Borderline personality disorder ( BPD ), also known as emotionally unstable personality disorder ( EUPD ), is a pattern term abnormal behavior characterized by unstable relationships with others, unstable self-feelings, and unstable emotions. Often there is dangerous behavior and self-harm. People may also struggle with feelings of emptiness and fear of abandonment. Symptoms can be caused by seemingly normal events. Behavior usually begins in early adulthood, and occurs in a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. About 10% of people affected died of suicide.
The causes of BPD are unclear, but they seem to involve genetic, brain, environmental, and social factors. That happens about five times more often in someone with a close relative who is affected. Adverse life events also seem to play a role. The underlying mechanism seems to involve a network of frontolimbic neurons. BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorder (DSM) as a personality disorder, along with nine other distractions. Diagnosis is based on symptoms while a medical examination can be done to rule out other problems. This condition should be distinguished from the problem of identity or substance use disorders, among other possibilities.
Borderline personality disorder is usually treated with therapy, such as cognitive behavioral therapy (CBT). Another type, dialectical behavior therapy (DBT) can reduce the risk of suicide. Therapy can occur one on one, or in groups. Although drugs do not cure BPD, they can be used to help with related symptoms. Some people need hospitalization.
Approximately 1.6% of people experience BPD in a given year. Women are diagnosed about three times more often than men. It seems to be less common among parents. Up to half of people increase over a period of ten years. Affected people typically use large amounts of health care resources. There is an ongoing debate about naming the disorder, especially the suitability of the word limit . This disorder is often stigmatized in both the media and the psychiatric field.
Video Borderline personality disorder
Signs and symptoms
Borderline personality disorder may be marked with the following signs and symptoms:
- Identity identity marked disturbed
- Panic attempts to avoid a real neglect or imagination and extreme reaction to such
- Splitting ("black-and-white" thinking)
- Impulsive and impulsive or dangerous behavior
- Intense or uncontrollable emotional reactions that often seem disproportionate to events or situations
- Unstable and chaotic interpersonal relationships
- Self-destructive behavior
- Self-image is distorted
- Merge
- Often accompanied by depression, anxiety, anger, substance abuse, or anger
The most prominent symptoms of BPD are sensitivity to rejection or criticism, and intense fear of possible abandonment. Overall, BPD features include an intense, intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Fear of neglect may lead to overlapping dating relationships as new relationships are developed to protect against neglect in existing relationships. Other symptoms may include feeling unsure of one's identity, morals, and personal worth; have paranoid thoughts when feeling stressed; depersonalization; and, in moderate to severe cases, stress-induced breaks with realistic or psychotic episodes.
Emotions
People with BPD can feel emotions more easily, deeply and for longer periods than others. The core characteristic of BPD is affective instability, which generally manifests as an unusually intense emotional response to environmental triggers, with a slower return to basic emotional states. People with BPD are often involved in the idealization and devaluation of others, alternating between the high positive things for the people and the great disappointment among them. In Marsha Linehan's view, sensitivity, intensity, and duration when people with BPD feel emotions have both positive and negative effects. People with BPD are often very enthusiastic, idealistic, happy, and loving. However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing profound sadness instead of sadness, shame and humiliation instead of light shame, anger instead of annoyance, and panic instead of being nervous.
People with BPD are also very sensitive to feelings of rejection, criticism, isolation, and perceived failure. Before learning other coping mechanisms, their efforts to manage or escape their negative emotions can lead to emotional isolation, self-injury or suicidal behavior. They are often aware of the intensity of their negative emotional reactions and, because they can not manage them, they shut everything down. This can be dangerous for people with BPD, because negative emotions warn people about the existence of problem situations and move them to overcome them which people with BPD will usually be aware only to cause further distress. People with BPD may feel emotionally relieved after cutting themselves off.
While people with BPD feel euphoria (momentarily or occasionally intense excitement), they are especially susceptible to dysphoria (depression, discomfort or depth), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognize four distinct dysphoria categories of this condition: extreme, destructive or self-destructive emotions, feeling divided or lacking identity, and feelings of being victimized. In this category, the diagnosis of BPD is strongly associated with a combination of three specific countries: feelings of being betrayed, "feeling like hurting yourself," and feeling out of control. Because there are various types of dysphoria experienced by people with BPD, the amplitude of distress is an indicator that helps borderline personality disorder. In addition to strong emotions, people with BPD experience emotional "lability"; or in other words, changeable. Although the term emotional lability shows the rapid change between depression and excitement, people's moods with this condition actually fluctuate more frequently between anger and anxiety and between depression and anxiety.
Behavior
Impulsive behavior is common, including substance or alcohol abuse, eating disorders, unprotected sex or indiscriminate sex with multiple partners, reckless spending, and reckless driving. Impulsive behavior can also include leaving a job or relationship, running away, and hurting yourself. People with BPD act impulsively because it gives them a sense of immediate relief from their emotional pain. However, in the long run, people with BPD experience increased pain due to shame and guilt that follow the action. The cycle often begins when people with BPD feel emotional pain, engage in impulsive behavior to relieve the pain, feel embarrassed and guilty for their actions, feel the emotional pain of shame and guilt, and then experience a stronger push to engage in impulsive behavior. ease the new pain. Over time, impulsive behavior can be an automatic response to emotional pain.
Self-injury and suicide
Self-injury or suicide behavior is one of the core diagnostic criteria in DSM-5. Self-destruction occurs in 50 to 80% of people with BPD. The most common method of self-harm is cutting. Bruising, burning, head-banging or biting is not uncommon in BPD.
