Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is defined "as a prolonged disturbance of personality characterized by depth and variability of moods." The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships; unstable self-image, identity, and behavior; and a disturbance in the individual's sense of self.
In extreme cases, this disturbance in the sense of self can lead to periods of dissociation, or mental breakdown.
Borderline personality disorder can have a long-term negative impact on many aspects of a person's life. This includes sometimes extreme difficulties in relationships at work, home, and in social situations. Self-harming is also a symptom, with attempted (or complete) suicide a possibility, especially without proper care and effective therapy.
The negative emotional states of BPD are grouped into four categories:
- Destructive or self-destructive feelings,
- Extreme feelings in general,
- Feelings of fragmentation or lack of identity, and
- Feelings of victimization.
Individuals suffering from BPD tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, and unacceptable.
They can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone.
Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.
Individuals with BPD engage in high levels of intimacy- or novelty-seeking, and yet are very alert to signs of rejection or not being valued. They tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.
It is very important to locate professionals who are experienced and qualified in the treatment of borderline personality disorder.
Many professional studies recommend against the use of medication for treating BPD. Antidepressants, antipsychotics and mood stabilizers such as lithium are often used to treat co-occurring symptoms such as depression.
Dialectical Behavior Therapy (DBT) has been show to be very effective in the treatment of borderline personality disorder.
Several types of psychotherapy for BPD have developed in recent years. Studies suggest that people with BPD can benefit on at least some outcome measures. Supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD.
Dual Diagnosis/Co-Occurring Disorder
Borderline personality disorder often occurs together with substance abuse and substance dependence disorders. Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with BDP being secondary. In either case, both disorders must be treated simultaneously to achieve an effective outcome.
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