Borderline Personality Disorder - Medtick
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Borderline Personality Disorder

What is it?

A disorder of mood and how a person interacts with others.

  • It occurs one feels a poor self-image, a feeling of emptiness, and great difficulty coping with being alone and also the way one thinks about others an can cause extreme emotions.
  • This condition occurs more in females  than men.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosis of BPD requires the presence of five or more of the following personality characteristics[1]:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization (in which a person assigns exaggeratedly positive characteristics to the self or others) and devaluation (in which a person assigns exaggeratedly negative characteristics to the self or others), commonly referred to as “splitting”[3]
  • Identity disturbance, with a markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (i.e. spending, sex, substance abuse, reckless driving, binge eating)
  • Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
  • Affective instability due to a marked reactivity of mood (i.e. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty in controlling anger (i.e. frequent displays of temper, constant anger, recurrent physical fights)
  • Transient, stress-related paranoid ideation or severe dissociative symptoms

[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association; 2013.

[3] Stern TA, Fricchione GL, Rosenbaum JF. Massachusetts General Hospital Handbook of General Hospital Psychiatry. 6th ed. Saunders Elsevier; 2010.

Cause

  • Family history maybe
  • Brain regions involved in managing fear and controlling aggressive responses function differently in people with borderline personality disorder [The brain areas of particular interest in borderline personality disorder are the limbic system and the frontal areas. The limbic system is a collection of structures that includes the amygdala and hippocampus. This area is believed to regulate emotion (the amygdala regulates fear and anxiety and the hippocampus is responsible for memory)]:
    • Neuroimaging studies have found there is a reduction in volume of the amygdala in people with borderline personality disorder.
    • This is believed to be caused by excitotoxicity, a process in which nerve cells are damaged by excessive stimulation (e.g., stress).

Tyrka A, Burgers D, Philips N et al. The neurobiological correlates of childhood adversity and implications for treatment. Acta Psychiatrica Scandinavica 2013;128:434–437.

    • It has been suggested that the amygdala is also more sensitive in people with borderline personality disorder; when people with borderline personality disorder are shown images designed to elicit unpleasant emotions, activation of the amygdala — as shown on a function magnetic resonance imaging scan — has been found to be higher compared with those without the disorder

Koenigsberg HW, Siever LJ, Lee H et al. Neural correlates of emotion processing in borderline personality disorder. Psychiatry Res 2009;172:192–199.

  • Something wrong with the neurotransmitters (chemicals that send signals in the brain) in their brain, particularly serotonin.
  • Distinctive patterns in hormone levels and the immune system in people with the disorder.
  • Scan with this condition conclude that three parts of the brain were either smaller than expected or had unusual levels of activity.
  • These parts were:
    • the amygdala – which plays an important role in regulating emotions, especially the more “negative” emotions, such as fear, aggression and anxiety
    • the hippocampus – which helps regulate behaviour and self-control
    • the orbitofrontal cortex – which is involved in planning and decision making

NHS Choices 

  • Child sexual abuse
  • Child abuse
  • Child neglect
  • Child distress and/or fear
  • Growing up with another family member who had a serious mental health condition or a drink or drug misuse problem
  • Person’s relationship with their parents and family has a strong influence on how they come to see the world and what they believe about other people.

Symptoms

  • Highly reactive and intense moods (rage, sorrow, shame, panic, terror)?
  • Wide mood swings lasting from a few hours to a few days (i.e. feel really down even to the point of suicide and then feel positive later)?
  • Irritable and  anxiety?
  • Really happy?
  • Depression and shame?
  • intense anger, such as frequently losing your temper?
  • Inappropriate sarcastic or bitter?
  • Impulsive behaviour (gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse or ending a positive relationship)?
  • Misinterpret or amplify what other people feel about them?
  • Assume a friend or family member is having extremely hateful feelings toward them?
  • Unstable relationships?
  • Experience  twisted thoughts of their perceptions or beliefs resulting you changing your self image and values because one feels they have done something wrong/bad?
  • Compete for social acceptance?
  • Idealize a family member, romantic partner or friend, and then become enraged when a small thing goes wrong ad/or believing the person doesn’t care enough or is cruel?
  • Blame others for the pain they feel?
  • Terrified of rejection?
    • Constantly texting or phoning a person/partner
    • suddenly calling that person/partner in the middle of the night
    • Physically clinging on to that person/partner and refusing to let go
    • Making threats to harm or kill yourself if that person ever leaves you
  • May feel others are smothering, controlling or crowding you, which also provokes intense fear and anger (i.e tell one to ‘go away’ and then feel ‘I need you’ and fear rejection)?
  • Often feel lonely even in relationship?
  • Deep fear of abandonment?
  • Hearing voices (brief moments i.e couple of minutes)?
  • Harm themselves (for example, cutting or burning) as a form of self-punishment or to combat an empty feeling?
  • Distressing beliefs that no one can talk you out of?
  • Suicidal thoughts?

Complications /Information to beware of/General tips:

Do not wait, phone for an ambulance if one have symptoms and/or develop:

  • Suicidal thought
  • Harm oneself
  • Hallucinations (seeing things that are not there)

This condition can lead to:

This condition may be associated with:

One should also consider:

Individuals with this disorder display pervasive distrust and suspiciousness, with a tendency to attribute malevolent motives to others, to be preoccupied with unjustified doubts, and to persistently bear grudges. Common beliefs include the following:

  • Others are exploiting or deceiving the person
  • Friends and associates are untrustworthy
  • Information confided to others will be used maliciously
  • There is hidden meaning in remarks or events others perceive as benign
  • Attacks are being made on the person’s character or reputation that are not apparent to others
  • The person’s spouse or partner is unfaithful

Schizoid personality disorder

This type of personality disorder is uncommon in clinical settings. A person with this disorder is markedly detached from others and has little desire for close relationships, choosing solitary activities. The person’s life is marked by little pleasure in activities and little interest in sexual relations. People with this disorder appear indifferent to the praise or criticism of others and often seem cold or aloof.