The lifetime suicide risk among people with BPD is between 3% and 10%. There is evidence that men who were diagnosed with BPD were about twice as likely to die of suicide as women diagnosed with BPD. There is also evidence that most men who die of suicide may have undiagnosed BPD.
The reported reasons for self-harm are different from the reasons for attempted suicide. Nearly 70% of people with BPD harm themselves without trying to end their lives. Reasons for self-harm include expressing anger, self-punishment, generating normal feelings (often in response to dissociation), and diverting one's attention from emotional pain or difficult circumstances. In contrast, suicide attempts usually reflect the belief that others would be better off following suicide. Both suicide and self-harm are a response to feel negative emotions. Sexual harassment can be a special trigger for suicidal behavior in adolescents with BPD tendencies.
Interpersonal relations
People with BPD can be very sensitive to the way other people treat them, feeling a sense of joy and gratitude for the expression of the perceived goodness, and the intense grief or anger at the perceived criticism or pain. Their feelings about others often shift from admiration or love to anger or dislike after disappointment, the threat of losing a person, or losing a sense of respect in the eyes of someone they value. This phenomenon, sometimes called splitting, includes a shift from idealizing others to devalue them. Combined with mood disorders, idealization and devaluation can damage relationships with family, friends, and co-workers. Self-image can also change rapidly from healthy to unhealthy.
Despite intense intimacy, people with BPD tend toward unsafe, avoidance or ambivalent attachment patterns, or are very busy in relationships, and they often view the world as dangerous and evil. BPD, like other personality disorders, is associated with an increase in chronic stress levels and conflicts in romantic relationships, decreasing satisfaction on the part of romantic couples, harassment, and unwanted pregnancies.
Sense of self
People with BPD tend to have difficulty seeing a clear picture of their identity. In particular, they tend to have trouble knowing what they value, believe, love, and enjoy. They are often unsure about their long-term goals for relationships and jobs. This difficulty with knowing who they are and what they value can cause people with BPD to experience "empty" and "lost" feelings.
Cognitions
The emotions often experienced by people with BPD can make it difficult for them to control the focus of their attention - to concentrate. In addition, people with BPD may tend to dissociate, which can be considered an intense form of "zoning out". Dissociation often occurs in response to experiencing a painful event (or experiencing something that triggers a memory of a painful event). This involves the mind automatically distracts from the event, perhaps to protect from experiencing strong emotions and impulses of undesirable behavior that might be triggered by such emotions. Although the habit of mind to block painful emotions can provide temporary relief, it can also have unwanted side effects from blocking or dulling ordinary emotional experiences, reducing people's access to BPD to information contained in emotions, which helps guide effective decision-making in everyday life. Sometimes, it is possible for others to say when someone with BPD dissociates, because their facial expressions or vowels can be flat or expressionless, or they may appear to be disturbed; at other times, dissociation may be almost invisible.
Disabled
Many people with BPD can work if they find a suitable job and the condition is not too severe. People with BPD can be found to have a disability at work, if the condition is severe enough that the behavior sabotages the relationship, engages in risky behavior, or intense anger prevents the person from functioning in his professional role.
Maps Borderline personality disorder
Cause
As with other mental disorders, BPD causes are complex and not fully agreed upon. Evidence suggests that BPD and post-traumatic stress disorder (PTSD) may be associated in several ways. Most researchers agree that a childhood trauma history may be a contributing factor, but less historical attention has been paid to investigate the causal role played by congenital brain abnormalities, genetics, neurobiological factors, and environmental factors other than trauma.
Social factors include how people interact in their early development with family, friends, and other children. Psychological factors include personality and individual temperament, shaped by their surroundings and coping skills learned that are related to stress. These different factors together show that there are several factors that can contribute to the disorder.
Genetics
Inheritance of BPD has been estimated at 40%. That is, 40 percent of the variability in the underlying obligations of BPD in the population can be explained by genetic differences. Twin studies may exaggerate the effect of genes on variability in personality disorders due to the complex factors of shared family environment. Nevertheless, the investigators of this study concluded that personality disorders "appear to be stronger influenced by genetic effects than almost all axis I disorders [eg, bipolar disorder, depression, eating disorder], and more of the widest personal dimensions." In addition, the study found that BPD is thought to be the third most inherited personality disorder of 10 personality disorders reviewed. Twins, relatives, and other family studies show partial heritability for impulsive aggression, but studies of genes associated with serotonin suggest only modest contributions to behavior.
Families with twins in the Netherlands are participants of ongoing studies by Trull and colleagues, in which 711 pairs of siblings and 561 parents are examined to identify the location of genetic traits that affect the development of BPD. Researchers found that the genetic material on chromosome 9 was associated with BPD features. The researchers concluded that "genetic factors play a major role in individual differences in borderline personality features." The same researchers had previously concluded in a previous study that 42 percent of variation in BPD features was due to genetic influences and 58 percent caused by environmental influences. The genes studied in 2012 include a Dopamine D4 receptor polymorphism (DRD4) on chromosome 11, which has been associated with irregular regularity, while the combined effect of 7-rupture polymorphism and dopamine transporter 10/10 (DAT) genotype has been associated with abnormalities in inhibitory control, both noted features of BPD. There is a possibility of connecting to chromosome 5.
Brain abnormality
A number of neuroimaging studies at BPD have reported findings of reduction in brain regions involved in regulating stress and emotional responses, affecting the hippocampus, orbitofrontal cortex, and amygdala, among other areas. A small number of studies have used magnetic resonance spectroscopy to explore changes in neurometabolite concentrations in certain brain regions of BPD patients, looking specifically at neurometabolites such as N-acetylaspartate, creatine, glutamate-related compounds and choline-containing compounds.
