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Friday, July 23, 2010

Understanding and Coping with Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health diagnosis with a wide spectrum.

There are people who have borderline personality traits who are considered high functioning (i.e., they are able to hold a job and might even be very successful in their careers; they have intense emotional upsets, including intense anger, but they are able to recover from them relatively quickly; and their relationships are usually chaotic, but they're not extremely chaotic).

Understanding and Coping with Borderline Personality Disorder

However, someone who has intense borderline personality traits often will not be high functioning (i.e., they might have problems maintaining a job; they usually have very intense emotional upsets and it takes them longer to recover; their anger can turn to rage very quickly; they might even become violent; and they tend to have extremely chaotic relationships).

If someone who is usually high functioning is under an inordinate amount of stress that leads to a feelings of emotional fragility, their symptoms can worsen very quickly.

In order to understand borderline personality disorder, it's important to understand BPD traits. Although each person is unique, the following traits are usually associated with BPD:

Relationships and Fear of Abandonment:
People with BPD tend to have intense and chaotic relationships with a lot of conflict. These conflictual relationships often include ongoing cycles of breakups and reconciliations with the same people. People with BPD also often go from idealizing a loved one to completely devaluing him or her and this change can be very sudden.

Borderline Personality Disorder and Fear of Abandonment

Underlying these emotional dynamics is a strong fear of being abandoned by loved ones. Understanding this fear, which might not be apparent when the person with BPD is angry or rageful, is one of the keys to understanding his or her behavior. Often this fear originates from an early history of emotional abandonment, neglect or abuse making the person with BPD vulnerable to real or imagined threats of abandonment as an adult.

Loved ones are often shocked and bewildered at the ability of a person with BPD to do a "180" with sudden mood shifts. This might involve a sudden change from this person being loving and kind to being angry and rejecting, often with little provocation.

People with BPD will often alternate between wanting to be "rescued" emotionally, where they might be very clingy with their loved ones, to severing ties with their loved ones due to a real or imagined slights.

Emotions:
People with BPD often experience strong emotional instability, especially when under stress. BPD is associated with intense feelings of anger, rage, sadness, and feelings of emptiness, which can be extremely overwhelming.

People With Borderline Personality Disorder Are Often on an Emotional Roller Coaster

They are often on an emotional "roller coaster" with frequent "ups and downs" for no obvious reason. There are often frequent and sudden mood shifts which might frighten the person with BPD as well as their loved ones.

Sense of Self:
People with BPD often do not have a stable sense of self. They might experience themselves as being happy one moment and then sad the next moment for no apparent reason.

Behavior:
Borderline personality disorder is usually associated with impulsive behavior. People with BPD might engage in impulsive shopping sprees, sexual behavior, alcohol or drug abuse, gambling, cutting themselves, bingeing and purging food, violence or they might make impulsive suicide attempts.

People With Borderline Personality Disorder Often Engage in Substance Abuse

Aside from being impulsive and engaging in risky behavior, people with BPD frequently engage in "cutting off" or severing relationships precipitously. They also have a low tolerance for frustration which can lead to angry outbursts or violent behavior.

Thinking:
For people with BPD, their thinking is usually as chaotic as their emotions which, of course, go hand in hand. They might become highly suspicious or paranoid. They might also dissociate (i.e., "space out" or get numb) as a defense against intolerable feelings. Often, their thinking and perceptions can be distorted. Also, they tend to think in "all or nothing" terms.

What Causes Borderline Personality Disorder?
Research has shown that there seems to be both genetic and environmental components to the development of borderline personalty disorder. With regard to genetics, it's often the case that a person with BPD has at least one parent who also has BPD. In terms of the environment, there is often emotional neglect or abuse in early childhood.

What to Do if You or a Loved One Has Borderline Personality Disorder:  Get Help
If you or a loved one has BPD, it's important to get help. Since BPD is often confused with bipolar disorder and ADHD, it's important to start with an evaluation by a psychiatrist who is a good diagnostician. If a person who has BPD is drinking or abusing drugs, the substance abuse problem needs to be addressed and stabilized in an appropriate dual diagnosis program.

For people with BPD, Dialectical Behavioral Treatment (DBT) is often the best form of psychotherapy either in a group setting or in individual treatment. Although I am not trained in DBT, I have heard from many colleagues and clients that DBT is often very effective. In NYC, you can contact the American Institute for Cognitive Therapy (http://www.cognitivetherapynyc.com/) for a referral to a DBT therapist.

For loved ones who are struggling to deal with spouses or other family members who have BPD, it's important to understand that BPD is a mental health disorder and to try to have some compassion for the person with BPD. However, it's also very important that you take care of yourself at the same time. And if there is the potential for violence, first and foremost, you must have an escape route to ensure your safety as well as the safety of your children.

Being in a relationship with someone who has BPD can be very challenging. It can often lead to feelings of anger or despair. Only you can decide if you want to remain in the relationship or not, and you might need the help of a licensed mental health professional to decide what's best for you. In a future post, I'll write specifically about people who are in relationships with loved ones who have BPD.

I am a licensed NYC psychotherapist, hypnotherapist EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006.