Symptoms
In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to: Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members.
Causes
Once thought to be an untreatable condition, borderline personality disorder (BPD) is now effectively treated by a growing number of evidence based psychotherapeutic treatments.
Complications
Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD.
Why do people get borderline personality disorder?
Borderline personality disorder usually begins by early adulthood. The condition seems to be worse in young adulthood and may gradually get better with age. If you have borderline personality disorder, don't get discouraged.
Can borderline personality disorder be treated?
What are the evidence-based advances in the treatment of borderline personality disorder?
Can borderline personality disorder get worse with age?
What is the most successful approach to treating borderline personality disorder?
Dialectical Behavioral Therapy (DBT) The most well-known, well researched, and widely available EBT for BPD is DBT [39, 40].
Which treatment has been recently suggested for borderline personality disorder?
Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed specifically to treat borderline personality disorder.
What is the goal of treatment for borderline personality disorder?
Goals of treatment For many people with BPD, important goals are: to overcome emotional problems (such as depression, anxiety and anger) to find more purpose in life (e.g. by making a positive contribution to their community) to build better relationships.
Can borderline personality disorder be successfully treated?
While there is no definitive cure for BPD, it is absolutely treatable. 1 In fact, with the right treatment approach, you can be well on the road to recovery and remission. While remission and recovery are not necessarily a "cure," both constitute the successful treatment of BPD.
Can BPD be treated without medication?
How do you manage BPD without medication? BPD is generally treated with psychotherapy, with dialectical behavior therapy and cognitive behavioral therapy being the most common types. 4 Finding ways to cope with your emotions, reducing stress, and seeking treatment for any other co-occurring conditions can help as well.
What is the best mood stabilizer for borderline personality disorder?
Divalproex sodium and valproate Divalproex sodium is among the mood stabilizers, which are comprehensively studied in patients with BPD [52]. Wilcox claimed that divalproex decreased agitation significantly in patients with BPD.
What triggers a person with borderline personality disorder?
These include: being a victim of emotional, physical or sexual abuse. being exposed to long-term fear or distress as a child. being neglected by 1 or both parents. growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem.
Why is it hard to treat personality disorders?
Personality disorders are some of the most difficult disorders to treat in psychiatry. This is mainly because people with personality disorders don't think their behavior is problematic, so they don't often seek treatment.
Is BPD a disability?
The Social Security Administration placed borderline personality disorder as one of the mental health disorders on its disabilities list.
Is BPD caused by trauma?
Most people who suffer from BPD have a history of major trauma, often sustained in childhood. This includes sexual and physical abuse, extreme neglect, and separation from parents and loved ones.
Is BPD a lifelong disorder?
BPD is not necessarily a lifelong disorder. Many patients retain residual symptoms later in life.
Can people outgrow borderline personality?
Burn Out. Some experts have speculated that BPD symptoms decline because the symptoms naturally “burn out” or that people simply grow out of the symptoms as they mature. In particular, research has shown that the impulsivity symptoms of BPD are the most likely to decline over time.
How many studies have been published on borderline personality disorder?
The Cochrane review of psychological therapies for borderline personality disorder, which analyzed 28 studies published until 2011, is among the most significant additions to the literature on treatments for BPD in the last 5 years [5]. The major randomized controlled studies can be characterized in four major waves (Table (Table1).1). The first wave of studies compared specialized therapies for BPD to TAU. In this first wave of studies, DBT and MBT were established as EBTs [1, 9–11]. Additionally, a short-term group therapy, STEPPS, was added to TAU and found to be more effective than TAU alone in reducing symptoms of BPD, negative mood states, and impulsivity while increasing functioning [4].
What is evidence based treatment for BPD?
Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment.
What is mentalization in BPD?
Mentalization refers to the complex capacity human beings develop to imagine the thoughts and feelings in one’s own and other’s minds to understand interpersonal interactions [41]. Therein lies its mechanism of change. MBT proposes that BPD symptoms arise when a patient stops mentalizing, leading patients to operate from pathologically certainty about other’s motives, the disconnection from grounding influence of reality, and a desperate need for proof of feelings through action. Attachment interactions become hyperactivated, feeding into distress and difficulty coping, rather than providing safety and security, rendering the therapeutic process with BPD difficult.
