What is Borderline Personality Disorder?

Borderline Personality Disorder is a persistent pattern of unstable mood, intense and unstable relationships and identity confusion.

What are the symptoms of Borderline Personality Disorder?

People with this disorder have at least five of the following symptoms:

• Unstable and intense relationships
• Impulsive acts with a high risk of harm, such as spending, sex, reckless driving, substance use, shoplifting, or binge eating
• Rapid shifts from a normal mood to depression, irritability or anxiety
• Inappropriate, intense anger or lack of control of anger
• Suicide threats, thoughts, or behavior, or self-mutilation
• Persistent identity confusion, including self-image, sexual orientation, long-term goals or career choice, choice of friends, or values
• Chronic feelings of emptiness
• Frantic efforts to avoid real or imagined abandonment
• Brief, stress-related paranoia or loss of touch with reality

What causes Borderline Personality Disorder?

The cause is unknown at this time, but several theories are being looked at. There is some evidence that inheritance and other biological or biochemical factors may be involved in some people. Psychological factors are also involved for most patients. For example, having had childhood trauma (physical, sexual, or emotional abuse or neglect, or prolonged separation) is far more common in people with this disorder than in the general population.

What happens to people who have Borderline Personality Disorder?

The course of this illness is variable and often prolonged. It is more common in women, and usually surfaces during the teen years or young adulthood, with the first serious symptoms often appearing at the time of a significant change or separation. All patients with this disorder experience upheaval, chaos and pain. Sometimes the illness can be managed with outpatient treatment. Some patients require periodic brief hospitalizations when symptoms are intense. Other patients require longer inpatient treatment to provide safety while they are learning healthier patterns of behavior. Most patients make a reasonable work and social adjustment.

How is Borderline Personality Disorder treated?

Treatment of Borderline Personality Disorder may include individual, group or family therapy, structure (making a daily written schedule so there are no long periods of unplanned time), support, medicines, limit-setting, consistent rules, education about the illness, social skills training, behavior modification and learning healthy communication and coping skills. Inpatient or day hospitalization may be necessary when symptoms make the patient a danger to self or others.

What can I do to deal with my Borderline Personality Disorder?

Advice from people who have successfully managed this illness includes:

• Set clear, realistic goals.
• Be patient with yourself.
• Develop methods to manage specific problem behaviors.
• Avoid alcohol and street drugs.
• Accept the responsibility for managing your illness.
• Make a written schedule every day so your time is structured.
• Make every effort to follow your schedule.
• Find a satisfying job.
• Make and keep at least one good friend.
• Work hard at being honest in therapy.
• Take medication if prescribed.
• Learn to express your feelings directly and appropriately.
• Remember you can't always change the way you feel, but you can always change what you do about it.
• Find a balance between work and fun.
• Choose healthy role models.

What happens if the symptoms return after I get them under control?

Certain life events are especially stressful for people with this illness and increase the risk of relapse: therapist's or other vacations; change in job, housing or finances; change in significant relationships; birthdays, anniversary dates, and holidays; increased job pressure or promotion; discharge from a hospital or program; changes in physical health, including pregnancy, abortion, trauma or illness. Patients can plan ahead for these events by carefully following self-management measures and watching for increasing symptoms. If signs of relapse appear, there should be a specific plan decided in advance for actions that can be taken (e.g. brief hospitalization, medications, increased structure, etc.).

Where can I get more information about Borderline Personality Disorder?

There are several good books about Borderline Personality Disorder:

Jerold J. Kreisman. I Hate You. Don't Leave Me. The Body Press, 1990.

Marsha Linehan. Skills Training Manual for Treating Borderline Personality Disorder. 1993.

Paul T. Mason, Randi Kreger and Larry J. Siever. Stop Walking on Eggshells; Coping When Someone You Care About has Borderline Personality Disorder. 1998.

John Oldham and Lois B. Morris. Personality Self-Portrait, revised, Bantam, 1995.

Melissa Ford Thornton. Eclipses: Behind the Borderline Personality Disorder. Monte Sano Publishing, 1998.

The following organization can provide help, information and support:

National Alliance for the Mentally Ill (NAMI). A support and information-giving organization for people with psychiatric illness and their family members. For information about NAMI membership and availability of local meetings, call 1-800-950-NAMI, or reach them online at www.nami.org.