Hippocampus
Hippocampus tends to be smaller in people with BPD, as in people with post-traumatic stress disorder (PTSD). However, in BPD, unlike PTSD, the amygdala also tends to be smaller.
Amygdala
The amygdala is smaller and more active in people with BPD. A decrease in amygdala volume has also been found in people with obsessive-compulsive disorder. One study has found a remarkably powerful activity in the left amygdalas people with BPD when they experience and see the appearance of negative emotions. Because the amygdala produces all emotions (including unpleasant ones), this powerful activity can explain the tremendous power and longevity of fear, sadness, anger, and embarrassment experienced by people with BPD, and their increased sensitivity to display these emotions in the other.
Prefrontal cortex
The prefrontal cortex tends to be less active in people with BPD, especially when recalling abandoned memories. This relative inactivity occurs in the right anterior cingulate (areas 24 and 32).
Given its role in regulating emotional arousal, the relative inactivity of the prefrontal cortex may explain the difficulty of people with BPD experience in regulating emotions and their responses to stress.
Hypothalamus-pituitary-adrenal axis
The hypothalamic-pituitary-adrenal axis (HPA axis) regulates the production of cortisol, which is released in response to stress. The production of cortisol tends to increase in people with BPD, indicating the hyperactive HPA axis in these individuals. This causes them to experience a greater biological stress response, which may explain their greater vulnerability to irritability. Since traumatic events can increase cortisol production and HPA axis activity, one possibility is that the higher-than-average prevalence of activity in HPA axis people with BPD may only be a reflection of the prevalence of childhood traumatic and higher maturity events than average among people. with BPD. Another possibility is that, by increasing their sensitivity to stressful events, increased cortisol production may affect those with BPD to experience stressful childhood and adult events as traumatic.
Increased production of cortisol is also associated with an increased risk of suicidal behavior.
Neurobiological factors
Estrogen
Individual differences in the female estrogen cycle may be associated with expression of BPD symptoms in female patients. A 2003 study found that women's BPD symptoms were predicted by changes in estrogen levels during their menstrual cycle, an effect that remained significant when the results were controlled for a general increase in negative effects.
Development factors
Child trauma
There is a strong correlation between child abuse, especially child sexual abuse, and BPD development. Many people with BPD report abuse histories and neglect as children, but the cause is still debatable. Patients with BPD have been found to be significantly more likely to report being verbally, emotionally, physically or sexually abused by good gender caregivers. They also reported incidence of insects and high caregiver losses in early childhood. Individuals with BPD also tend to report having caregivers of both sexes deny the validity of their thoughts and feelings. Caregivers have also reportedly failed to provide the required protection and neglect their child's physical care. Parents of both sexes are usually reported to have withdrawn from children emotionally and have treated children inconsistently. In addition, women with BPD who reported prior history of abandonment by female carers and harassment by male caregivers were significantly more likely to be sexually abused by non-caregivers.
It has been argued that children with chronic persecution problems and the difficulty of chronic attachment may continue to develop a threshold personality disorder. Writing in the psychoanalytic tradition, Otto Kernberg argues that the failure of the child to accomplish the task of developing self and other psychical clarification and failure to overcome solutions can increase the risk of developing a boundary personality. The inability of a child to tolerate delayed gratification at age four does not predict future BPD development.
Neurological pattern
The intensity and reactivity of a person's negative effectiveness, or the tendency to feel negative emotions, predict the symptoms of BPD stronger than childhood sexual abuse. These findings, differences in brain structure (see Brain abnormalities), and the fact that some patients with BPD did not report a traumatic history, suggest that BPD is distinct from the frequent post-traumatic stress disorder that accompanies it. Thus, researchers examined the causes of development other than childhood trauma.
The study, published in January 2013 by Dr. Anthony Ruocco at the University of Toronto has highlighted two patterns of brain activity that may underlie the emotional dysregulation shown in this disorder: (1) increased activity in brain circuits responsible for increased emotional experience. pain, plus (2) the reduced activation of brain circuits that usually regulate or suppress these painful emotions. These two neural networks appear to function dysfunctionally in frontolimbic areas, but specific areas vary widely in individuals, which call for more analysis of neuroimaging studies.
Also (contrary to previous research results) BPD patients show less activation in the amygdala in situations of increased negative emotions than controls. Dr. John Krystal, editor of the journal Biological Psychiatry, wrote that these results "[added] to the impression that people with borderline personality disorder are 'set-up' by their brains to have a volatile emotional life. although not necessarily living unhappy or unproductive ". Their emotional instability has been found to correlate with differences in some areas of the brain.
Mediation and moderation factors
Executive function
While high rejection sensitivity is associated with stronger personality threshold dysfunctional symptoms, executive function seems to mediate the relationship between the rejection sensitivity and BPD symptoms. That is, a group of cognitive processes that include planning, working memory, attention, and problem solving may be the mechanism by which the sensitivity of rejection affects BPD symptoms. A 2008 study found that the relationship between the sensitivity of a person's rejection and BPD symptoms was stronger when the executive function was lower and that the relationship was weaker when the executive function was higher. This suggests that high executive functioning may help protect people with high rejection sensitivity to BPD symptoms. A 2012 study found that problems in working memory may contribute to greater impulsivity in people with BPD.
Family environment
The family environment mediates the effects of child sexual abuse on the development of BPD. Unstable family environments predict the development of disturbances, while stable family environments predict lower risks. One possible explanation is that a stable environment buffers its development.