Schizotypal personality disorder

Persons with this disorder exhibit marked eccentricities of thought, perception, and behaviour. Typical examples are as follows:

  • Ideas of reference – believing that public messages are directed personally at them
  • Odd beliefs or magical thinking
  • Vague, circumstantial, or stereotyped speech
  • Excessive social anxiety that does not diminish with familiarity
  • Idiosyncratic perceptual experiences or bodily illusions

Obsessive-compulsive personality disorder

People with obsessive-compulsive personality disorder display the following traits:

  • Preoccupation with orderliness, perfectionism, and control; however, such preoccupations interfere with efficiency, despite the individual’s focus on a task
  • Lack of flexibility or openness
  • Reluctance to delegate tasks
  • An excessive devotion to work, with the exclusion of leisure activity
  • Often, scrupulousness and inflexibility with regard to matters of morality, ethics, and values to a point beyond cultural norms
  • In many cases, stinginess and stubbornness
  • Prurigo Nodularis

Antisocial Personality Disorder:

Patients must have evidence that a conduct disorder has been present before age 15 years.Patients must also demonstrate a persistent disregard for the rights of others. This disregard is shown by the presence of at least three of the following:

  • Disregarding the law, indicated by repeatedly committing acts that are grounds for arrest
  • Being deceitful, indicated by lying repeatedly, using aliases, or conning others for personal gain or pleasure
  • Acting impulsively or not planning ahead
  • Being easily provoked or aggressive, indicated by constantly getting into physical fights or assaulting others
  • Recklessly disregarding their own safety or the safety of others
  • Consistently acting irresponsibly, indicated by quitting a job with no plans for another one or not paying bills
  • Not feeling remorse, indicated by indifference to or rationalisation of hurting or mistreating others

Histrionic personality disorder

Major traits of this condition include the following:

  • Need to be the centre of attention with self-dramatisation
  • Inappropriate sexual seductiveness
  • Speech lacks detail
  • Aggrandising, but insincere, relationships
  • Suggestibility

Narcissistic personality disorder

Narcissistic patients are grandiose and require admiration from others. Particular features of the disorder include the following:

  • Exaggeration of their own talents or accomplishments
  • Preoccupation with fantasies of success, beauty, and love
  • Sense of entitlement
  • Exploitation of others
  • Lack of empathy
  • Envy of others
  • An arrogant, haughty attitude

 

Avoidant personality disorder

Avoidant patients are generally very shy. They display a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to rejection. Unlike patients with schizoid personality disorder, they actually desire relationships with others but are paralysed by their fear and sensitivity into social isolation.

Major traits include the following:

  • Lack of close friends and unwillingness to get involved unless certain of being liked
  • Avoidance of social activities and fear of criticism
  • Embarrassment or anxiety in front of people

Dependent personality disorder

While many people exhibit dependent behaviours and traits, people with dependent personality disorder have an excessive need to be taken care of that results in submissive and clinging behaviour, regardless of consequences. Diagnosis requires at least 5 of the following features:

  • Difficulty making decisions without guidance and reassurance
  • Need for others to assume responsibility for most major areas of the person’s life
  • Difficulty expressing disagreement with others
  • Difficulty initiating activities because of lack of confidence
  • Excessive measures to obtain nurturance and support
  • Discomfort or helplessness when alone
  • Urgent seeking for another relationship when one has ended
  • Unrealistic preoccupation with fears of being left to fend for themselves

Imposter syndrome

When one doubts their own skills and successes. One feel one is not as talented or worthy as others believe, and one is scared that one day, people will realise that.

Symptoms include:

  • Believe that everyone knows more than you
  • Think that others believe you’re more skilled than you really are
  • Dismiss your success and credit it to luck, people you know, others’ poor judgment, or other things besides your abilities
  • Notice “the imposter cycle” happening in your life
  • Worry that you don’t belong and others too will finally realise that
  • Feel like you always have to do your very best or more than what’s asked of you
  • Feel uncomfortable being praised
  • Hold yourself back from reaching goals
  • Are afraid you’ll disappoint others
  • Have a hard time forgetting mistakes, even small ones, that you’ve made
  • Feel that you wouldn’t doubt yourself if you were brighter, smarter, better, etc.
  • Find it important to get others’ approval
Some of the characteristics that often show up with imposter syndrome are:

  • Perfectionism. You aim to be perfect at everything you do, but you also easily find fault in your achievements and are rarely pleased with the outcome. You might also expect other people to be perfect, too.
  • Superheroism. Many people with imposter syndrome feel like they have to take on more tasks (and be better at them) than others. One sign that you’re trying to be a superhero is that you often say “yes” to things that you may not have the energy or time to do.
  • Fear of failure. When you have imposter syndrome, any failure, no matter how small, can feel shameful. It feeds that inner fear you have that you’re a fraud and are about to be called out. As a result, you often work harder to avoid falling short of a task. You might also be afraid to speak up if you have a different idea or point of view than others.
  • Denying your wins. Imposter syndrome makes you ignore or deflect anything good that happens or any praise you receive. If you hear a compliment, you have an excuse like “I was just lucky” or “My boss says that to everyone.”
  • Fear of success. It’s really common to be scared of success when you have imposter syndrome. You might worry that once you get your dream job or win an award you’ve been hoping for, you won’t be able to keep up. In your mind, getting ahead is an opportunity to be rejected.
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