Borderline personality disorder

Borderline personality disorder (BPD) is a type of personality dysfunction that makes it difficult to control their emotions, impulses and actions. This feeling of dissatisfaction itself can be so deeply ingrained that they may need a lot of reassurance and validation from others to feel good. Moreover, there can be spontaneous periods of inflated self-esteem making it confusing for the sufferer to know who they actually are. This can cause distress in their work, family and social life. For most people with BPD, symptoms begin during their teenage years or as a young adult, then improve during adult life.

Is it caused by moral deficiency?

Borderline personality disorder is a condition of the brain and mind. If someone has BPD, it is not their fault and they did not cause it. Moreover, the development of Borderline personality disorder traits is passed on genetically with other impulsive compulsive spectrum traits, which often present as co-morbidities. Female hormone related conditions such as Endometriosis, PCOS and some connective tissue disorders may be present as co-morbidities in severe forms of the illness.

Why is it called ‘borderline’?

Borderline personality has been a matter of study for decades. Historically it was considered to lie between the realms of “psychosis” and “neurosis”. This was probably because it also included the then uncategorised diagnosis of Schizotypy. Schizotypy itself is related to the modern concept of Autism spectrum disorder. Factor analysis studies have shown high level of concordance between the items in the Schizotypy scale and the Asperger scale. Moreover in clinical practice we see a combination of semi-psychotic symptoms such as pseudo-hallucination and other neurotic symptoms such as dissociation.

Symptoms of borderline personality disorder

Borderline personality is one of the classic impulsive-compulsive spectrum disorders. The impulsive and compulsive traits interact with the environment during development to bring about a wide range of adaptive and maladaptive patterns of thinking and behaving. Some of the common maladaptive patterns are categorised under these traits below.

Impulsive maladaptive traits:

  • Frequent changes in mood
  • Changing self image
  • Anger outburst
  • Impulsive break ups
  • Promiscuity
  • Binges- Binge eating, drinking or shopping
  • Self harm
  • Panic attacks
  • Dissociation

Compulsive maladaptive traits:

  • Need for control.
  • Need for reassurance and validation.
  • Fear of losing relationships, tendency to self-sabotage or cling onto relationships.
  • Excessive self–criticism.
  • Sensitivity to criticism from others.
  • Excessive attempts to ensure social desirability.

Is it found only in females?

Borderline personality is often diagnosed in women, as they are more likely to present with classical symptoms. Nonetheless, men do get diagnosed with Borderline personality as well.

Risk factors that predict development of BPD

  • maternal–child discord
  • maternal BPD
  • paternal Substance use and depression
  • substance use and suicidality in the adolescent

Course and outcome of Borderline personality disorder

Longitudinal studies in Adolescents indicate that more than half of those diagnosed with Borderline personality no longer met criteria on 2-4 year follow up. These studies however showed that those who did not meet criteria did have some residual borderline traits. Studies in Adults with borderline personality showed more consistent results. 80-90% of those diagnosed with Borderline personality went into remission for varying periods ranging from months to decades. This is highly encouraging and reassuring.

It is well known that the basic traits underlying the personality are less likely to change over time but the relative contribution of the adaptive over maladaptive traits may increase with age. Studies have shown that there might be an overall decrease in neuroticism and extraversion that limits instability and a relative increase in agreeableness and conscientiousness, which fosters harmony in relationships. This could also have a bidirectional link as those with full-time vocational or educational functioning and at least one stable and supportive relationship with a friend or partner achieve recovery.

Reference: The Lifetime Course of Borderline Personality Disorder. Robert S Biskin. Can J Psychiatry. 2015 Jul; 60(7): 303–308.

Predictors to recovery

  • Higher IQ
  • Stable job
  • Less compulsive traits
  • Being outgoing and agreeable.
  • Being married with kids.

In a nutshell, although borderline personality disorder is a lifelong illness, the troublesome symptoms and behaviours do not last longer than few years. Most individuals with Borderline personality would attain remission by adulthood. This could be for varying periods. Hence, it should be seen as a treatable condition that requires professional help. Psychiatrists at Mindoc have expertise in treating such individuals in a non-judgemental way.  Finding a psychiatrist for Borderline personality in Melbourne could not be easier as our books are open at the moment. Call us today or book online to reserve your spot.