ANSWER
Borderline personality disorder is a mental illness that impairs a person’s ability to control emotions. This loss of emotional control can lead to increased impulsivity, a negative self-image, and a negative impact on relationships with others. Borderline personality disorder symptoms can be managed effectively with effective treatments.
Symptoms and Signs
Borderline personality disorder patients may experience intense mood swings and be unsure how they see themselves. Their feelings for others can shift quickly from extreme closeness to extreme dislike. These shifting emotions can lead to strained relationships and emotional distress.
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Borderline personality disorder patients also tend to see things in extremes, such as all good or all bad. Their interests and values can shift quickly, and they may act rashly or impulsively.
Other signs and symptoms could include:
Attempts to avoid real or perceived abandonment, such as diving headfirst into relationships—or quickly ending them.
An intense and unstable pattern of relationships with family, friends, and loved ones.
Self-image or sense of self that is distorted and unstable.
Spending binges, unsafe sex, substance abuse, reckless driving, and binge eating are impulsive and often dangerous behaviors. Please remember that if these behaviors occur primarily during times of high mood or energy, they may be symptoms of a mood disorder rather than a borderline personality disorder.
Cutting is an example of self-harming behavior.
Suicidal thoughts or threats that reoccur.
Moods are intense and highly variable, with episodes lasting from a few hours to a few days.
Feelings of emptiness regularly.
Anger that is inappropriate, intense, or difficult to control.
Dissociative feelings include being cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.
Not everyone suffering from borderline personality disorder will exhibit all of these symptoms. The severity, frequency, and duration of symptoms vary according to the individual and their illness.
A borderline personality disorder is associated with significantly higher rates of self-harm and suicidal behavior than the general population.
People with borderline personality disorder contemplating self-harm or suicide require immediate assistance.
If you or someone you know is in immediate distress or considering self-harm, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. You can also contact the Crisis Text Line (HELLO to 741741).
Risk Elements
Researchers aren’t sure what causes borderline personality disorder, but research suggests that genetic, environmental, and social factors may all play a role. These elements may include:
People who have a close family member (such as a parent or sibling) with the illness are more likely to develop a borderline personality disorder.
Brain structure and function: According to research, people with a borderline personality disorder may have structural and functional changes in their brains, particularly in areas that control impulses and emotion regulation. The studies, however, do not show whether these changes were risk factors for the illness or if the disorder caused them.
Environmental, cultural, and social factors: Many people with borderline personality disorder report traumatic life events as children, such as abuse, abandonment, or hardship. Others may have been subjected to volatile, invalidating relationships or conflicts.
Although these factors may raise a person’s risk, they do not guarantee that they will develop a borderline personality disorder. Similarly, people who do not have these risk factors may develop the disorder during their lifetime.
Diagnosis
A licensed mental health professional with experience diagnosing and treating mental disorders, such as a psychiatrist, psychologist, or clinical social worker, can diagnose borderline personality disorder based on a thorough interview and discussion of symptoms. A thorough medical examination can also help rule out other possible causes of symptoms. Providers will discuss a person’s symptoms and ask about family medical histories, including histories of mental illness when diagnosing the illness.
A borderline personality disorder is most commonly identified in late adolescence or early adulthood. A person under 18 may be diagnosed with a borderline personality disorder if their symptoms are severe and last for at least a year.
What other conditions can coexist with a borderline personality disorder?
A borderline personality disorder is frequently found in conjunction with other mental illnesses, such as post-traumatic stress disorder (PTSD). These co-occurring disorders can make diagnosing and treating borderline personality disorder more difficult, particularly if symptoms of other illnesses overlap with symptoms of the disorder. A person with borderline personality disorder, for example, is more likely to suffer from major depression, PTSD, bipolar disorder, anxiety disorders, substance abuse, or eating disorders.
