What is borderline personality disorder?

DEAR DOCTOR K:

My daughter is in her 20s. She had a hard time during her teenage years and was recently diagnosed with borderline personality disorder. Can you tell me what this is?

DEAR READER:

Borderline personality disorder (BPD) is a mental health condition that involves poor self-image, a feeling of emptiness and great difficulty being alone. BPD is surprisingly common: About 6 percent of the U.S. population suffers from it at some point in their lifetime.

People with BPD have intense moods and unstable relationships. They can be impulsive and have unsafe sex, drive dangerously, eat too much, drink too much and squander money.

Unfortunately, people with BPD are more likely than others to harm themselves. In fact, they are more likely than average to attempt or commit suicide.

We really don’t understand what causes BPD. Most doctors think that it, as with many psychiatric illnesses, is a combination of genes and life experience. A person is born with a genetic vulnerability to develop the condition if he or she has certain life experiences. In particular, many teens and adults with BPD have experienced some form of abuse in childhood, including verbal, physical or sexual abuse, as well as being separated from one or both parents.

A doctor will diagnose BPD when a person has had many of the following symptoms. The symptoms must be severe and be present for a long time:

  • Unstable, intense and difficult relationships;
  • Poor self-image;
  • Self-destructive, impulsive behavior;
  • Suicidal threats or attempts;
  • Self-mutilation;
  • Extreme mood reactions, including intense, inappropriate anger;
  • Feeling empty or alone;
  • Fear of abandonment;
  • Short-lived distortions of perception or belief. For example, a person may assume a friend or family member hates them. In fact, the person may be only mildly annoyed or angry.

Psychotherapy is a key part of treatment. But this treatment itself can present challenges because people with BPD tend either to idealize the therapist or become easily frustrated with them. As a result, it may be difficult for them to sustain a relationship with a therapist.

Also, people with BPD may understand interpersonal problems or coping strategies on an intellectual level, but they may still be unable to successfully manage intense emotions.

Another approach helps people with BPD to look at issues from different points of view. It then encourages them to use what they learn to better manage their own feelings and behaviors.

Medication is another treatment option. No single drug clearly helps treat BPD; instead, medication is usually used to treat symptoms as they emerge.

A person with BPD may also need or benefit from extra support. This may include a day-treatment program, live-in treatment, or group, couples or family therapy.

Most people experience at least some improvement in symptoms with treatment. Significant numbers even recover from the disorder. That means they no longer meet the criteria for having BPD, and they function well.