Borderline Personality Disorder: Symptoms, Causes and Treatment

Medications are not usually the main treatment for borderline personality disorder. In general, more use is made of psychotherapy.

Written and verified by la psicóloga Paula Villasante.

Last update: 11 June, 2021

Have you ever heard of borderline personality disorder? It’s a condition that, despite reasonably common in the entertainment and communication media, is generally little known.

For this reason, we have prepared the following article, in which you will find key information to understand this pathology from its scientific basis.

From a clinical point of view, affected patients tend to have behavioral problems that prevent them from having adequate social relationships, in addition to frequent mood and opinion changes associated with self-destructive behaviors. Its neurobiological bases are well defined, and there are several treatment methods based on psychotherapy.

The concept of “borderline personality disorder”

This concept was coined for the first time in 1938 by Adolf Stern, although it wasn’t until 1981 that its existence became official when it was included in the DSM-III (‘Diagnostic and Statistical Manual of Mental Disorders’). It was at this time that the “borderline” diagnosis began to be the subject of debate and research with striking growth.

Clinical manifestations of the disease

People with borderline personality disorder can experience uncertainty and mood swings about how they see themselves and their role in the world. Thus, their values and interests can change regularly.

In addition, people with this type of disorder tend to see the extremes: either all good or all bad. Your opinions about other people can change fast too.

A person they see as a friend one day may be regarded as an enemy or a traitor the next day. These changing feelings tend to lead to unstable and intense relationships.

Causes and pathophysiology of borderline personality disorder

A neurobiological model of borderline personality disorder proposes that it may be the result of interactions between genetic and environmental influences that affect brain development through neuropeptides and hormones.

In addition, the quality of parental care during early childhood can affect gene expression and the structure and functions of the brain, resulting in behavioral traits that are stable throughout life.

However, frontolimbic dysfunction (the brain mechanism most associated with BPD) seems to be a transdiagnostic phenomenon that is related to negative affectivity in the context of social stress, and is found in patients with other psychiatric disorders and even in healthy individuals who suffered traumatic events in the past.

The frontolimbic dysfunction appears to be sensitive to changes over time, and more research is needed to understand this process, as well as others that could influence the pathogenesis and progression of BPD.

Below, we’ll explore in a little more depth the possible causes and factors associated with this disease. Keep reading!

1. Genetic and structural factors

BPD has a high heritability. People who have a close family member with this disorder, such as a sibling or parent, may be more likely to develop borderline personality disorder.

There are also certain alterations in various brain circuits that underlie BPD phenotypes. These are as follows:

• Brain circuits related to the interpersonal instability phenotype.
• Circuits related to the self-disruption phenotype.
• The brain circuits related to the affective/emotional dysregulation phenotype.
• Circuits involved in the prediction of negative results and the inhibitory control.

On the other hand, it’s believed that the affective pain processing circuit mediates hypalgesia in self-injurious behavior in patients with BPD.

2. Having gone through adverse experiences

These childhood events are highly associated with BPD in clinical and community samples. In fact, childhood trauma is the most important environmental risk factor in this diagnosis, although it isn’t a necessary precondition for developing BPD.

Unconscious parenting, excessive involvement of the mother, aversive behaviors, and low parental affection are also associated with the development of BPD, although they aren’t specific either.

In addition, the fact of separating children from their mothers before the age of 5, can predispose them to BPD in adulthood. The personality profiles of children who have been abused are characterized by high neuroticism, low kindness, low awareness, and little openness to experience.

3. Alterations during critical periods of development

In addition to this, it seems that certain moments in life are involved in the creation of personality pathology.

Abnormal attachment to a primary caregiver, due to separation or poor parenting, has been observed, and attachment interrupted early in life leads to deficits in emotional regulation and self-control.

4. High reactivity to stress

High reactivity to stress in a child could contribute to a problem attachment. Disorganized mother-child attachment is capable of producing borderline symptoms in young adults.

In adolescence, developing a stable identity or sense of self is an important task and can lead to personality pathology if delayed or prevented.

5. A tendency to self-harm and problem behaviors in the past

Deliberate self-harm, suicide attempts, and other characteristics of BPD, such as insecure identity, low goal orientation, negative affectivity, impulsivity, risky behavior, anger, and interpersonal aggression, can all predict the development and persistence of BPD in children and adolescents.

Diagnosis

To diagnose a case of BPD, it’s necessary to go to a psychologist or a doctor specializing in psychiatry. By means of clinical assessment scales and a correct evaluation of the patient, it’s possible to diagnose the disease, always taking into account the criteria of the current Diagnostic and Statistical Manual of Mental Disorders.

Treatment of borderline personality disorder

People who don’t receive proper treatment are more likely to develop other chronic medical or mental illnesses and less likely to choose a healthy lifestyle.

These patients tend to resort to self-harm and have suicidal behavior much more frequently than the rest of the population. Although more research is needed in this regard, the following are some of the options that are considered as treatments for BPD:

Psychotherapy

This is the first-line treatment for people with borderline personality disorder. Both individual therapy and group therapy can be used.

In particular, directed group sessions can help teach people with the disease how to interact with others and how to express themselves effectively.

Two of the therapies used to treat borderline personality disorder include the following:

Dialectical Behavior Therapy (DBT)

In this, concepts of mindfulness and acceptance are used. It’s about the patient developing mindfulness as well as acceptance of the present situation and their emotional state. In itself, this therapy can help:

• Control intense emotions
• Improve relationships
• Reduce self-destructive behaviors

Cognitive-behavioral therapy (CBT)

In BPD, this type of therapy can be helpful in identifying and changing the beliefs and behavior that underlie inaccurate perceptions of themselves and others. It can also help with problems interacting with other people.

Typically, this therapy can reduce a variety of anxiety and mood symptoms and reduce the number of suicidal or self-injurious behaviors.

Medicines

Antidepressants and anxiolytics are not usually the main treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend these types of medications to treat specific symptoms such as the following:

• Other concurrent mental disorders
• Humor changes
• Depression

For the family and caregivers of those affected by BPD, it may be helpful to go to therapy. Having a family member who suffers from this disorder can be stressful. That’s why some BPD therapies include caregivers, family members, and/or loved ones in their sessions. These can be helpful to:

• Allow the family member or loved one to develop skills to better understand and support a person with borderline personality disorder.
• Focus on the needs of family members to help them understand the obstacles and strategies that arise from caring for these patients.

A difficult condition to cope with but with many therapeutic options

Yes, borderline personality disorder can be exhausting for both patients and their loved ones or caregivers. Fortunately, the treatments mentioned throughout the article allow us to deal with the disease from a multidisciplinary point of view and improve the quality of life little by little.