What is SCM in BPD?
Like GPM, SCM provides a structured framework for approaching treatment for BPD (see Table Table22for comparisons). This framework is guided by a number of generalist principles and is meant to make treatment understandable and predictable for patients. There is an emphasis on sharing the borderline diagnosis with patients, psychoeducation, alliance building that is based both on contractual (e.g., goal agreement) and relational factors (e.g., trust, reliability, liking), encouragement of family involvement, limited reliance on psychopharmacological intervention, some guidance on managing co-morbid conditions, and explicit safety planning. Both GPM and SCM recommend intersession contact be used sparingly. However, SCM takes a more cautious approach, advocating for “vigorously supporting the patient on the telephone if necessary” [47, p. 69], vehemently pursuing clients who have not come to treatment, and a willingness to meet them at home or elsewhere when safety risk is elevated. This may have more to do with differences in the legal climate of the UK versus the USA than with beliefs about the utility of intersession contact. Also, SCM includes specifically articulated weekly group therapy. Group therapy is open on a rolling basis for patients and includes psychoeducation and a framework focused on problem solving.
How does MBT help with BPD?
MBT aims to stabilize the problems of BPD by strengthening the patient’s capacity to mentalize under the stress of attachment activation [41]. MBT therapists adopt a stance of curiosity, and “not knowing” in order to encourage patients to assess their emotional and interpersonal situation through a more grounded, flexible, and benevolent lens. Prioritizing the maintenance of mentalizing, MBT therapists support patients to think through hyperactivated states themselves, rather than providing prepackaged or intellectualized explanations, insights, or skills. Outpatient MBT involves 50 min of weekly individual therapy, 75 min of group therapy, and a reflecting team meeting which serves to support clinical team members in their mentalization in the process of treatment [25]. Developed within the National Health Services (NHS) in the United Kingdom, MBT provides a tenable model for treating personality disordered patients settings where patients and clinicians face scarce resources.
What is the best EBT for BPD?
The most well-known, well researched, and widely available EBT for BPD is DBT [39, 40]. Informed by clinical experience with suicidal personality disordered patients who did not improve with standard cognitive behavioral therapy intervention, Linehan developed DBT by incorporating the concept of dialectics and the strategy of validation into a treatment focused on skills acquisition and behavioral shaping. DBT formulates the problems of BPD as a result of the transaction between individuals born with high emotional sensitivity and “invalidating environments” that is, people or systems (i.e., families, schools, treatment settings, workplaces) that cannot perceive, understand, and respond effectively to their vulnerabilities.
What are the co-morbidities of BPD?
Investigators have also adapted the established evidence based treatments for BPD to manage the usual complex co-morbidities of BPD including substance use disorders substance use disorders (SUDs) [32], eating disorders (EDs) [33], and post-traumatic stress disorder (PTSD) [34]. BPD patients who present with acutely symptomatic co-morbidities of these types are often challenging to manage with strictly BPD oriented treatments [35]. Conversely, in SUD and ED treatments, individuals with co-morbid BPD may also present with problems that are difficult to manage in those treatment environments. Efforts to target BPD with its co-morbid disorders simultaneously have been developed and studies of their feasibility and effectiveness have been published in the last 5 years [15•, 32, 33, 36, 37, 38].
Can borderline personality disorder cause anger?
Yet besides the point, anger, impulsiveness, and frequent mood swings can also push others away, even though you want to have loving and lasting relationships. Borderline personality disease generally begins by way of early adulthood.
Is there a final medical check for BPD?
There is not any final medical check to help diagnose BPD, and determination has been made that does not appear to be based totally on one unique sign or symptom of borderline personality disorder. BPD is best recognized by using a mental health professional following a complete medical interview that may include speaking with previous clinicians, reviewing previous medical reviews, and, when appropriate, interviews with buddies and their own family.
What are the other mental health disorders that are associated with BPD?
