Updated: Jan 12

Hello Readers, I trust we are all doing great? I was compelled by a friend to educate you on this topic: Borderline Personality Disorder. It is a disorder that can bring your relationships down the drain and leave you feeling empty inside.

I came into contact with a friend in the consulting room who had multiple scars on her left forearm; these scars were deliberate attempts at harming herself. This puts up the question what is self harm?

Self harm is the deliberate injury to oneself. Also known as self-injury, this is defined as the intentional, direct injuring of any part of the body, which is done without the intent to commit suicide. This is typically as a manifestation of a psychological or psychiatric disorder.

So let’s move to Borderline personality disorder.

Borderline personality disorder is characterized by instability, impulsiveness, chaotic sexuality, suicidal acts, feeling of emptiness and self multilating behaviors. Lots of English words I know!

Affective instability, defined as repeated, rapid, and abrupt shifts in mood, is considered the core pathology in borderline personality disorder. Impulsivity, or an impulsive behavior, is broadly defined as actions without foresight that are poorly conceived, prematurely expressed, unnecessarily risky, and inappropriate to the situation. Impulsivity is associated with undesirable outcomes such as financial and legal harm if left unchecked. Chaotic sexuality implies they are more likely to exhibit greater sexual preoccupation, have earlier sexual exposure, engage in casual sexual relationships, report a greater number of different sexual partners as well as promiscuity.

Borderline personality disorder is thought to be present in about 1-2% of the population and is twice as common in women than men.

Patients with borderline personality disorder stand between the border of neuroses and psychoses. Neurosis is relatively a mild mental illness which is not radically a loss of touch with reality. An individual with neuroticism may be self-conscious and shy. They may tend to internalize phobias and other traits, such as anxiety, panic, aggression, negativity, and depression. Neuroticism is an ongoing emotional state defined by these negative reactions and feelings. People with psychosis however have their thoughts and emotions are so impaired that they lost contact with external reality. Psychosis is a symptom and not an illness predominantly caused by either mental or physical illnesses.

People with borderline personality disorder have an extraordinary unstable affect, mood, behavior and issues with self image.

Diagnosis of borderline personality disorder can be made in early adulthood when the patient shows at least five of the criteria discussed below.

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable or intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Idealization is an action regarding something as perfect than it is in reality. Devaluation on the other hand, is the reduction or underestimation of the worth or importance of something.

3. Identity disturbance markedly or persistently unstable self image or sense of self.

4. Impulsivity in at least 2 areas which are potentially self driving and binge eating. This may include suicidal or self multilating behaviours.

5. Affective instability due to a marked reactivity of mood.

6. Chronic feelings of emptiness.

7. Inappropriate, intense anger or difficulty controlling anger.

8. Transient, stress related paranoid ideations or severe dissociative symptoms (significant memory loss of specific times, people and events).

9. Out of body experiences, such as feelings as though they were watching a movie of themselves.

People with borderline personality disorder appear to be in a state of crisis in which mood swings are common. They can become very argumentative at one moment, depressed at the next, and complain of having no feelings.

The behavior of those with Borderline Personality Disorder are highly unpredictable and their achievements are rarely at the level of their abilities. The painful nature of their lives is reflected in repetitive self destructive self such as slashing their wrists and performing other self multilating acts to elicit for help from others, or to express anger, or to numb themselves to overwhelming affect.

Because they feel both dependent and hostile, they have tumultous interpersonal relationships. They can be dependent on those with whom they are close and, when frustrated, can express enormous anger towards their intimate friends.

Patients with borderline personality disorder can not tolerate being alone, and they prefer for a frantic search for companionship which tends to be short lived. To assuage loneliness, if only for brief periods, they accept a stranger as a friend or behave promiscuously.

They often complain about chronic feelings of emptiness and boredom and a lack of consistent sense of identity (identity diffusion). When pressed, they often complain about how depressed they feel despite the flaring of other affects.

Functionally, patients with BPD distort their relationships by grouping people into good or bad. They see persons as either nurturing them of security needs and therefore threaten them with abandonment. As a result of this, the good person is idealized and the bad person is devalued. Shifts of allegiance from one person or group to another are frequent.

Borderline Personality Disorder is fairly stable with patients changing a little over time. It is said the patients have a high incidence of major depressive disorder episodes.

Diagnosis is usually made before age 40 years when patients are attempting to make occupational, marital and other choices and are unable to deal with the normal stages of the life cycle.

Treatment involves psychotherapy to deal with intensive investigation. This allows the patient to be attentive to the mental state of him or herself and others. Drugs can be given to control episodes of agitation and aggression.

Seek help if you fall into the category of any of these and trust me, we can make life a better place for you.

Thanks for reading


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