Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, behavior, and self-image, frequently disrupting daily life, long-term planning, and interfering with an individual’s sense of self-identity. Though originally thought to be at the “borderline” of psychosis (hence its name), people with BPD actually suffer from a disorder of emotion regulation. BPD has a high rate of self-injury, suicide attempts, and completed suicide (in severe cases). Extensive mental health treatment and services are often needed.

Those with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These symptoms may include impulsive aggression, self-injury, and drug or alcohol abuse, frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Additionally, people with BPD view themselves as fundamentally bad, or unworthy, and suicide threats and attempts may occur.

Other impulsive behaviors, such as excessive spending, binge eating and risky sex manifest themselves as well, and BPD often co-occurs with other psychiatric problems such as bipolar disorder, depression, anxiety disorders, and other personality disorders.

History of Borderline Personality Disorder

The symptoms of Borderline Personality Disorder have been noted and recorded from the earliest times. The presence of impulsive anger, melancholy, and mania has been described from as far back as 800 c.e. Following the suppression of the concept during the Middle Ages (due in part to the conflict it created with ecclesiastical teachings), more serious acknowledgement of its existence begins in the mid-17th century. By the late 1930s, the first clinical analysis of the disorder appears, however lack of specific definitions and terminology hindered studies as the term “borderline” became a catchall term applied to a number of conditions.

By the late 1970s, efforts were made to create a standardized model of BPD, and by 1980 it was recognized as a personality disorder in the DSM-III, with the current terminology established by the APA.

Stigma

Because of the lack of understanding and the development of definitive criteria, BPD has long been looked upon as a set of behaviors rooted in the decision making process of the individual. Those who evidence symptoms have long been called “difficult”, “troublesome”, “manipulative”, “moody”, and a wide-range of terms that indicate the problem rests with the individual and it is only a question of wanting to behave properly that will make things better. Even today, though it is recognized as a personality disorder, those who have been identified as having BPD, are looked upon fearfully because of the past misunderstandings.

Treatment for borderline personality disorder

Significant advances in treatment for BPD have emerged in recent years. Studies show that group and individual psychotherapy can be effective for most patients, and the development of Dialectical Behavior Treatment (DBT) shows great promise.

Pharmacological treatments including antidepressants, mood stabilizers, and antipsychotic are often prescribed based on specific target symptoms shown by the individual patient.  Because Serotonin, norepinephrine and acetylcholine are among the chemical messengers that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability, drugs that enhance the presence of these chemicals and their functions may improve emotional symptoms in BPD, allowing people to manage BPD in the same as fashion as those susceptible to diabetes or high blood pressure. For inpatient treatment of borderline personality disorder long term rehabilitation seems to be one of the most effect treatment modalities especially those with drug addiction or alcoholism. This is due to the high structure and constant therapeutic support.