Self-complexity
Self-complexity, or self-consideration to have many different characteristics, seems to moderate the relationship between actual self-discrepancy problems and the development of BPD symptoms. That is, for individuals who believe that their actual characteristics do not match the characteristics they expect, high self-complexity reduces the impact of their conflicting self-image on the symptoms of BPD. However, self-complexity does not moderate the relationship between actual self-discrepancy and the development of BPD symptoms. That is, for individuals who believe that their actual characteristics do not match the characteristics they should have, high self-complexity does not reduce the impact of their conflicting self-image on the symptoms of BPD. The protective role of the complexity of the self in the actual self-discrepancy, but not in actual self-differences, shows that the impact of contradictory or unstable self-image in BPD depends on whether the individual views himself in terms of the characteristics they expect to obtain, or in terms of the characteristics they should have got.
Mind Emphasis
A 2005 study found that mind suppression, or a conscious effort to avoid certain thoughts, mediates the relationship between emotional susceptibility and BPD symptoms. Further studies have found that the relationship between emotional susceptibility and BPD symptoms is not always mediated by mind suppression. However, this study found that thought stress mediates the relationship between invalid environments and BPD symptoms.
Diagnosis
The diagnosis of threshold personality disorder is based on clinical judgment by mental health professionals. The best method is to present the criteria of interference to someone and ask them if they feel that these characteristics accurately describe them. Actively involving people with BPD in determining their diagnosis can help them become more receptive to it. Although some doctors prefer not to tell people with BPD what their diagnosis is, either from concerns about the stigma attached to this condition or because BPD is used to be considered untreatable, it usually helps for people with BPD to know their diagnosis. This helps them know that others have similar experiences and can direct them to effective care.
In general, psychological evaluation includes asking the patient about the onset and severity of the symptoms, as well as other questions about how the symptoms impact the quality of life of the patient. Special note issues are suicidal ideas, experiences with self-harm, and thoughts about hurting others. The diagnosis is based both on people's reports of their symptoms and on the doctor's own observations. Additional tests for BPD may include physical examination and laboratory tests to rule out other possible triggering symptoms, such as thyroid conditions or substance abuse. The ICD-10 manual refers to the disorder as an unstable emotional personality disorder and has similar diagnostic criteria. In DSM-5, the name of the interference remains the same as in the previous edition.
Diagnostic and Statistical Manual
The fifth edition Mental Disorder Diagnostic and Statistical Manual (DSM-5) has removed the multiaxial system. Consequently, all disorders, including personality disorders, are listed in Part II of the manual. A person must meet 5 of the 9 criteria to accept the diagnosis of personality threshold disorder. The DSM-5 defines the main features of BPD as a spreading pattern of instability in interpersonal relationships, self-image, and influence, as well as real impulsive behavior. In addition, the DSM-5 proposes alternative diagnostic criteria for personality threshold disorder in section III, "Alternative DSM-5 Models for Personality Disorders". This alternative criterion is based on research on traits and includes determining at least four of the seven maladaptive traits. According to Marsha Linehan, many mental health experts find it difficult to diagnose BPD using DSM criteria, because these criteria describe a wide range of behaviors. To address this problem, Linehan has grouped symptoms of BPD under five main areas of dysregulation: emotion, behavior, interpersonal relationships, sense of self, and cognition.
International Classification of Diseases
The World Health Organization ICD-10 defines a disorder that is conceptually similar to a threshold personality disorder, called (G60.3) Unstable emotional personality disorder . The two subtypes are described below.
- F60.30 Impulsive type
At least three of the following must exist, one of which must (2):
- tendencies are marked to act unexpectedly and without considering the consequences;
- a marked tendency to engage in quarrelsome behavior and have conflict with others, especially when impulsive action is thwarted or criticized; liability
- for an outburst of anger or violence, with an inability to control the resulting behavioral explosion;
- difficulty in maintaining any action that does not offer a direct reward;
- the atmosphere is unstable and fickle (impulsive, strange).
- F60.31 Borderline type
At least three phenomena mentioned in F60.30 Impulsive Type must exist [see above], with at least two of the following in addition:
- disturbance and uncertainty about self-image, purpose, and internal preferences;
- the obligation to engage in intense and unstable relationships, often leading to an emotional crisis;
- excessive attempts to avoid neglect;
- repeated threats or self-harmful acts;
- chronic empty feeling.
- shows impulsive behavior, for example, speeds up the misuse of cars or drugs
ICD-10 also describes some general criteria that define what is considered a personality disorder.
Millon subtype
Theodore Millon has proposed four subtypes of BPD. He suggests that someone diagnosed with BPD may show none, one or more of the following:
Misdiagnosis
People with BPD can be misdiagnosed for various reasons. One of the reasons for misdiagnosis is BPD has coexisting symptoms (comorbidities) with other disorders such as depression, PTSD, and bipolar disorder.
Family members
People with BPD tend to feel angry at their family members and alienated from them. On their part, family members often feel angry and helpless to see how their BPD family members relate to them. Parents of adults with BPD are often too involved and less involved in family interactions. In romantic relationships, BPD is associated with increased levels of stress and chronic conflict, decreased romantic partner satisfaction, harassment, and unwanted pregnancies. However, this link may apply to personality disorders in general.
