Overview
Borderline Personality Disorder (BPD) is one of the least understood and stigmatized mental disorders, yet it is more common than many other mental health problems. BPD is characterized by a continuous pattern of instability in moods, self-image, relationships, and behaviour.
The two predominant phenomena of BPD are uncontrollable emotional liability and impulsivity. They may experience a range of intense dysphoric effects, experienced as aversive tension, including rage, sadness, shame, panic, and chronic feelings of loneliness. They may also experience rapid mood shifts from one state to another, making them feel like they are on a rollercoaster of emotions because of their wavering sense of self..
This emotional instability impacts a person’s self-image, relationships, emotional responses to stressors and self-regulation. They tend to contain intense of fear of abandonment by their loved ones and suffer from feeling of emptiness.
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The core symptoms common to most people with BPD are:
- An intense fear of abandonment by their loved ones
- Unable to regulate and have intense emotions
- Unclear or constantly changing self-image
- Periods of stress-related panic and may feel out of touch with reality
- Impulsive behaviour such as gambling, reckless driving, rash actions
- Intense mood swings that can last from a few hours to a few days
- Unstable personal relationships that vary between idealization and devaluation.
- Distorted perceptions and impaired reasoning including problems with real or perceived abandonment
- Unclear or shifting self-image
- Suicidal intentions or self-harming behaviour.
- Chronic feeling of emptiness
- Intense anger often followed by shame or guilt.
- Poorly regulated and intense emotional responses
- Distorted perceptions and impaired reasoning including problems with real or perceived abandonment.
- Unclear or shifting self-image.
- Explosive anger often followed by shame or guilt.
- Feeling suspicious or out of touch with reality.
Not every person with BPD experience all these symptoms. Some might experience few of these symptoms while for some, all the symptoms are present.
These symptoms generally manifest during one’s early teenage years and may gradually improve during adulthood. Most people are able to maintain a stable work and home life with this condition once they reach their 30s and 40s (DSM 5th edition, 2013). An estimated 1% of the population may be diagnosed with borderline personality disorder (National Institute of Health and Clinical Excellence, 2009) with nearly 75% of people being diagnosed with BPD are women. Men may often get misdiagnosed with Depression or PTSD.
Development of BPD Symptoms
The symptoms generally manifest during the early teenage years and gradually improve during adulthood. Most people can maintain a stable work and home life once they reach their 30s and 40s (DSM 5th edition, 2013). Estimate people who have borderline personality disorder vary from less than 1% to 6% (National Institute of Health and Clinical Excellence, 2009). Nearly 75% of people diagnosed with BPD are women. Men most often get misdiagnosed with Depression or PTSD.
Though Singapore doesn’t have definitive reports but a review about suicide stated that borderline personality disorder and Avoidant Personality Disorder were the most common to be present in general population amongst others (Wong, 2018). Studies based here in Singapore also reported prevalence rate of 16.3% found in prison settings (Abdin, Subramanian, Guo et al., 2011) and 36% in Psychiatric settings (Keng, Lee et al., 2018). People here tend to live in proximity and share close knitted ties so they are more vulnerable to dysregulations arising from interpersonal relationships which can in turn lead to behavioural problems like self-harm.
This contrasts with many studies conducted in Western setting where behavioural and interpersonal dysregulation are considered different entities (Selby & Joiner, 2008). As BPD is considered a disorder of emotional dysregulation, so a society which values control of emotions, this dysregulation can result from a person’s pre-existing emotional vulnerabilities and invalidating environment.
Suicide Risk of Borderline Personality Disorder
Although there are no substantive reports about the BPD in Singapore, a review about suicide stated that borderline personality disorder and Avoidant Personality Disorder were the most common mental conditions present in the general population amongst others (Wong, 2018). Studies have also reported a prevalence rate of 16.3% found in prison settings (Abdin, Subramanian, Guo et al., 2011) and 36% in Psychiatric settings (Keng, Lee et al., 2018) in Singapore. People in these settings tend to live in proximity and are more vulnerable to dysregulations arising from troubled interpersonal relationships which can in turn lead to behavioural problems like self-harm.
This contrasts with many studies conducted in Western settings where behavioural and interpersonal dysregulation are considered different entities (Selby & Joiner, 2008). As BPD is a disorder involving the dysregulation of emotional response, this dysregulation can result from a person’s pre-existing emotional vulnerabilities and invalidating environment.
