Borderline Personality Disorder: causes, symptoms and treatment
The Borderline personality disorder or TLP It is considered one of the most serious personality disorders, along with the Paranoid Personality Disorder and Schizotypal Disorder, since many experts conceive them as more accentuated versions of the rest.
In that sense, the TLP can share many characteristics with other personality disorders, such as the dependent, the histrionic, the avoidant or the antisocial.
Borderline personality disorder
Different doubts and characteristics have arisen around the concept of Borderline Personality Disorder that have been in debate among the academic community. However, according to the DSM-V we can already know the most effective symptoms, causes and treatments for this condition.
Symptoms
DSM diagnostic criteria include:
- Frantic efforts to avoid abandonment, real or imagined;
- Alternation between extremes of idealization and devaluation in interpersonal relationships;
- Markedly unstable self-image;
- Potentially dangerous impulsiveness, for example in relation to money, sex, substance abuse or bingeing;
- Self-harm or suicide threats or attempts;
- Instability in the state of mind due to a marked emotional reactivity;
- Chronic feelings of emptiness;
- Intense anger and inappropriate or difficulty controlling anger;
- Paranoid ideation or severe, transient, stress-related dissociative symptoms.
Causes
Borderline Personality Disorder is currently believed to It is the result of the combination of the biological predisposition to feel a high emotional reactivity, which would lead to especially frequent and intense episodes of impulsivity or irritability, and a disabling environment.
Marsha Linehan, creator of this concept and an expert in Borderline Personality Disorder, defines the disabling environment as one in which children Caregivers project their own emotions and motivations onto the child instead of acknowledging and approving of theirs, showing emotions not being tolerated negative. In this way, the child's analysis of her experiences would be trivialized (for example, saying "You're angry but you don't want to admit it") and it would be conveyed that these are caused by Personality traits rated as negative, which would be summarized in messages such as "You are bad." Without proper validation of own experiences, the child cannot learn to label her emotions correctly or to consider his reactions natural, which hinders the development of the identity.
Childhood trauma
Borderline Personality Disorder It has also been frequently associated with childhood trauma; among the risk factors for the development of the disorder are neglect and emotional abuse, witnessing domestic violence, criminality and substance abuse by parents and, in particular, sexual abuse reiterated. It has been hypothesized that this type of chronic victimization would lead the child to believe that he is vulnerable and powerless and others are dangerous and therefore would affect their ability to form secure and secure attachments. satisfactory.
According to Pretzer (1996), people with Borderline Personality Disorder conceive the world in dichotomous terms, it is that is, their opinions about themselves, the world, and the future tend to be either completely positive or completely negatives. This way of thinking would lead to emotions that are always intense and rapidly changing from one extreme to the other, with no possibility of middle terms. As a natural consequence, these changes are perceived by others as irrational and random.
Self-injurious behaviors
The tendency of people with Borderline Personality Disorder to feel negative emotions more intensely and frequently than most people partly explains their propensity to use drugs, bingeing on food - and therefore bulimia nervosa- or risky sex.
All these behaviors are carried out with the intention of reducing discomfort, as also occurs in occasions with self-injurious behaviors, which are used to temporarily divert attention from emotions negative. Many people with Borderline Personality Disorder who engage in these types of behaviors state that they feel little or no pain during these episodes, which are more frequent between the ages of 18 and 24 years.
Relationship with emotional dependence
The self-devaluation inherent in Borderline Personality Disorder is related to the intense need to have an intimate relationship with another person, romantic or not. These relationships reduce feelings of emptiness and worthlessness and make the person with Borderline Personality Disorder feel protected in a world that, as has been said, conceives as dangerous. Their need to be united with the significant other is so strong, it is not surprising that people with Borderline Personality Disorder are extremely sensitive to the possibility of being abandoned; Banal acts of others are often interpreted as signs of imminent abandonment.
Thus, not only are frequent outbursts of despair and anger against others produced as a consequence, but behaviors Self-harm can be used as attempts to manipulate others into not leaving them or as a way to get revenge if they feel they have been abandoned. BPD symptoms tend to decrease with age, including self-injurious behaviors. However, in older people these can manifest themselves in somewhat different ways, such as through neglect of diet or pharmacological treatments.
However, and paradoxically, the strong union with the other can also lead to the fear that one's own identity, fragile and unstable, will be absorbed. It is also feared that the abandonment perceived as inevitable will be more painful the more intimate the relationship. This is why the chaotic interpersonal behavior of people with Borderline Personality Disorder can in a way be considered an unconscious strategy to avoid a stability that can be feared as much as the feelings of empty.
In this way, many people with BPD fluctuate between a fear of loneliness and the fear of dependency, maintaining their relationships for a time in an unstable and pathological balance. Others, feeling frustrated and exasperated, tend to withdraw from them, reinforcing their belief that deserve to be abandoned, setting up a vicious circle in which the person with BPD causes the very thing they fear that happen.
BPD and depression
TLP carries a strong predisposition to depressive episodes, because it is related to low self-esteem, feelings of guilt, hopelessness and hostility towards others. In fact, some experts claim that BPD could be considered a mood disorder, and the emotional instability characteristic of BPD has even been linked to bipolar disorder, which is defined by the alternation between periods of weeks or months of depression and others of pathologically mood high.
Treatments
It is probably the severity of Borderline Personality Disorder itself that has led to more research on its treatment than on that of any other personality disorder, in such a way that it is currently the only one for which an effective treatment is known. We refer to Dialectical Behavior Therapy, devised in the 90s by the aforementioned Linehan (1993), who, to the surprise of the scientific community, recently revealed that she herself was diagnosed with BPD.
The Dialectical Behavior Therapy It is based on the apparent paradox that, according to Linehan, led her to improve and motivated her to develop her therapy: in order to change, radical self-acceptance is necessary. Among other strategies, this treatment includes strategies of emotional regulation, social skills training and belief modification.
Bibliographic references:
- Carey, B. Expert on Mental Illness Reveals Her Own Fight. The New York Times Online. June 23, 2011. Recovered from http://www.nytimes.com/2011/06/23/health/23lives.h...
- Linehan, M. M. (1993). Cognitive-behavioral therapy of borderline personality disorder. New York: Guilford Press.
- Millon, T.; Grossman, S.; Millon, C.; Meagher, S.; Ramnath, R. (2004). Personality disorders in modern life, 2nd Ed (pp. 493-535). Hoboken, New Jersey: John Wiley & Sons.
- Pretzer, J. L. & Beck, A. T. (1996). A cognitive theory of personality disorders. In J. F. Clarkin & M. F. Lenzenweger (Eds.), Major theories of personality disorder (pp. 36–105). New York: Guilford Press.
- Stone, M. H. (1981). Borderline syndromes: A consideration of subtypes and an overview, directions for research. Psychiatric Clinics of North America, 4, 3-24.