According to a report from the National Institute of Mental Health (NIMH), 85% of people with BPD will have at least one other mental health disorder, including anxiety disorders, impulse-control disorders, substance abuse or dependence disorders, and mood disorders (like major depressive disorder or MDD). 1 .
What are the best medications for BPD?
Medications can be helpful in treating some of the symptoms of BPD. 5 While drugs are not always needed, some of the more commonly prescribed include: 1 Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) commonly used in first-line therapy 2 Antipsychotics, such as Zyprexa (olanzapine) which is known to reduce impulsivity, hostility, and psychotic symptoms of BPD 3 Mood stabilizers, including Topamax (topiramate), Lamictal (lamotrigine), and Depakote (valproate semisodium) which may be useful in treating BPD aggression 4 Anti-anxiety medications, including Ativan (lorazepam), Klonopin (clonazepam), Xanax (alprazolam), and Valium (diazepam)
How long does it take for BPD to go into remission?
What they found was that remission (defined as no longer meeting the diagnostic criteria for at least two years) tended to occur spontaneously within two to eight years of the diagnosis and initial treatment.
What is the backbone of BPD?
Psychotherapy. The backbone treatment for BPD is psychotherapy , also known as talk therapy. 4 Among the various approaches: Cognitive behavioral therapy (CBT) is the foundational structured approach to talk therapy incorporated into all other forms of psychotherapy .
How many co-occurring conditions are there in BPD?
People with BPD will often meet the criteria for other personality disorders as well. The average number of co-occurring conditions in BPD is three . These co-occurring conditions (also known as comorbidities) can make treatment far more complex and result in delayed or missed diagnoses due to overlapping symptoms.
What is MBT therapy?
Mentalization-based therapy (MBT) aims to improve mentalization (the process by which we make sense of each other and ourselves, implicitly and explicitly).
How to be a good therapist?
Therapy relies heavily on trust and open interaction. Take the time to interview several therapists, zeroing in on someone with whom you feel safe, comfortable, and supported. Educate yourself. Take the time to learn about your condition and become an advocate in your own care .
What are the factors that increase the risk of borderline personality disorder?
Some factors related to personality development can increase the risk of developing borderline personality disorder. These include: Hereditary predisposition. You may be at a higher risk if a close relative — your mother, father, brother or sister — has the same or a similar disorder. Stressful childhood.
How does borderline personality disorder affect you?
Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.
What are the causes of stress in childhood?
Many people with the disorder report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.
What are the risks of having a hereditary predisposition?
Hereditary predisposition. You may be at a higher risk if a close relative — your mother, father, brother or sister — has the same or a similar disorder. Stressful childhood. Many people with the disorder report being sexually or physically abused or neglected during childhood.
How long does paranoia last?
Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
Who to reach out to for help?
Reach out to a loved one, close friend, trusted peer or co-worker.
Can personality disorders be inherited?
Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members .
Why does BPD occur?
Most experts believe that BPD develops as a result of biological, genetic, and environmental factors. 1 However, it is essential to keep in mind that the exact causes of BPD are not known yet.
What are the types of experiences that may be associated with BPD?
2 The types of experiences that may be associated with BPD include: Early separation from caregivers. Emotional or physical neglect. Parental insensitivity.
What is the BPD?
If you or a loved one has a borderline personality disorder ( BPD ), you may be wondering what caused it or if you are to blame. The development of this disorder is complex, and there are likely a variety of borderline personality disorder causes, and you should rest assured that no one person or thing is at fault.
What is an emotionally invalidating environment?
An emotionally invalidating environment is one in which a child's emotional needs are not met. 3.
Does BPD run in families?
While early studies showed that BPD does tend to run in families, for some time, it was not known whether this was because of environmental influences or because of genetics. There is now some evidence that in addition to the environment, genetic factors play a significant role. 1
Does BPD affect the brain?
BPD has been associated with excessive activity in parts of the brain that control the experience and expression of emotion. 6
Who is Kristalyn Salters-Pedneault?
Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.
Why do people get BPD?
While the causes of BPD aren’t entirely known, it’s believed that a combo of environmental, genetic, and brain-related factors might increase someone’s chances of developing BPD.
What are the causes of BPD?