Teen
Symptom onset usually occurs during adolescence or young adulthood, although symptoms suggestive of this disorder can sometimes be observed in children. Symptoms among adolescents who predict the development of BPD in adulthood may include problems with body image, extreme sensitivity to rejection, behavioral problems, non-suicidal self-injury, trying to find exclusive relationships, and severe shyness. Many teenagers experience these symptoms without having to develop BPD, but those who experience it are 9 times more likely than their counterparts to develop BPD. They are also more likely to develop other forms of long-term social disability. Doctors are not advised to diagnose anyone with BPD before the age of 18, due to the ups and downs of adolescence and a developing personality. However, BPD can sometimes be diagnosed before the age of 18, in which case the feature must be present and consistent for at least one year.
Diagnosis of BPD in adolescence may predict that the disorder will continue into adulthood. Among the adolescents who ensured the diagnosis of BPD, there appears to be a group in which the disorder remained stable over time and other groups in which individuals move in and out of the diagnosis. Previous diagnosis may be helpful in creating a more effective treatment plan for adolescents. Family therapy is considered a useful treatment component for adolescents with BPD.
Differential diagnosis and comorbidity
Lifetime comorbidity (co-occurring) common conditions in BPD. Compared with those diagnosed with other personality disorders, people with BPD indicating higher levels also meet the criteria for
- mood disorders, including severe depression and bipolar disorder
- anxiety disorder, including panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD)
- Other personality disorders, including schizotypal, antisocial, and dependent personality disorders
- substance abuse
- eating disorders, including anorexia nervosa and bulimia
- attention deficit hyperactivity disorder
- somatic symptom disorder (formerly known as somatoform disorder, this is a category of mental disorders that is included in a number of diagnostic schemes of mental illness)
- dissociative disorder
The diagnosis of personality disorder should not be performed during untreated mood/untreated episodes, unless a lifelong history supports personality disorders.
Comorbid Axis I disorder
A 2008 study found that at some point in their lives, 75 percent of people with BPD met the criteria for mood disorders, especially severe depression and Bipolar I, and nearly 75 percent met the criteria for anxiety disorders. Almost 73 percent met the criteria for substance abuse or dependence, and about 40 percent for PTSD. It should be noted that fewer than half of participants with BPD in this study were presented with PTSD, a prevalence similar to that reported in previous studies. The finding that fewer than half of patients with BPD had PTSD during their lifetime challenged the theory that BPD and PTSD were the same disorder.
There are marked gender differences in the types of comorbid conditions a person with BPD tends to have - a higher percentage of men with BPD meets the criteria for substance use disorders, while a higher percentage of women with BPD meet the criteria for PTSD and eating disorders. In one study, 38% of participants with BPD met the criteria for the diagnosis of ADHD. In another study, 6 of 41 participants (15%) met the criteria for autism spectrum disorder (a subgroup that significantly more often attempted suicide).
Irrespective of it being an infradiagnosed disorder, several studies have shown that "low expression" from it may lead to a false diagnosis. Axis I disturbances that are numerous and shifted to BPD sufferers can sometimes lead to clinicians losing the presence of an underlying personality disorder. However, since complex patterns of Axis I diagnostics have been found to predict strong BPD presence, clinicians may use features from complex comorbid patterns as a clue that BPD may exist.
Mood disorder
Many people with personality disorder thresholds also have mood disorders, such as major depressive disorder or bipolar disorder. Some BPD characteristics are similar to mood disorders, which can complicate the diagnosis. It is common for people to be misdiagnosed with bipolar disorder when they have borderline personality disorder or vice versa. For someone with bipolar disorder, suggestive behavior of BPD may appear when the client is experiencing episodes of depression or large mania, only disappears after the client's mood is stabilized. For this reason, it is ideal to wait until the client mood stabilizes before attempting to make a diagnosis.
At face value, the affective attachment of BPD and the rapid mood cycle of bipolar disorder may appear very similar. This can be difficult even for experienced doctors, if they are not familiar with BPD, to distinguish between mood swings from these two conditions. However, there are some obvious differences.
First, mood changes BPD and bipolar disorder tend to have different durations. In some people with bipolar disorder, episodes of depression or mania last at least two weeks at a time, which is much longer than the last mood in people with BPD. Even among those who experience bipolar disorder with faster mood swings, their mood usually lasts for days, while the mood of people with BPD may change within minutes or hours. So while euphoria and impulsivity in someone with BPD may resemble an episode of mania, the experience will be too short to qualify as an episode of mania.
Second, the atmosphere of bipolar disorder does not respond to environmental changes, while BPD mood responds to environmental changes. That is, positive events will not raise the mood of depression caused by bipolar disorder, but positive events will potentially lift the mood of a person's depression with BPD. Similarly, undesirable events will not discourage euphoria caused by bipolar disorder, but unwanted events will reduce a person's euphoria with a threshold personality disorder.
Thirdly, when people with BPD experience euphoria, usually without racing thinking and a decreased need for typical hypomania sleep, though a 2013 data study collected in 2004 found that the diagnosis and symptoms of borderline personality disorder were associated with chronic sleep. disorders including difficulty getting started, having difficulty maintaining sleep, and waking up earlier than desirable, as well as with the consequences of poor sleep, and noting that "[f] some new studies have examined the experience of chronic sleep disorders in those with impaired personality thresholds".
