With the rise of mental health concerns as exacerbated by the COVID-19 pandemic, understanding the signs, symptoms and treatment options for mental health conditions has become increasingly important. Leading the pack as one of the hardest to diagnose is borderline personality disorder (BPD).
What Is Borderline Personality Disorder?
BPD is a mental disorder that impacts one’s moods and behavior. BPD can be difficult to diagnose because of its overlap with other disorders. There are several disorders that often occur with BPD, such as depression, anxiety and substance abuse, says Dr. Alex Dimitriu, a double board-certified psychiatry and sleep medicine expert and founder of Menlo Park Psychiatry and Sleep Medicine in Menlo Park, California.
Studies indicate BPD affects 1.6% of the general population, but the condition is more common in certain groups, Dimitriu notes. BPD tends to be diagnosed three times as often in women, who account for approximately 75% of BPD diagnosis, adds Dr. Deena Manion, chief clinical officer for Westwind Recovery in Los Angeles, California. This stems from differences in genetics, hormone levels, upbringing and multiple psychosocial and environmental influences. BPD is also more common in teenagers.
Symptoms and Types of BPD
According to the Centers for Disease Control and Prevention, more than 50% of Americans will face a mental illness in their lifetime, making it all the more important to understand a diagnosis.
BPD is diagnosed by mental health providers, such as psychiatrists and psychologists, based on a psychological evaluation, review of an individual’s medical history and discussion of symptoms.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) helps psychiatrists diagnose BPD on the basis of two criteria:
— A prevalent pattern of instability in areas of life, such as interpersonal relationships and self-image.
— Marked impulsivity beginning in early adulthood and present in a variety of contexts.
This impulsivity in a variety of contexts can be indicated by at least five of the following traits:
— Clear and consistent instability of self-image or sense of self.
— Pattern of unstable and intense interpersonal relationships, characterized by alternating between idealization and devaluation extremes.
— Potentially self-damaging impulsivity in at least two areas. These include things such as spending, substance abuse, sex and more.
— Frantic avoidance of real or imagined abandonment.
— Chronic feelings of emptiness.
— Intense, inappropriate anger or difficulty controlling anger.
— Stress-related paranoid ideation or severe dissociation.
— Marked reactivity of mood causing affective instability.
— Recurrent suicidal ideation or behaviors.
Similar to depression, there are subtypes of BPD that are primarily based on which symptoms are most present. These include:
— Impulsive. Characteristics of this subtype include high energy levels, easily becoming bored or distracted and flirtatious behaviors. Labeled as charmers, this BPD personality can be manipulating and craves attention.
— Self-destructive. Those who have been diagnosed with self-destructive BPD are often tied to more destructive behaviors, such as substance abuse or misuse, suicidal ideation or action and feelings of being alone or unloved.
— Discouraged. Codependency in most relationships marks the discouraged subtype of BPD. Commonly labeled as followers, these individuals lack ability to take charge and are more likely to identify with self-harming, even suicidal, behaviors.
— Petulant. This type of BPD stems from a need for control. Drastic mood swings and rude behaviors are frequent.
[READ: What’s the Difference Between Bipolar Disorder and Borderline Personality Disorder?]
BPD Causes
Although the causes of BPD remain largely unclear, there are a number of commonalities among those diagnosed, says Lauren Kerwin, a psychologist with over 20 years of experience working with adolescents and adults struggling with BPD and other mental health issues. These commonalities include environmental factors, such as:
— Being a victim of emotional, physical or sexual abuse.
— Exposure to long-term fear or distress during childhood.
— Experiencing neglect by one or more parents.
— Continuous exposure to another family member with a serious mental health condition.
According to a 2014 research study published in the journal Neuroscience and Behavioral Reviews, there is strong evidence to suggest a genetic basis to BPD. The study reports that if one twin has BPD, there is a two-thirds chance the second twin will have the same disorder. Similarly, another study suggests children could be at higher risk for BPD development if their parents have it.
A study published in Current Psychology Reports in 2014 indicates that BPD is both genetic and environmental, meaning those with BPD are born with the biological wirings tying to the disorders and then exacerbated by environmental factors typically outside of their control, especially those in childhood.
[Read: What to Look for in a Therapist.]
Diagnosing BPD
Diagnoses are typically made by a mental health practitioner. In the case of mental health, this is most often a psychiatrist or psychologist.
Although primarily diagnosed in adults ages 18 and older, research indicates that children as young as age 13 can develop BPD, Manion notes. While some experts quote higher diagnosis rates in women, “studies indicate BPD may actually be equally common, but harder to diagnose in men as the behaviors and presentations of BPD are slightly different, resulting in different expressions of BPD,” says Kerwin.
BPD is notoriously one of the hardest mental health conditions to diagnose and is often misdiagnosed. The symptoms overlap heavily with those of other disorders, and those disorders can co-occur with BPD to make finding a diagnosis even more challenging. Depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) and substance abuse commonly co-occur with BPD in both genders, with research indicating antisocial personality disorder and substance use being more prevalent in men and anxiety and eating disorders being more common among women.
Kerwin notes that adult diagnoses are more common due to a “reluctance from mental health providers to diagnose BPD in children or adolescents as the symptoms are typical” of younger ages.
But after extensive interviewing and questioning, plus a medical workup and family history, a diagnosis can be made.
[READ: Types of Therapy: Choosing the Right One for You.]
BPD Treatment
The severity of BPD “tends to decrease in frequency and intensity with age,” Dimitriu says, but treatments are available to help mitigate symptoms throughout one’s life. As with most other conditions, improved lifestyle habits and increased self-care can help keep a BPD diagnosis in check.
Dimitriu recommends his patients follow a routine he calls “SEEM,” an acronym that stands for sleep, exercise, eating — specifically a Mediterranean style diet — and meditation.
In addition to lifestyle changes, Manion lists additional treatments — including therapy and prescription antidepressant and mood stabilizer medications — to help mitigate BPD’s effects. Dialectical behavioral therapy, or DBT, is a specific form of therapy that focuses on having awareness, knowledge and use of healthy outlets commonly used to help those with BPD. Cognitive behavioral therapy is another frequently suggested treatment option.
Living with BPD
If you think you may have BPD, talk with your health care provider or a mental health professional to better understand what you’re experiencing. The 9-8-8 mental health hotline is also available 24/7 to offer assistance. If your symptoms are intensely painful or impacting your quality of life or ability to function, seek emergency care, Kerwin says.
Although this disorder may seem overwhelming to understand, with the proper diagnosis and treatment plan, a happy, healthy life is well within reach for those with BPD.
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The Signs, Symptoms, and Treatments of BPD originally appeared on usnews.com
Update 04/04/23: This piece was previously published at an earlier date and has been updated with new information.