Therapies and Treatments
Borderline personality disorder has traditionally been regarded as difficult to treat. Many people with this disorder have fewer and less severe symptoms, improved functioning, and a higher quality of life thanks to newer, evidence-based treatments. Patients with borderline personality disorder must seek treatment from a licensed mental health professional. Other types of treatment, or treatment from an inexperienced provider, may be ineffective or dangerous.
Many factors influence how long it takes for symptoms to improve after treatment begins. People with borderline personality disorder and their loved ones must be patient and receive support during treatment.
Seek and adhere to treatment.
Individuals with borderline personality disorder who do not receive adequate treatment are more likely to develop other chronic medical or mental illnesses. According to research funded by the National Institute of Mental Health (NIMH), they are less likely to make healthy lifestyle choices.
Psychotherapy
Psychotherapy, also known as “talk therapy,” is the first-line treatment for borderline personality disorder. Most psychotherapy is done one-on-one with a licensed, trained mental health professional or in groups with other people. Group sessions may help teach people with BPD how to interact with others and express themselves effectively.
The following are two examples of psychotherapies used to treat borderline personality disorder:
Dialectical Behavior Therapy (DBT) was created specifically for people with a borderline personality disorder. DBT employs the concepts of mindfulness or being aware of one’s current situation and emotional state. DBT teaches people how to control their intense emotions, reduce self-destructive behaviors, and improve relationships.
Cognitive Behavioral Therapy (CBT): This treatment can assist people in identifying and changing core beliefs and behaviors that stem from misperceptions of themselves and others and difficulties interacting with others. It may aid in the reduction of mood swings and anxiety symptoms, as well as the reduction of self-harming or suicidal behavior.
More information is available on the NIMH’s Psychotherapies health topic page.
Medications
Because the benefits of prescription medication for borderline personality disorder are unknown, it is not typically used as the primary treatment method. A psychiatrist may, however, recommend medications to treat specific symptoms or co-occurring mental disorders such as mood swings or depression in some cases. Medication treatment may necessitate the collaboration of more than one medical professional.
Medications can also cause side effects in some people. Discuss with your provider what to expect from a specific medication. More information can be found in the NIMH’s Mental Health Medications health topic.
Other Components of Care
Some people with borderline personality disorder have severe symptoms that necessitate intensive, often inpatient, treatment. Others may seek outpatient care but never require hospitalization or emergency care.
Therapy for Family Members and Caregivers
It can be stressful to have a relative or loved one with the disorder, and family members or caregivers may unintentionally act in ways that aggravate their loved one’s symptoms.
Although more research is needed to determine how well family therapy aids in treating borderline personality disorder, studies on other mental disorders show that including family members can aid in a person’s treatment. Therapy can also help families and caregivers.
Family therapy can help by doing the following:
Allowing a relative or loved one to learn how to understand and support someone with a borderline personality disorder.
Putting the needs of family members first to help them understand the challenges and strategies for caring for someone with the disorder.
Obtaining Assistance
If you are unsure where to turn for help, a healthcare provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist who has treated people with a borderline personality disorder. If you need help starting the conversation, consult the fact sheet Tips for Talking With Your Health Care Provider.
Additional resources include:
The Behavioral Health Treatment Services Locator from the Substance Abuse and Mental Health Services Administration is a tool for locating mental health services in your area.
The National Institute of Mental Health’s Help for Mental Illnesses website and the Agency for Healthcare Research and Quality’s website
Advice for Families and Caregivers
Here are some suggestions for how to assist a friend or relative suffering from the disorder:
Take the time to learn about the illness to understand what your friend or relative is going through.
Provide emotional support, comprehension, patience, and encouragement. People with a borderline personality disorder may find change difficult and frightening, but things can improve over time.
Encourage your borderline personality disorder patient to inquire about family therapy.
Seek professional help for yourself. Choose a therapist other than the one your relative is seeing.
QUESTION
Read the case study attached below about Borderline Personality Disorder and answer the following questions:
How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and appropriate nursing intervention.
What interdisciplinary referrals might be appropriate?
150 words only