Borderline Personality Disorder: What It Is—And Isn’t

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Understanding the symptoms of borderline personality disorder, also known as BPD, can make all the difference in how you or a loved one can manage the condition and live a rich, full life. Here are some things you should know, including the importance of an accurate diagnosis and where to get effective treatment.

What Is Borderline Personality Disorder?

The history of borderline personality disorder began with American psychoanalyst Adolph Stern, who discovered that some patients he treated were “on the border” of having either neurosis or psychosis classification. In many cases, an individual would display certain symptoms under stressful circumstances but then return to regular functionality. Stern first used the term “borderline personality” in 1938 to describe these individuals who were on the cusp of these other conditions.

Research into the disorder continued well into the 1970s. At one point, the condition was referred to as borderline schizophrenia. Another psychoanalyst, Otto Kernberg, referenced it as “borderline personality organization” in 1978. Two other researchers, John Gunderson and Jonathan Kolb, further classified some of the typical behaviors and symptoms associated with the condition, including:

  • Intense fluctuations between confidence to despair
  • Unstable self-image
  • Rapid changes in moods, including anxiety, anger, depression, and dysphoria (being uneasy or dissatisfied with life)
  • Strong fears of abandonment and rejection
  • Self-damaging and compulsive behavior, such as substance use, gambling, sex, and other process addictions
  • A strong tendency towards suicidal thinking and self-harm
  • Delusions and hallucinations

In 1980, BDP was recognized as an official disorder by the American Psychiatric Association and entered into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III).

How Is Borderline Personality Disorder Diagnosed?

According to the Merck Manual, based on DSM-5 criteria, patients must experience a “persistent pattern of unstable relationships, self-image, and emotions (ie, emotional dysregulation) and pronounced impulsivity” to receive a diagnosis of BPD. The diagnosis is assigned when someone experiences five or more of the following (which we provide verbatim) by early adulthood or even adolescence:

  • Desperate efforts to avoid abandonment (actual or imagined)
  • Unstable, intense relationships that alternate between idealizing and devaluing the other person
  • An unstable self-image or sense of self
  • Impulsivity in ≥ 2 areas that could harm themselves (eg, unsafe sex, binge eating, reckless driving)
  • Repeated suicidal behavior and/or gestures or threats or self-mutilation
  • Rapid changes in mood, lasting usually only a few hours and rarely more than a few days
  • Persistent feelings of emptiness
  • Inappropriately intense anger or problems controlling anger
  • Temporary paranoid thoughts or severe dissociative symptoms triggered by stress

These symptoms frequently interfere with daily life. In fact, the Social Security Administration classifies BPD as a disability.

The causes of BPD are similar to other mental illnesses, usually comprising one or more genetic, neurological, or social factors. Unresolved trauma might also be a contributing factor. The National Alliance on Mental Illness (NAMI) reports that an estimated “1.4 percent of the adult U.S. population experiences BPD. Nearly 75 percent of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression.”

Confusion & Controversy Involving Borderline Personality Disorder

One reason why BPD can be so challenging for some people is that it’s often misdiagnosed as other disorders. This means proper treatment is often elusive. Merck notes that BDP is confused with:

  • Anxiety
  • Bipolar disorder
  • Depression
  • Histrionic personality disorder or narcissistic personality disorder
  • PTSD
  • Substance use disorder or alcohol use disorder

Further, it’s quite possible for someone to have co-occurring disorders—say, BPD and an eating disorder—but one presents more symptoms during evaluation and that becomes the focus of treatment. If a dual diagnosis isn’t clearly identified, it can be troubling if the other disorder manifests additional symptoms under certain circumstances but is overlooked.

Stigma Surrounding BPD

There’s also a movement to change the name of the disorder to eliminate the stigma surrounding it. For example:

  • Advocates in Australia aim to change clinicians’ views and the DSM-5 classification so the condition is no longer perceived as a personality flaw. They point to a strong connection to the development of BPD after trauma and are rallying to update the name to something more along the lines of “trauma-spectrum condition.”
  • In the U.S., some psychiatrists believe continuing to use the term “borderline” means that it’s not treated as a disorder in and of itself, and also that clinicians need to focus less on “personality” and more on the reasons for mood dysregulation to enable a better prognosis.
  • In the U.K., BPD is also referred to as emotionally unstable personality disorder and emotional intensity disorder, but not everyone is in favor of those terms, either.

Treating BPD at Cottonwood

Proper mental health care is a delicate balance between invested health professionals with the necessary resources to accurately diagnose conditions…and an individual who is willing to put their well-being first and trust a proactive approach, especially when other treatments haven’t improved their quality of life.

At Cottonwood Tucson, our whole-person approach doesn’t simply look at the diagnosis in a chart. We strive to meet each person where they are, uncover their history, and formulate a new therapeutic direction based on an individual’s needs. If you or a loved one needs this quality care, please reach out.

If you’re having suicidal thoughts, contact the National Suicide Prevention Lifeline immediately: 800-273-8255.

Considering co-occurring disorders treatment in AZ? For more information about Cottonwood Tucson, call (800) 877-4520. We are ready to help you or your loved one find lasting recovery.

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