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The mind of a borderline is, typically, characterized centrally by its rapid and frequent changes in emotional state. Unlike the changes in mental state found in individuals with Bipolar and Cyclothymic Disorders, the emotional fluctuations are usually far more chaotic. While the reasons are complex and not fully understood, perception seems to be a primary cause.
Those with BPD seem to have difficulty separating where the self ends and others begin. A harmless comment or critique can be interpreted as a cutting remark or verbal attack. This can often cause unpredictable reactions including, but not limited to withdrawal and a sense of self-loathing or an apparent demonization of the ‘offending’ person. In the case of the former, the person will internalize the feeling, feeling that they are the cause of the event or comment that set off the change in mood. In the later, it is the other person who receives the blame and are often judged solely on the event in question.
Both of these instances relate to what is known as splitting, or all-or-nothing thinking. The mind of someone with BPD often thinks in black and white. Something is seen as either all good or all bad. If something new is brought to the individuals attention, the mind has difficulty integrating the two conflicting pieces of evidence and the stronger and/or most recent bit overpowers the other. Someone with BPD may see another, or even themselves, as someone to be idolized one day only to be vilified the next. The conflict between these two extremes is frequently a source of anxiety for the individual. Anxiety that, because of the innate difficulty in separating the ideas of the self from those of others become a source of interpersonal turmoil. If someone else seems to be the cause of such anxiety, then why should they be trusted or even respected? Similarly, if another appears to be the source of seemingly disparaging remarks or actions, then why seek to continue the relationship?
But those with BPD generally need the very interpersonal relationships that can become a source of fear, anger and depression. Whether the person feels they are unworthy of the affection of others, sees it as an attempt to control them or simply has difficulty dealing with the inner conflict brought on by the all-or-nothing mode of thinking, the end result is often the same. A deep fear that they will be, in some way, alone – and to be alone with thoughts that seem unpredictable even to the sufferer can be overwhelming.
When looking at themselves, those with BPD will see something that can be as tumultuous as their views on others. Who and what they see themselves as can change just as easily. A feeling of worthlessness can be suddenly changed into elation at what would normally be seen as a small occurrence. Likewise, a perceived criticism can lead to the individual being pulled down into a depression that they cannot see a way out of.
Compulsiveness is often another trademark of the Borderline, frequently in a self damaging way. From compulsive purchases to drug and alcohol addiction, from the starting and stopping of hobbies to self mutilation. These feelings are rarely fully understood by the individual but can be as difficult to ignore as the split thinking seen elsewhere.
Not all of these are seen in everyone who have been diagnosed or are thought to have BPD and other related behaviors are looked at when a diagnosis is considered. While a diagnosis can only be given by a mental health professional, the site BPDCentral provides both a primary diagnostic list as well as quotes from those who have the condition. BPD is also well known for its frequent comorbidities, conditions held at the same time. These can range from Narcissistic Personality Disorder to anxiety disorders, eating disorders and others.
BPD is estimated to be found in 1 to 3% of the US population and is primarily seen in young women, with a ratio of roughly three to one. However the reason for this discrepancy is yet to be fully understood.
There is no single agreed upon cause for BPD and it may very well require a series of interrelating conditions for it to manifest itself. The most commonly attributed cause is childhood abuse or neglect. There is evidence to suggest that BPD can run in families, but it is uncertain if this is because of genetics or a more psychosocial cause, or even a combination there of. The idea of BPD being a learned condition has been around for quite some time and it does seem that untreated borderlines do have a higher likelihood to raise another generation of borderlines. But like so many mental health conditions, the relation between all of these may be more crucial than any single cause could ever be.
Thankfully the condition is seen as treatable, if potentially difficult. About a third of those diagnosed can achieve ‘remission’ within a year or two of treatment and within six over half generally find the mental stability they seek. There are no quick fixes and the Cochrane Collaboration -an independent group that looks at both individual studies and the cumulative effects of multiple studies- has found no evidence to suggest that the condition itself can be treated with medication, though certain symptoms can be successfully treated with them. While multiple techniques are used in the treatment of BPD, a review published in 2010 suggests that dialectical behavior therapy and mentalization-based therapy have the highest success rates.
Unfortunately, the understanding of the condition by the general public is weak at best and it has been mischaracterized in popular fiction on more than one occasion. Those who know people with BPD may avoid them out of confusion or frustration and even some mental health professionals may prefer not to treat this condition due to the potential difficulty involved. But these only allow the cycle to continue. It can only be through a mutual understanding that the sufferer, their loved ones, and those treating the condition can reach the middle ground needed for all involved.
References used in the preparation of this article:
Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K (2010). Lieb, Klaus. ed. “Pharmacological interventions for borderline personality disorder”. Cochrane Database Syst Rev (6): CD005653. doi:10.1002/14651858.CD005653.pub2. PMID 20556762
Paris, J. (2010). “Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder”. Current Psychiatry Reports 12 (1): 56–60. doi:10.1007/s11920-009-0083-0. PMID 20425311