About Borderline Personality Disorder

 
What is Borderline Personality Disorder (BPD)?
Borderline personality disorder (BPD) is a serious psychiatric illness. The diagnosis encompasses patients with a pervasive pattern of affective instability, severe difficulties in interpersonal relationships, problems with behavioral or impulse control  (including suicidal behaviors), and disrupted cognitive processes. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. The estimated prevalence of BPD in the general adult population is about 2%, mostly affecting young women. It has also been estimated that 11% of outpatients and 20% of psychiatric inpatients presenting for treatment meet the criteria for the disorder.
What are the symptoms of BPD?
  1. Frantic efforts to avoid real or imagined abandonment.
  2. Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
  5. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood.
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger.
  9. Transient, stress, related paranoid ideation or severe dissociative symptoms. (DSM IV)
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change of plans.

Distortions in thinking and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone by acting out; i.e. impulsive behavior or suicide attempts.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatments
People with BPD often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Treatments for BPD have improved in recent years, and group and individual psychotherapy, as well as the use of medication have been effective for many patients.

Within the past 15 years, a new psychosocial treatment termed Dialectical Behavior Therapy (DBT) has been developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking. With help, many improve over time and are eventually able to lead productive lives.

What should I consider when seeking treatment for BPD?

The agency/institution/hospital:

  • License to operate:

     a. By whom?
     b. For what?
     c. Date of most recent licensing?

  • How many years has the agency been actively treating persons with BPD?

  • Maximum number of clients in program(s)?

  • Number of staff and their disciplines and level of education?

  • Client/staff ratio?

 

Facilities and services:

  • What are the criteria for admission to the program?
  • Who provides the referral information?
  • What kind(s) of treatment(s) are available: individual therapy, group, family, residential, medication?
  • How often is each type of therapy offered per week?
  • Treatment orientation? e.g. Dialectical Behavior Therapy (DBT); Psychodynamic?
  • What kind of training has the staff had to specifically treat persons with BPD?
  • Anticipated length of stay (LOS)?
  • Handbook of rules: program expectations, i.e., days absent, if outpatient; visiting hours, if inpatient.
  • What kind of family involvement: sessions, family group, contact with staff?
  • Are there any support groups in the area?
  • Is there any contact maintained with most previous treater (e.g., community psychiatrist)?
  • When does planning for discharge start and who is included in the discussions?
  • Does the agency take responsibility to identify the possible aftercare options?
  • If someone signs themselves out of the program, who is notified?
 
Financial aspects:
  • Cost: Flat charges? Extra charges? How often billed? Terms of payment?
  • What funding is accepted: Medicaid, Medicare, private insurance, self-pay?
  • Is an agency financial counselor available to explain charges and billing procedures? For example, is SSI affected?

 

 

 


 

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