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January 2016 | Read this issue and more at www.healthandwellnessmagazine.net |
Understanding
Borderline Personality
Disorder
Diagnosis is difficult because it
‘borders’ other conditions
By Angela S. Hoover, Staff Writer
Borderline personality disorder
(BPD) is commonly overlooked and
easily misunderstood. It derives its
name from the fact that it sits on the
border of several other major mood
disorders and impulse control disorders, said Dr. John Oldham, executive
chair in the Menninger Department
of Psychiatry and Behavioral Sciences
at Baylor College of Medicine in
Houston, Texas. An estimated 1.6
percent of American adults have BPD.
BPD substantially interferes with
daily life and relationships. The condition is characterized by pervasive
instability in moods, self-image and
behavior, according to the National
Institute of Mental Health (NIMH).
The main characteristics of BPD
are emotional dysregulation, loss
of impulse control and difficulties in interpersonal relationships.
Emotional dysregulation refers to
intense emotions that come out of
nowhere – not even in relation to a
present event – and escalate like a
runaway train speeding off the tracks.
When added to high emotionality,
impulsivity and difficulty trusting
other people, it becomes clear why
those with BPD have very difficult
interpersonal relationships and a
great deal of instability in all aspects
of their lives.
Diagnosis of BPD is difficult. Cases
are usually diagnosed only after sever-
al years of clinical evaluation because
the disorder “borders” so many other
conditions. Often the diagnosis
evolves over years of therapy as all
the layers eventually come to light. A
diagnosis of BPD looks for an enduring pattern of at least five of these
nine symptoms:
• Extreme reactions. This could
be panic, depression, rage, acting
frantically or having feelings of abandonment. One, several or all of these
reactions are felt consistently. Some
individuals with BPD have a limited
range of intense emotional reactions
they exclusively cycle through, such
as feeling abandoned, depressed or
vengeful or feeling panicked and acting in a frantic manner.
• A pattern of intense and stormy
relationships with family, friends and
loved ones. These relationships can
traverse between closeness and idealized or adoring love to extreme dislike and anger.
• Distorted and unstable self-image
or sense of self. This is often due to
sudden changes in feelings, opinions
and values or plans and goals.
• Impulsive and often dangerous
behaviors. These may include substance abuse, unsafe sex or promiscuity, reckless driving, binge eating or
spending sprees.
• Self-harming behavior and/or
suicidal thoughts or threats.
• Intense and highly changeable
moods, each episode lasting from a
few hours to a few days.
• Chronic feelings of boredom
and/or emptiness.
• Inappropriate, intense anger or
problems controlling anger.
• Stress-related paranoid thoughts
or severe dissociative symptoms,
such as feeling cut off from oneself,
observing oneself from the outside or
losing touch with reality.
Brain imaging can help with
diagnosis. Neuroanatomical data
of patients with BPD show some
distinctive features. Brain imaging
shows structural abnormalities that
impact the limbic system. A review
of BPD neuroimaging written by
Krause-Utz, Winter, Niedtfeld and
Schmahl and published at www.ncbi.
nlm.nih.gov/pubmed/24492919 in
2010 found “structural and functional
abnormalities in a fronto-limbic network, including regions involved in
emotion processing (e.g., amygdala
insula), and frontal brain regions
implicated in regulatory control processes (e.g., anterior cingulate cortex,
medical frontal cortex, orbitofrontal
cortex and dorsolateral prefrontal
cortex).” This same review suggests
patients may have altered function in
neurotransmitter systems, including
the serotonin, glutamate, and GABA
systems. Serotonin is attributed to
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feelings of well-being. Glutamate
is involved more generally in brain
function and cognition. GABA is a
chemical messenger that calms overexcited neurons.
Another study that compared
BPD patients with healthy volunteers
found deficits within fronto-limbic
connections, specifically decreased
white matter integrity in the cingulum and fornix – two separate
bundles of fibers (white matter) that
aid communication in the limbic
system. Emotions form within the
limbic system, which also plays a role
in memory formation. Interestingly,
the abnormalities within the fornix
and cingulum were related to severity
of symptoms.
BPD is generally treated with psychotherapy alone, although in some
cases medication may be used to treat
specific symptoms, such as depression or anxiety. However, no medication has been approved by the Food
and Drug Administration for treatment. Only a few studies show m YX