Borderline Personality Disorder
Borderline personality disorder (BPD) is a serious mental illness
that centers on the inability to manage emotions effectively. The
disorder occurs in the context of relationships: sometimes all
relationships are affected, sometimes only one or several.
The symptoms include: fear of abandonment, impulsivity, anger,
bodily self-harm, suicide, feelings of emptiness, chaotic relationships.
While some persons with BPD are high functioning in certain settings,
their private lives may be in turmoil. Others are unable to work and
require financial support.
Relationships with others are intense but stormy and unstable with
marked shifts of feelings and difficulties in maintaining intimate,
close connections. The person may manipulate others and often has
difficulty with trusting others. There is also emotional instability
with marked and frequent shifts to an empty lonely depression or to
irritability and anxiety. There may be unpredictable and impulsive
behavior which might include excessive spending, promiscuity, gambling,
drug or alcohol abuse, shoplifting, overeating or physically
self-damaging actions such as suicide gestures. The person may show
inappropriate and intense anger or rage with temper tantrums, constant
brooding and resentment, feelings of deprivation, and a loss of control
or fear of loss of control over angry feelings. There are also identity
disturbances with confusion and uncertainty about self-identity,
sexuality, life goals and values, career choices, and friendships. There is
a deep-seated feeling that one is flawed, defective, damaged or bad in
some way, with a tendency to go to extremes in thinking, feeling or
behavior. Under extreme stress or in severe cases there can be brief
psychotic episodes with loss of contact with reality or bizarre behavior
or symptoms. Even in less severe instances, there is often significant
disruption of relationships and work performance. The depression which
accompanies this disorder can cause much suffering and can lead to
serious suicide attempts.
Treatment includes psychotherapy which allows the patient to talk
about both present difficulties and past experiences in the presence of
an empathetic, accepting and non-judgemental therapist. The therapy
needs to be structured, consistent and regular, with the patient
encouraged to talk about his or her feelings rather than to discharge
them in his or her usual self-defeating ways.