Since both of these conditions have a number of similar symptoms, BPD was once considered a form of mild bipolar disorder or present in the bipolar spectrum. However, this will require an underlying mechanism that causes these symptoms to be similar for both conditions. Phenomenological differences, family history, longitudinal courses, and response to treatment indicate that this is not the case. Researchers have found "only a simple relationship" between bipolar disorder and borderline personality disorder, with "strong spectrum linkages with BPD and bipolar disorder very unlikely". Benazzi et al. shows that the diagnosis of DSM-IV BPD combines two unrelated characteristics: the dimensions of affective instability associated with Bipolar II and the impulsive dimension unrelated to Bipolar II.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) occurs in 3-8 percent of women. Symptoms begin 5-11 days before menstruation and stop a few days after menstruation. Symptoms may include marked mood swings, irritability, depressed mood, feeling desperate or suicidal, subjective feelings overwhelmed or out of control, anxiety, binge eating, difficulty concentrating, and substantial interpersonal disorder. People with PMDD usually start experiencing symptoms in their early twenties, although many do not seek treatment until their early thirties.
Although some of the symptoms of PMDD and BPD are similar, they are a different disorder. They can be differentiated by the time and duration of symptoms, which are very different: PMDD symptoms occur only during the luteal phase of the menstrual cycle, whereas BPD symptoms occur continuously at all stages of the menstrual cycle. In addition, PMDD symptoms do not include impulsivity.
Comorbid Axis II Disorder
More than two thirds of people diagnosed with BPD also meet the criteria for other Axis II personality disorders at some point in their lives. (In a 2008 study, that figure was 73.9 percent.) Clitor A disorders, which included paranoia, schizoid, and schizotypal, were the most common, with a prevalence of 50.4 percent in people with BPD.
The second most common are other Cluster B disorders, which include antisocial, histrionic, and narcissistic. It has an overall prevalence of 49.2 percent in people with BPD, with narcissism being the most common, at 38.9 percent; the second most common antisocial, at 13.7 percent; and the most common histrionic, by 10.3 percent. The most common are Cluster C disorders, which include avoidant, dependent, and obsessive-compulsive, and have a 29.9 percent prevalence in people with BPD. Percentages for specific Axis II comorbid disorders can be found in adjacent tables.
Management
Psychotherapy is the primary treatment for personality disorder threshold. Care should be based on individual needs, not on the general diagnosis of BPD. Drugs are useful for treating comorbid disorders, such as depression and anxiety. Short-term hospitalizations have not been found to be more effective than community care to improve outcome or long-term prevention of suicidal behavior in those with BPD.
Psychotherapy
Long-term psychotherapy is currently the treatment of choice for BPD. While psychotherapy, particularly dialectical behavioral therapy and psychodynamic approaches, are effective, the effect is small.
Tighter care is not much better than less restrictive treatment. There are six treatments available: dynamic deconstructive psychotherapy (DDP), mental-based treatment (MBT), transference-focused psychotherapy, dialectical behavioral therapy (DBT), general psychiatric management, and schema-focused therapy. While DBT is the most studied therapy, all of these treatments appear to be effective for treating BPD, except for scheme-focused therapy. Any long-term therapy, including schema-focused therapy, is better than no treatment, especially in reducing the drive to self-injury.
Transference-focused therapy aims to escape from absolute thought. In this case, he makes people articulate their social and emotional interpretations to turn their view into a less rigid category. The therapist handles individual feelings and discusses situations, real or realistic, that can occur as well as how to approach them.
Dialectical behavioral therapy has components similar to CBT, adding in practice like meditation. In doing this, it helps individuals with BPD acquire skills to manage symptoms. These scenarios include setting emotions, attention, and stress resilience.
Cognitive behavioral therapy (CBT) is also a type of psychotherapy used for the treatment of BPD. This type of therapy depends on changing people's behavior and beliefs by identifying the problem of the disorder. CBT is known to reduce some of the anxiety and mood symptoms as well as reduce thoughts for suicide and self-injurious behavior.
Therapeutic-based Mentalization and transference psychotherapy focuses are based on psychodynamic principles, and dialectical behavioral therapy is based on cognitive-behavioral and awareness principles. General psychiatric management combines the core principles of each of these treatments, and it is considered easier to study and less intensive. Randomized controlled trials have shown that DBT and MBT may be the most effective, and both have much in common. Researchers are interested in developing a shorter version of this therapy to improve accessibility, to reduce the financial burden on patients, and to alleviate resource loads on care providers.
From a psychodynamic perspective, the particular problem of psychotherapy with people with BPD is an intense projection. This requires the psychotherapist to be flexible in considering negative attribution by the patient rather than quickly interpreting the projection.
Several studies have shown that mindfulness meditation can bring beneficial structural changes in the brain, including changes in the brain structure associated with BPD. Awareness-based interventions also appear to bring about improvements in symptoms of BPD characteristics, and some clients undergoing awareness-based care no longer meet at least five DSM-IV-TR diagnostic criteria for BPD.
Drugs
A 2010 review by the Cochrane collaboration found that no cure showed promise for "BPD's core symptoms of chronic emptiness, identity disturbance and neglect". However, the authors found that some drugs may affect isolated symptoms associated with BPD or symptoms of comorbid conditions. A review of 2017 examines the evidence published since the 2010 Cochrane review and found that "evidence of drug effectiveness for BPD remains highly diverse and is still strongly compromised by less-than-optimal study design".
Of the typical antipsychotics studied in association with BPD, haloperidol may reduce anger and flupenthixol may reduce the likelihood of suicidal behavior. Among atypical antipsychotics, one experiment found that aripiprazole can reduce interpersonal and impulsivity problems. Olanzapine may decrease affective instability, anger, psychotic paranoid symptoms, and anxiety, but placebo has a greater ameliorative effect on the idea of ​​suicide than olanzapine. The effect of ziprasidone is not significant.
