Do you know what borderline personality disorder is and how it is treated?

Borderline Personality Disorder (BPD) affects the way think, perceive and relate to the person who suffers from it. The person who has this disorder has these traits affected permanently and inflexibly. This causes maladjustment and behaviors that deviate from social norms. The essential characteristic of borderline personality disorder (BPD) or borderline personality disorder (BPD) is a general pattern of instability associated with interpersonal relationships, self-image and emotions.

The TLP means, in short, a persistent anomaly of social and personal functioning, a peculiar way of facing problems and interpersonal relationships. It usually begins in adolescence or early adulthood and when the diagnosis is made, most people are between 19 and 34 years old.

Main symptoms of borderline personality disorder

Please don’t abandon me

People with borderline personality disorder make frantic efforts to avoid real or imagined abandonment.. The perception of being abandoned or rejected can lead to profound changes in self-image, affect, cognition, and behavior.

These individuals are very sensitive to environmental circumstances. They experience immense fear of abandonment and inappropriate anger. This is true even when the separation is real, but of limited time or when there are inevitable changes in your plans. For example, they may experience this fear or anger when someone important to them arrives a few minutes late or they have to cancel an appointment.

People with BPD may come to believe that this “abandonment” implies that they are “bad.” Fears of abandonment are related to an intolerance of loneliness and the need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive acts such as self-harm or suicidal behaviors..

Neither with you nor without you

People with borderline personality disorder have a pattern of unstable and intense relationships. They may idealize caregivers or their potential lovers on the first or second date. They may also require spending a lot of time together and sharing the most intimate details of a relationship too soon.

However, They can quickly go from idealizing to devaluing people. They may feel that the other person doesn’t care that much, doesn’t give them enough, or isn’t there for them enough time. These people can understand and care for others, but only with the expectation that that person “will be there” to meet their own needs when asked. These individuals are prone to sudden and dramatic changes in their view of others. Others can be considered your best supporters and also your most cruel punishers.

These changes often reflect disillusionment with a caregiver whose parenting qualities have been idealized or whose rejection or abandonment is expected.

Now yes, now no

There may be an alteration of identity, characterized by an unstable self-image or sense of self, in a pronounced and persistent way. They suddenly and dramatically change their self-image, goals, values, and career aspirations.

In addition, There may be sudden changes in opinions and projects about profession, sexual identity, values ​​and types of friends. These individuals can suddenly change and assume the role of a needy person who begs for help, to that of an avenging person who makes amends for the mistreatment suffered.

Typically, people with borderline personality disorder have a poor or harmful self-image. However, Sometimes they feel like they don’t exist at all.. This occurs when they feel the lack of a meaningful relationship, care and support.

Additionally, people with borderline personality disorder often get a poorer performance in unstructured situations, at work or at school.

Impulsivity and suicide risk

People with borderline personality disorder exhibit impulsivity in at least two areas that are potentially harmful to themselves. They may gamble pathologically, spend money irresponsibly, binge eat, consume substances of abuse, have unprotected sexual relations or drive recklessly. In addition, they usually present recurrent suicidal behaviors, gestures or threats, as well as self-harming behaviors.

Completed suicide occurs in 10% of these individuals. Acts of self-harm (cuts, burns…) and suicide threats and attempts are also common. Suicidal tendency is usually the reason why these people ask for help or someone close to them does so.

Many Self-harm is a reaction to the perceived threat of separation or rejection. During these experiences, self-mutilation may occur, which often implies relief because it reaffirms your ability to feel or atone for the feeling of guilt for being a bad or despicable person.

Experiencing intense moods

People with borderline personality disorder demonstrate emotional instability that is due to their highly reactive emotionality. For example, suffer episodes of irritability or anxiety which usually last a few hours and rarely more than a few days. These episodes may reflect the individual’s extreme reactivity to interpersonal stressors.

Chronic feelings of emptiness and anger

These people too They often complain of chronic feelings of emptiness and get bored easily., constantly looking for something to do. Furthermore, they express anger inappropriately and intensely and have great difficulty controlling it.

They usually express themselves in a very sarcastic way, with lasting resentments and verbal outbursts. The anger they feel is often provoked when they perceive that a caregiver or lover is negligent, distant, indifferent, or intending to abandon them.

On the edge of “madness”

During periods of extreme stress may appear transient paranoid ideation or dissociative symptoms (e.g. depersonalization). These episodes occur most frequently in response to real or imagined abandonment.

Symptoms tend to be transient and last minutes or hours. The actual return of care from the significant other can cause the symptoms to subside.

What is the cause of borderline personality disorder?

As in other disorders, there is still no clear identification of the precipitants or causes that enable the development of this type of personality. The existence of different risk factors that can predispose the person is highlighted. These factors can be biological, psychosocial and genetic.

What we know is that, in terms of the power of genetics, borderline personality disorder is approximately five times more common among first-degree biological relatives. There is also an increased familial risk for substance use disorders, antisocial personality disorder, and depressive or bipolar disorders.

What is the treatment of borderline personality disorder?

The treatment of this disorder continues to be a difficult subject for professionals due to its complexity and way of manifesting itself.. The instability of people with this disorder makes it difficult to adhere to treatment and abandonment is common.

The therapeutic approach currently proposed responds to the following guidelines:

Treatment with psychotropic drugs. Psychotherapy. Crisis intervention through hospitalization. Approach from the support network: family and professionals.

Psychotropic drugs

Pharmacotherapy should be viewed as a complementary intervention in the treatment of BPD. In no case should it be treated as a substitute for the work carried out between the person and their social support group.

Depending on the present symptoms, the most appropriate drugs will be prescribed. Normally, they are aimed at alleviating the symptoms presented within emotional and affective instability, impulsivity and behavioral lack of control, and cognitive difficulties.

Psychotherapy

Psychotherapeutic interventions combine different modalities: individual and group. The specific units that currently exist are characterized by developing highly structured, multidisciplinary and inclusive programs.

Cognitive-behavioral techniques, social skills training and psychoeducation have proven effective in this regard. A type of therapy that is giving good results It is Dialectical Behavioral Therapy, by Marsha Lineham.

The results that are intended to be achieved with the therapy are the following:

Increase the level of adaptive skills and functional capacities (personal self-care, job search, access to the community, management at home, establishing friendships…). Reduce impulsivity. Increase the feeling of conscious presence in the here and now. In general , increase physical and psychological well-being.

Crisis intervention through hospitalization

Admissions occur in Acute Units and respond to self-harm attempts, self-harm, psychotic and depressive episodes, psychosocial deterioration and family overflow. They are usually brief admissions aimed at controlling acute symptoms or the crisis situation (compensate the person as much as possible). Once the crisis episode is controlled, the person returns home under medical supervision and with pharmacological treatment.

As we have seen, BPD is a complex disorder, rarely understood and difficult to treat. However, the suffering of these patients and the people around them is such that it is essential to delve into research and implement effective treatments.

Bibliography:

Mosquera, D. (2004). Diamonds in the rough (I), an approach to borderline personality disorder: informative manual for professionals, patients and family members. Pleiades.

Foret, M. (2000). My son, borderline personality. STJ Editions.

American Psychiatric Association (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Panamericana Medical Editorial.

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