This means people with BPD may be more likely to have certain temperamental traits. Some traits that have been linked to BPD include: a tendency to seek out new experiences. less self-direction.
How many of the symptoms of BPD are genetic?
The study found that across three countries, 42% of the signs and symptoms of BPD could be traced to genetic causes. Meanwhile, 58% were linked to environmental factors.
Why do people with BPD have a history of childhood trauma?
Major life stressors could be the reason — many people with BPD have a history of childhood trauma. Critical parenting styles that cause anxiety and stress may also contribute to BPD in similar ways. Child abuse can cause long-term changes in the brain.
How many people with BPD have traumatic childhood?
Childhood trauma is also more likely to be linked to BPD than to other personality disorders, mood disorders, or psychosis. Out of more than 5,000 people, 71.1% of people with BPD had at least one traumatic childhood ...
What are the risk factors for BPD?
Risk factors include childhood trauma or severe long-term stress, genetics, and certain brain differences. Managing your BPD symptoms can have a learning curve, but there are many resources and treatment options that can help along the way.
What is the tendency to seek out new experiences?
a tendency to seek out new experiences. less self-direction. higher likeliness to want to avoid harm. lower cooperation. Having a close family member, like a parent or sibling, with BPD can also increase your chances of developing the condition.
What is the treatment for BPD?
Treatment of BPD is often difficult. Antidepressants, as well as anti-anxiety and mood-stabilizing medicines, have helped some patients. So have a number of forms of talk therapy, including dialectical behavioral therapy (DBT), transference -focused psychotherapy (TFP) and mentalization -based treatment (MBT).
How many people have borderline personality disorder?
Several research studies have estimated that between 1 and 3 percent of American adults suffer from borderline personality disorder (BPD)—at least 2 million adults and perhaps several times that number. BPD can have a profound impact on a person’s ability to function. Its symptoms, while diverse and not all present at the same time, ...
How can BPD be replicated in humans?
To replicate the development of BPD in humans, the team proposes a “two-hit model,” in which rodents would be exposed, at different points in their development, to different environmental and social challenges. The first is early-life stress. Stress or trauma early in life is thought to be one of the potential triggers for some people with BPD, with potentially harmful impacts upon the body’s “HPA axis,” the trio of organs (the hypothalamus and the pituitary and adrenal glands) that regulate responses to stress and adversity. Early-life stress also alters communications between parts of the brain’s frontal cortex and emotion centers deep within the brain. Researchers have linked anomalies in these regions with problems in processing pain and gauging the emotional salience of events, extinguishing fear, and handling strong emotions like anger or rejection. All are relevant in BPD.
What is the mouse model of BPD?
The mouse model of BPD proposed by Dr. Likhtik and colleagues introduces to this first “hit” a second “hit” that takes the form of mild stress during adulthood. Such stress, although in a stronger form, is also a staple in mouse models of other psychiatric disorders, including rodent models of depression, PTSD, and anxiety. ...
What are the organs that regulate BPD?
Stress or trauma early in life is thought to be one of the potential triggers for some people with BPD, with potentially harmful impacts upon the body’s “HPA axis,” the trio of organs (the hypothalamus and the pituitary and adrenal glands) that regulate responses to stress and adversity.
Does BPD need alternative health?
BPD definitely needs alternative health and alternative minds, but the severity of symptoms really does warrant getting sensibly involved with medications and the company's that sell them, and using the established research methods time has made available. Reply to Suzanne Ngatai. Quote Suzanne Ngatai.
Is BPD a cardinal symptom?
Noting that difficulties in interpersonal functioning “are a cardinal symptom” of BPD, the team proposes that the BPD-like rodents, having sustained the two “hits,” be given tests of social interaction in pairs and groups, in which their behavior—pre- and post-“hits”—can be studied.
Treatment Goals
Remission Rates
Treatment Approaches
Co-Occurring Conditions
Coping
- Personality disorders, including borderline personality disorder, are diagnosed based on a: 1. Detailed interview with your doctor or mental health provider 2. Psychological evaluation that may include completing questionnaires 3. Medical history and exam 4. Discussion of your signs and symptoms A diagnosis of borderline personality dis…