Borderline Personality Disorder Causes
Like most psychological disorders the cause of BPD is still unknown but some of the risk factors for the development of this disorder can be:
- Genetics- research suggests that people who have a close family member with BPD can be at a higher risk of developing BPD. This risk is four times higher among first degree relatives (Gunderson, 2011).
- Genetics- research suggests that people who have a close family member with BPD can be at a higher risk of developing himself.
- Environmental Factors- childhood abuse or neglect, negative peer influence, socioeconomic status, poor parenting, and family or community disintegration.
- Environmental Factors- childhood abuse or neglect, peer influences, socioeconomic status, faulty or inadequate parenting, family, and community disintegration.
- Brain function- neurotransmitter dysfunction (i.e., serotonin) which leads to emotional instability, poor regulation, autonomic nervous system arousal and reactivity, and perinatal factors.
- Brain function- neurotransmitter responsivity, autonomic nervous system arousal and reactivity, perinatal factors.
Comorbidity of Borderline Personality with Other Mental Health Concerns
Other conditions can also occur with BPD. A successful treatment for BPD needs to address these comorbidities such as:
There are additional conditions also that can occur with BPD. A successful treatment for BPD needs to address those co occurring mental health conditions also. Common disorders include:
- Depression
- Anxiety disorders
- Eating disorders
- Post-traumatic stress disorder
- Bipolar disorder
- Substance abuse
In a study, approximately 300 former inpatients with BPD were followed for 10 years, interviewing them at 2 years interval to assess the severity of their illness and the improvements made. Nealy 7 out of 8 patients achieved symptom remission lasting at least 4 years and half no longer met the criteria for BPD (Mary Zanarini, 2010). Hence the research shows that BPD is treatable.
Treatment of Borderline Personality Disorder
Borderline personality can be treated but it usually requires long-term care, coping, and building of rapport. Therapy methods include Dialectical Behavioural Therapy (DBT), Cognitive Behavioural Therapy (CBT) or Schema Therapy. An assessment using the Minnesota Multiphasic Personality Inventory 2 or the MIllon Clinical Inventory can also be useful to obtain objective measure for Borderline Personality treatment.
BPD is very much treatable. A 10-year long study of 300 former inpatients with BPD were followed and interviewed at 2-year intervals to assess the severity of their illness and improvements to their condition. Nealy 7 out of 8 patients achieved symptom remission lasting at least 4 years and half no longer met the criteria for BPD (Mary Zanarini, 2010).
Most of the people with BPD can manage this condition and live a fulfilling life. Psychotherapy is an important tool for people with BPD. It is even helpful for caregivers and family members of those affected to learn about taking care of their needs. Counselling can help people get a better understanding of their thoughts, feelings and behaviours.
Types of therapy effective for BPD include:[1]
Dialectical behaviour therapy (DBT)[2]
DBT aims to teach individuals skills to manage their difficult emotions by increasing tolerance towards troubled feelings, improving emotion regulation and relationship management.
Mentalization-based therapy (MBT) or treatment (MBT)[3]
MBT aims to help individuals understand their mental states and thoughts and those of other people. This teaches them how to improve ways of interpreting thoughts, emotions, and feelings and evaluate them appropriately.
Schema-focused therapy (ST)[4]
Schemas are deep-set ways of thinking and behaving that form as the brain develops. They are influenced by the person’s environment and experiences around them and is closely linked to how people view themselves and the world. ST aims to change a person’s schemas by identifying unmet needs that have led to negative life patterns. This includes developing healthier alternatives to these negative patterns of thinking, behaving and feeling.
Transference-focused psychotherapy (TFP)[5]
Transference occurs when an individual projects their thoughts, feelings and behaviours onto something or someone, such as their therapist. TFP aims to uncover the unconscious process of identifying unhealthy patterns of emotions, thoughts, and behaviours. Together with the therapist, they can develop more healthy alternatives to these patterns that occur.
Effectiveness of Borderline Personality Therapy
Most of the people with BPD can manage this condition and live a fulfilled life. Psychotherapy is an important tool for people with BPD. It is even helpful for caregivers and family members of those affected and to learn about taking care of them. Counselling can help people get a better understanding of their thoughts, feeling and behaviours. The key approach to handle this is to seek and stick with the treatment.
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This article uses material from WebMD and other useful references for borderline personality disorder. The article is for use of reference and information only, for specific diagnoses and treatment, please reach out to our licensed and/or certified professionals.