From mood stabilizers studied, semisodium valproate can improve depression, interpersonal problems, and anger. Lamotrigine can reduce impulsivity and anger; Topiramate can improve interpersonal problems, impulsivity, anxiety, anger, and general psychiatric pathology. Carbamazepine effect is not significant. Of antidepressants, amitriptyline can reduce depression, but mianserin, fluoxetine, fluvoxamine, and phenelzine sulfate show no effect. Omega-3 fatty acids can improve suicide and improve depression. By 2017, trials with these drugs have not been replicated and long-term use effects have not been assessed.
Due to the weak evidence and potential serious side effects of some of these medications, the 2009 UK National Institute for Health and Clinical Excellence (NICE) clinical guidelines for the treatment and management of BPD recommends, "Drug treatments should not be used specifically for personality disorder thresholds or for individual symptoms or behaviors associated with the disorder. "However," drug therapy may be considered in the overall treatment of comorbid conditions ". They suggest "a review of the treatment of persons with impaired personality disorder who have no psychiatric or comorbid physical illnesses diagnosed and who are currently prescribed drugs, with the aim of reducing and stopping unnecessary treatment".
Services
There is a significant difference between the number of people who will benefit from treatment and the number of people being treated. The so-called "nursing gap" is a function of the suffering disinclination for treatment, which is less diagnosed to interfere by health care providers, and the limited availability and access to advanced care. Nevertheless, individuals with BPD accounted for about 20 percent of psychiatric hospitalizations in a single survey. The majority of individuals with BPD who are in care continue to use continuous outpatient treatment for several years, but the amounts that use tighter and more expensive forms of treatment, such as inpatients, decline over time.
Service experience varies. Assessing the risk of suicide can be a challenge for doctors, and patients themselves tend to underestimate deadly self-harmful behaviors. People with BPD usually have a chronically increased risk of suicide well above the general population and a history of several attempts when in crisis. About half of suicidal individuals meet the criteria for personality disorders. Borderline personality disorder remains a personality disorder most often associated with suicide.
After patients suffer from BPD dies, the National Health Service (NHS) in the UK is criticized by the coroner in 2014 due to the lack of services assigned to support them with BPD. Evidence is given that 45% of female patients experience BPD and there is no provision or priority for therapeutic psychological services. At that time, there were 60 special beds in the UK, all located in London or the northeast.
Prognosis
With treatment, most people with BPD can find relief from sad symptoms and achieve remission, defined as consistent relief from symptoms for at least two years. This longitudinal study tracked the symptoms of people with BPD found that 34.5% achieved remission within two years from the start of the study. In four years, 49.4% had achieved remission, and within six years, 68.6% had achieved remission. At the end of the study, 73.5% of participants were found in remission. In addition, of those who achieved recovery from symptoms, only 5.9% experienced recurrence. A later study found that ten years from baseline (during hospitalization), 86% of patients had a steady recovery from symptoms.
The patient's personality can play an important role during the therapeutic process, leading to better clinical outcomes. Recent studies have shown that patients with BPD who undergo dialectical behavioral therapy (DBT) show better clinical outcomes correlate with higher rates of patient willingness, compared with patients who are low on consent or not treated with DBT. The association is mediated through the strength of the working alliance between the patient and the therapist; that is, the more pleasant patients develop stronger working alliances with their therapist, which, in turn, leads to better clinical outcomes.
In addition to recovering from troublesome symptoms, people with BPD also achieve high levels of psychosocial function. A longitudinal study that tracked the social skills and work of participants with BPD found that six years after diagnosis, 56% of participants had good function in work and social environment, compared with 26% of participants when they were first diagnosed. Vocational achievements are generally more limited, even compared to those with other personality disorders. However, those whose symptoms have been significantly transmitted are more likely to have a good relationship with a romantic partner and at least one parent, good workplace and school performance, ongoing work and school history, and overall good psychosocial functioning.
Epidemiology
The prevalence of BPD is initially estimated to be 1 to 2 percent of the general population and occurs three times more frequently in women than in men. However, the prevalence of BPD lifetime in the 2008 study was found to be 5.9% of the general population, occurring in 5.6% of men and 6.2% of women. The differences in rates between men and women in this study were not found to be statistically significant.
Borderline personality disorder is estimated to contribute 20 percent of psychiatric hospitalizations and occurs among 10 percent of outpatients.
29.5 percent of new prisoners in the US state of Iowa correspond to a diagnosis of personality disorder threshold in 2007, and overall prevalence of BPD in US prison population is estimated at 17 percent. These high numbers may be associated with a high frequency of substance abuse and substance abuse among people with BPD, which is estimated at 38 percent.
History
The intense and distinct mood coexistence in a person is recognized by Homer, Hippocrates, and Aretaeus, the latter depicting the anger of impulsive, melancholy, and mania in one person. This concept was revived by Swiss physician ThÃÆ' Â © ophile Bonet in 1684 who, using the term folie maniaco-mÃÆ' © lancolique, described the unstable mood phenomenon following an unpredictable course. Other authors noted the same pattern, including American psychiatrist Charles H. Hughes in 1884 and J.C. Rosse in 1890, who called the disorder a "limitation of madness". In 1921, Kraepelin identified a "lucrative personality" parallel to the borderline traits outlined in the current BPD concept.
The first important psychoanalytic work using the term "limit" was written by Adolf Stern in 1938. It describes a group of patients who suffered from what he thought was a mild form of schizophrenia, at the boundary between neurosis and psychosis.
The 1960s and 1970s underwent a shift from thinking about conditions as border schizophrenia to thinking of it as a border affective disorder (mood disorder), on the periphery of bipolar disorder, cyclotimia, and dysthymia. In DSM-II, emphasizing the intensity and variability of mood, it is called cyclothymic personality (affective personality). While the term "limits" evolves to refer to different categories of disorders, psychoanalysts such as Otto Kernberg use them to refer to a broad spectrum of problems, describing the intermediate level of organizational personality between neurosis and psychosis.
