Borderline Personality Disorder

Borderline personality disorder (BPD) is a neuropsychiatric disorder associated with mood instability, significant impulsivity, and a high rate of suicide. Chronic and severe in nature, BPD affects nearly 1% of the human population, and individuals that are female, divorced, separated, below 20 years of age, and/or have lower incomes are more likely to be diagnosed with the disorder. Some evidence even points towards ethnic differences in the incidence of BPD, with a low prevalence being noted in Asians and a higher frequency among Native Americans.

According to the Diagnostic Manual and Statistical Manual of Mental Health Disorders V (DSM-5), the criteria outlined for the diagnosis of BPD describes the condition as one marked by unstable emotions, sense of identity, and interpersonal relationships with accompanying impulsivity. These symptoms typically emerge in early adulthood and affect an individual’s functioning in several different contexts. The presence of a minimum of five of the following symptoms is required to obtain a diagnosis of BPD: frantic attempts at avoiding abandonment (both imagined or real), emotional instability in everyday events, feelings of intense anger, impulsivity, disturbed sense of identity, chronic emptiness, paranoid ideation or dissociative symptoms, and self-harming or suicidal behaviour.

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Despite the severity of the disorder and its considerable prevalence, the causes of BPD remain largely unknown. It has been speculated that the disorder is likely developed due to an interplay of biological, psychological, and social factors. In terms of biological factors, impulsive behaviour and emotional instability are both heritable traits. Present research has shown that first-degree relatives of individuals with BPD are more likely to be diagnosed with other impulsive conditions, such as substance abuse or antisocial personality disorder. Although scientists have found a relationship between impulsivity and insufficient central serotonergic functioning, no such markers have been identified in the case of emotional instability.

Image: Brain Regions Associated with BPD (Psyche Blog UK)

Because the importance of psychological factors cannot be ignored when looking at mental health, this field requires further exploration. It has been demonstrated that nearly one-fourth of individuals with BPD report having been sexually abused by a caretaker. Moreover, one-third of patients describe having been subjected to severe forms of abuse. Impulsivity noted in BPD seems to stem from the individual’s childhood, but this theory needs further critical examination through studies of longitudinal design. Much like psychological factors, social factors leading to BPD remain relatively unexplored. In the past, evidence pointing towards the involvement of social factors has largely been indirect and there has not been any substantial cross-sectional research directly examining BPD. However, current research has shown that suicidal behaviour tends to be more frequent in modern, rapidly evolving societies than in stagnant, traditional ones.

To this date, effective management of BPD remains difficult. Treatment typically includes one or more forms of psychotherapy depending on individual needs and preferences. Psychotherapy directs an individuals’ attention towards the present level of their functioning. It encourages them to take a more observational approach and, in doing so, increases their awareness of their own feelings as well as the emotions of those around them. This in turn helps those with the condition control their impulsivity and improve their relationships. Although most cases of BPD are treated solely with psychotherapy, a healthcare professional may choose to prescribe medication. Currently, there are no FDA approved medicines for BPD, so drugs are instead prescribed to target symptoms such as anxiety, aggressive behaviour, impulsivity, and depression.

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Overall, BPD is a complicated condition, both in terms of its diagnosis and treatment. Further longitudinal, cross-sectional, and qualitative research is needed on the etiology of the disease and the effectiveness of various therapeutic options in order to better understand the disorder and thus provide more tailored support to individuals diagnosed with this condition.

References

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