Angry outbursts, unstable relationships and mood swings could describe symptoms of several psychiatric conditions. Bipolar disorder, discussed in last week’s column, is just one of them. Another particularly troublesome condition often associated with these traits is borderline personality disorder (BPD).
For the two per cent of Canadians with this disorder, life is chaotic – often moving from one crisis to the next. People with BPD usually have a long history of intense, unstable relationships and an extreme fear of being abandoned by people. They tend to evaluate people as either all good or all bad and evaluations can change from one extreme to the other very quickly.
Almost always, borderline patients have difficulty with the conception of self. One expert on the disorder explained it by saying borderline patients can describe themselves for hours and never give a realistic picture of what they’re like.
Borderlines exhibit anger that is inappropriate and difficult to control. They have a history of impulsive, reckless behaviour in sex, spending or eating; chronic feelings of emptiness and boredom; and mood states that last only hours.
Social adaptation is another problem that plagues people with BPD. Those with the disorder tend not to know or understand the rules regarding performance in job or academic settings. This often leads to frequent job changes and a string of unfinished educational pursuits.
As self-destructive behaviour and suicidal threats and gestures are common with BPD, it is important to find ways to help individuals suffering from this disorder. Symptoms do tend to improve as the individual ages, but the condition can still be debilitating in many ways during formative years so it is important to seek help as early as possible, which can be a difficult job.
Dialectical Behaviour Therapy is one of the best-researched treatments for BPD. It may involve one-on-one visits with a therapist or participation in group therapy sessions. In order to benefit from this therapy, patients must recognize their problems and be willing to work to solve them.
Dialectical Behaviour Therapy works from the theory that BPD occurs as a result of a negative and invalidating childhood environment as well as a biological predisposition. Many individuals with this disorder have been physically or sexually abused as children. They become over-sensitized to emotional stimuli and react more quickly and severely than most. Therapy teaches coping skills and helps borderline patients to deal more effectively with surges of emotion.
Specifically, therapy attempts to reduce any suicidal or self-destructive behaviour and reduce inappropriate responses that may interfere with the patient’s quality of life. It also focuses on dealing with post-traumatic stress and enhancing the patient’s self respect.
While there is no specific medication for BPD, getting treatment for the other psychiatric symptoms that frequently co-exist can help. The newer atypical antipsychotic medications can help to control anger, impulsiveness and mood.
Another important aspect to the treatment of BPD is fostering the education and support of the patient’s loved ones. Because borderline patients are often unpredictable and volatile, they can be difficult people to live with.
Loved ones need to offer support, avoid overreacting to upsetting behaviour, encourage getting treatment, set boundaries and be consistent with their loved one. All of these steps can help a borderline patient get through this difficult disorder. Keeping a positive attitude and taking time to be alone are also important things for friends and family to remember when dealing with a loved one suffering from borderline personality disorder.
Above all, if you think you or a loved one is experiencing this disruptive disorder, take time to discuss it with your doctor or with a mental health worker.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.
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