among disorders that arise largely from psychosocial and environmental factors, particularly in childhood.  

The risk factors—abandonment during childhood or adolescence, disruption in family life, having a family with poor communication skills, and sexual abuse—seem clearly linked to the resulting symptoms, which are overall characterized as people with unstable identities:

  • fear of abandonment
  • inappropriate anger, frequently expressed
  • emotions that are strong and frequently interchanging
  • impulsiveness and risk-taking; difficulty with self-control
  • inability to be alone
  • feeling bored and empty
  • repetitive crises, which may include self-injury
  • a distorted self-image, including feelings of worthlessness
  • “black-and-white” thinking (inability to see things except in terms of extremes)
  • suicidal behavior

The fear of abandonment and hope for acceptance that people with borderline personality disorder feel can lead them to idealize people initially, and demonize them when their (unrealistic) expectations are not met. The turbulent emotions and what may seem to others to be “neediness” and “emotional immaturity” can result in problems in all types of relationships, from work to social to intimate, and difficulty in school and the workplace.

People who are diagnosed with borderline personality disorder may have other mental health issues, including anxiety disorders; eating disorders; mood disorders, such as depression or bipolar disorder; and may be involved in substance abuse. Engaging in risky and/or impulsive behavior may also result in careless sexual behavior, with outcomes ranging from sexually transmitted diseases (STDs) to unplanned pregnancies.

Treatments for borderline personality disorder vary with the case. A person who is suicidal or self-injuring may be best served by hospitalization to keep the person safe. Medications may be used—not to cure, but to ameliorate symptoms and treat related problems, such as anxiety, depression, and impulsivity. The medications that are used include anti-anxiety medications, antidepressants, and antipsychotics.   

Psychotherapy is often the main treatment, and two different types have been found to be most effective. Dialectical Behavior Therapy (DBT), a form of cognitive behavioral therapy, was specifically adapted by Marsha Linehan from CBT in order to treat patients diagnosed with borderline personality disorder, and is considered the most effective approach overall. This type of therapy is conducted in person, with individual and group sessions, as well as phone contact, and helps the client learn skills that are useful in controlling emotions and tolerating stressful situations and feelings, all of which tends towards improving one’s relationship with oneself and others. The overarching sequencing plan is based on making sure the client is safe, so life-threatening issues are the first dealt with. Also used is Transference-Focused Psychotherapy (TFP), which uses the client–therapist relationship to help the client learn how to navigate the emotions and stresses that occur in any relationship and generalize from the one relationship to others.



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