Borderline Personality Disorder (Borderline Syndrome) – Causes, Symptoms & Treatment

Borderline personality disorder is what is known as a personality disorder. This means that borderline personality disorder is a very pervasive disorder that affects how a person experiences, perceives and behaves.

The original name of borderline personality disorder was ‘Emotionally Unstable Personality Disorder’. People suffering from this disorder usually show instabilities in their self-esteem, in their relationships with other people, and in their behavior.

There is often a vacillation between the extremes (e.g. idolatry on the one hand and contempt on the other).

causes

The causes of a borderline personality disorder (borderline syndrome) cannot be clearly determined; in each sufferer, different and individual factors in their combination usually contribute to the borderline personality disorder.According to scientific hypotheses, for example, hereditary factors can contribute to the development of borderline syndrome; Presumably, people whose families have known people with borderline personality disorder show a higher vulnerability (i.e. susceptibility) to the development of the disorder.

Physiological imbalances in what are known as transmitter substances in the brain (messenger substances that transport nerve signals) are also believed to be involved in borderline syndrome.

Environmental factors also presumably play an important role; for example, these are traumatic experiences or experiences that can impair healthy personality development.

When to the doctor?

Borderline personality disorder is relatively common in the population. The patients turn out to be psychologically unstable and impulsive, but perceive this differently due to insufficient self-assessment. Therefore, they should listen to the advice of those around them when the behavior becomes a burden. A major problem is that people can sometimes endanger themselves or others.

There are both mild and severe cases of borderline syndrome, which range from scratching one’s own skin with sharp objects to unauthorized physical assaults on other people. At that point at the latest, a specialist, a psychiatrist, should be called in to prescribe phase prophylactic drugs or neuroleptics , which many experts view critically because of the side effects. At the same time, other forms of therapy such as ergotherapy, talk therapy or schema therapy can help.

On the other hand, there are people who have lived with borderline syndrome for years without it being particularly noticeable or burdening the community. It often happens that people visit a doctor for another reason and the doctor recognizes a borderline disorder based on the behavior and refers the patient to a psychiatrist or a psychiatric clinic, depending on the medical care structure in the region. Of course, there are misjudgments or errors in the diagnosis, so that a second assessment should always be obtained from an independent specialist.

symptoms and course

The symptoms and course of borderline personality disorder are just as multifaceted as their possible causes. In psychiatry and psychology there are so-called diagnostic criteria that allow the diagnosis of a borderline syndrome; For this purpose, the affected person must be asked to confirm a minimum number of different symptoms. Symptoms of the questionnaire are, for example, the so-called ‘black and white vision’ – this means that those affected have difficulty feeling outside of extremes.

Other symptoms are, for example, rapidly changing sexual partners, uncontrollable outbursts of anger, pronounced emotional mood swings, a great fear of being abandoned, self-damaging or even suicidal (suicidal) behavior or moments of so-called dissociative experience – i.e. the feeling of standing next to oneself. Borderline syndrome usually develops in early adulthood.

Diagnose

When diagnosing a borderline personality disorder, it is important to use well-founded and generally recognized diagnostic criteria as a guide. A collection of common symptoms of mental disorders can be found, for example, in the DSM-IV (“Diagnostic and Statistical Manual of Mental Disorders”). The manual describes nine diagnostic criteria for borderline personality disorder, of which at least five must have occurred in a person over a longer period of time. In addition, the person must meet the criteria for the presence of a personality disorder. In general, diagnosticians must be aware that such diagnoses are not to be made lightly and should only be made on the basis of sufficient information.

A detailed diagnosis can be carried out using a structured interview, in which all important symptoms are queried and checked for their presence (e.g. the SKID-II (“Structured Clinical Interview for DSM-IV Personality Disorders”)). In the ICD-10, a diagnostic manual used almost exclusively in Germany, the syndrome is classified under the “emotionally unstable personality disorder” and, alongside the “impulsive type”, represents the second type of differentiation (“borderline type”) of this group of disorders.

When diagnosing the disorder, it is particularly important to make a detailed differential diagnosis, since the usual symptoms can also occur with other disorders. In addition, borderline patients often suffer from other mental illnesses: for example addiction disorders, eating disorders, post-traumatic stress disorders or affective disorders.

complications

Borderline personality disorder is a psychiatric syndrome that usually requires both medication and therapy. Since people with it are emotionally unstable in relation to themselves and others, it is important to establish an emotional balance so that they can better cope with their environment. Borderline patients are often a group of people who are discriminated against because they display severe behavioral problems. Therefore, untreated borderline syndrome can lead to social isolation, which can have consequences for family life and work.

In order to better integrate the individual, psychological stability should first be established. To achieve this, occupational therapy, talk therapy and behavioral therapy are recommended. If a borderline syndrome remains untreated, it can have serious consequences. Those affected can become self-endangering and injure themselves, for example, through scratches on the skin. However, comparable to the Ritalin medication for ADHD patients, doctors in borderline syndrome sometimes prescribe medication such as neuroleptics hastily and unthinkingly. This can lead to severe limitations and side effects. It is therefore better to try other forms of therapy first than strong medication. In many cases, however, this is not done due to a lack of capacity and lack of dedication on the part of the doctors. For people with borderline syndrome, history is sometimes key. Under certain circumstances, it provides clues as to what should change in the patient’s life in order to bring about an improvement.

treatment and therapy

There are different approaches to treating borderline personality disorder. Among other things, there is the possibility of drug treatment as well as psychotherapeutic treatment of borderline personality disorder. Both approaches are often combined.

The individual treatment of borderline personality disorder is based, among other things, on the symptoms of the person affected. Possible forms of psychotherapeutic treatment of the borderline syndrome are, for example, psychoanalytic or dynamic therapy, behavioral therapy or talk therapy.The so-called DBT (Dialectic Behavioral Therapy) according to Marsha M. Linehan is highlighted here as an example; this therapy concept in the treatment of borderline syndrome is primarily aimed at borderline patients with suicidal behavior.

Good successes of the treatment concept have already been scientifically proven: The DBT builds, among other things, on the patient’s attention to his own behavior and feelings in order to be able to uncover and change disturbed behavior himself.

The DBT also includes the modules of self-esteem, stress tolerance and interpersonal skills. The relevant points should be trained and strengthened in order to be able to counteract the symptoms of the borderline syndrome.

prevention

In principle, there are few ways to directly prevent borderline personality disorder. Among other things, the absence of the stressful environmental factors mentioned can have a preventive effect – i.e. growing up that has the least negative influence on personality development. However, since this in turn depends on many mutually dependent factors, it is difficult to prevent a borderline personality disorder in a planned manner – especially by the potentially affected person himself.