Borderline personality disorder (BPD) is a serious, long-lasting and complex mental health problem. People with BPD have difficulty regulating or handling their emotions or controlling their impulses. They are highly sensitive to what is going on around them and can react with intense emotions to small changes in their environment. People with BPD have been described as living with constant emotional pain, and the symptoms of BPD are a result of their efforts to cope with this pain.
It is very common for someone with BPD to have other mental health problems. These include:
Sometimes it can be difficult to diagnose BPD because the symptoms of the co-occurring disorder mimic or hide the symptoms of BPD. Relapse in one disorder may trigger a relapse in the other disorder.
The types and severity of BPD symptoms may differ from person to person because people have different predispositions and life histories, and symptoms can fluctuate over time.
Common symptoms include:
Our current understanding is that a person’s genetic inheritance, biology and environmental experiences all contribute to the development of BPD. A person is born with certain personality or temperamental characteristics because of the way his or her brain is “wired,” and these characteristics are further shaped by environmental experiences—and possibly by cultural experiences—as the person grows up.
Researchers have found differences in certain areas of the brain that might explain impulsive behaviour, emotional instability and the way people perceive events. As well, twin and family history studies have shown a genetic influence, with higher rates of BPD and/or other related mental health disorders among close family members.
Environmental factors that may contribute to the development of BPD in vulnerable individuals include separation, neglect, abuse or other traumatic childhood events. However, families that provide a nurturing and caring environment may still have children who develop BPD, while children who experience appalling childhoods do not necessarily develop BPD.
Though histories of physical and sexual abuse are reported to be high among those with BPD, many other experiences can play a role for a child who is already emotionally vulnerable.
In the past, specialized treatment for BPD was hard to find, but the disorder is now being better recognized and diagnosed, and more communities have established specialized treatment programs that significantly improve outcomes for people with BPD.
Specialized psychosocial treatment approaches are chosen to fit the goals of the client and the skills base of the clinician. These may include:
Though there is no specific medication for BPD, medication may be prescribed to reduce the impact of specific symptoms (e.g., depression, psychotic-like symptoms such as paranoia). Though medication can reduce the severity of symptoms, it does not cure BPD and is not appropriate for everyone with this diagnosis.
Treatment outcome research has found that for many people, treatment does work. Many people with BPD learn to cope with their symptoms and do things differently, particularly as they reach middle age. Because of the serious and complex nature of their symptoms, people affected by BPD frequently require long-term treatment, often over several years.
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