After standard criteria were developed to differentiate it from mood disorders and other Axis I disorders, BPD became a diagnosis of personality disorder in 1980 with the publication of DSM-III. Diagnosis is distinguished from sub-syndromal schizophrenia, called "Schizotypal personality disorder". The DSM-IV Axis II Working Group of the American Psychiatric Association finally decided on the name of "borderline personality disorder", which is still used by DSM-5 today. However, the term "boundary" has been described as not unique enough to describe the symptoms of the disorder's characteristics.
Controversy
Credibility and validity of testimonial
The credibility of individuals with personality disorders has been questioned since at least the 1960s. Two concerns are the occurrence of dissociation episodes among people with BPD and the belief that lying is a key component of this condition.
Dissociation
Researchers disagree about whether dissociation, or feelings of emotion and physical experience, impact the ability of people with BPD to remember specific past events. A 1999 study reported that the specificity of autobiographical memory decreased in patients with BPD. The researchers found that decreased ability to remember specific correlates with the degree of dissociation of patients.
Lying as a feature
Some theorists argue that patients with BPD often lie. Others, however, write that they are rarely seen lying among patients with BPD in clinical practice.
The belief that lying is a distinguishing characteristic of BPD may affect the quality of care that people with this diagnosis receive in the legal system and health care. For example, Jean Goodwin tells the anecdote of a patient with multiple personality disorder, now called dissociative identity disorder, who suffered pelvic pain due to a traumatic event in his childhood. Due to their unbelief in his account of this event, doctors diagnose him with a personality disorder threshold, reflecting the belief that lying is a key feature of BPD. Based on his diagnosis of BPD, the doctors then ignored the patient's statement that he was allergic to the adhesive tape. The patient is actually allergic to the adhesive tape, which then causes complications in surgery to ease pelvic pain.
Gender
Because BPD can be a diagnosis of stigmatization even within the mental health community, some survivors of childhood violence diagnosed with BPD are traumatized by the negative responses they receive from healthcare providers. One stronghold argues that it would be better to diagnose this man or woman with post-traumatic stress disorder, as this would acknowledge the impact of harassment on their behavior. Critics of the PTSD diagnosis argue that the drug is treating abuse rather than addressing the root causes in society. Regardless, the diagnosis of PTSD does not cover all aspects of the disorder (see Brain abnormalities and Terminology).
Joel Paris states that "At the clinic... Up to 80% of patients are women.That may not be true in society." He offers the following explanation of this gender incompatibility:
The most likely explanation for gender differences in clinical samples is that women are more likely to develop the kind of symptoms that bring patients to treatment. Twice as many women as men in the community suffer from depression (Weissman & Klerman, 1985). Conversely, there are more people who meet the criteria for substance abuse and psychopathy (Robins & Regier, 1991), and men with this disorder are not always present in the mental health system. Men and women with similar psychological problems can express difficulties differently. Men tend to drink more and do more crime. Women tend to change their anger on themselves, leading to depression as well as the overdose and overdose that characterizes BPD. Thus, anti-social personality disorder (ASPD) and personality disorder threshold may be from a similar underlying pathology but present with symptoms strongly influenced by sex (Paris, 1997a; Looper & Paris, 2000).
We even have more specific evidence that men with BPD may not seek help. In a completed suicide study among people ages 18 to 35 (Lesage et al., 1994), 30% of suicides involved individuals with BPD (as confirmed by psychological autopsies, where symptoms were assessed by interviews with family members). Most suicidal actors are male, and very few are in treatment. Similar findings emerge from subsequent studies conducted by our own research group (McGirr, Paris, Lesage, Renaud, & Turecki, 2007).
In short, men tend to seek or receive appropriate treatment, are more likely to be treated for BPD symptoms such as substance abuse than BPD itself (furthermore, the symptoms of BPD and ASPD may be derived from a similar underlying etiology) and perhaps men are more likely to commit suicide self before diagnosis.
Among men diagnosed with BPD there was also evidence of a higher suicide rate: "men were more than twice as likely as women - 18 percent versus 8 percent" - died of suicide.
There is also a gender difference in borderline personality disorder. Men with BPD are more likely to abuse substances, have explosive properties, seek high levels of novelty and have anti-social, narcissistic, passive-aggressive or sadistic personality traits. Women with BPD are more likely to have eating disorders, mood disorders, anxiety and post-traumatic stress.
Manipulative behavior
The manipulative behavior to obtain care is considered by DSM-IV-TR and many mental health professionals to characterize a personality threshold disorder. However, Marsha Linehan notes that doing so depends on the assumption that people with BPD who communicate severe pain, or who engage in self-harm and suicidal behaviors, do so in order to influence the behavior of others. The impact of such behavior on others - often intense emotional reactions to friends, family members, and therapists - is thus assumed to have been the intention of the person.
However, since people with BPD do not have the ability to successfully manage painful emotions and interpersonal challenges, frequent intense pain expression, self-harm, or suicidal behavior can instead represent a mood-setting method or escape mechanisms from situations that feel unbearable. Linehan notes that if, for example, a person withholds painkillers from burn victims and cancer patients, making them unable to manage their severe pain, they will also show "attention-seeking" and self-destructive behaviors to overcome.
Stigma
BPD features include emotional instability; strong interpersonal relationships and tid
Source of the article : Wikipedia
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