Translated and adapted with permission from HelpGuide International, original article.
Authors: Smiths M., Robinson L., Seagal J., Ph.D. of sciences
Translation: Igor Bronin, psychotherapist
Published as amended on March 2016
Does any of your loved ones suffer from borderline personality disorder? If so, you already know that borderline disorder affects not only people with this diagnosis, but also everyone who cares about such a person. People with borderline disorders have difficulty regulating their emotions and behavior, and this can leave a heavy imprint on partners, family members, and friends. But there is hope: both for a person with borderline disorder, and for you. You cannot force anyone to be treated for a borderline disorder, but you can take some steps to improve communication, establish healthy boundaries and stabilize relationships.
People with borderline emotional personality disorder can help themselves in some cases. They need to make an effort to separate the fantasies of a sick imagination from reality. Meditations, mindfulness exercises, and physical leaving the situation — sudden interruption of conversation and withdrawal help. The presence in the background processes of tracking your own thoughts helps to verify reality. So, in the mind, you can build a line of defense against the person whom the patient suspects is bad.
Well-established methods of cognitive-behavioral therapy of borderline personality disorder. A person learns to feel his boundaries, to realize what he feels and what he wants. It may be extremely important to look at yourself sides. There is even an application for the treatment of borderline personality disorder, People Skills To Go.
An important role in the treatment can also be played by loved ones. The patient can be stormed by strong desires to take possession of his loved ones completely and devalue him, expelling him forever from himself because of fear of intimacy.
Often other people find these individuals interesting, so it is not difficult for them to surround themselves with someone else.
Diagnostics in our country
Of great rarity are the above descriptions. The thing is that most patients do not know about their illness and do not consider this a pathology. BPD does not have such traditional manifestations of mental illness as hallucinations or psychoses. Cases when people injured themselves, they keep secret, and this is the most striking sign of the disease.
People around him consider a person with such a pathology a hysterical egoist with a heavy character, no one believes that he is changing. Due to the nature of the disorder, the patient himself is not able to correctly assess his own condition, he believes that external circumstances or people are to blame for his troubles.
Many recognize themselves in the descriptions of patients from articles, and only then understand what is happening to them. So, a person realizes that he is not a lazy and inconsistent lazy person, but there is a reason why something terrible is happening in his head.
About a third of all suicides occur in people with borderline personality disorder. Usually patients and get to a specialist only after trying to commit suicide. But when it does not reach these extremes, then to make a diagnosis means to thoroughly investigate a lot in the patient’s life.
Often during the diagnosis, the symptoms of PCR are confused with bipolar disorder: sharp mood swings, alternating excitement and depression are also characteristic of this. But the difference between them is that in PRL, the change of mood is instantaneous, it occurs 10 times a day and is caused not by events, but by internal processes.
In 10% of cases, a person combines both of these disorders.
The diagnosis of this disease is very important, since it greatly facilitates the patient's life. He understands the nature of the processes taking place with him and learns to control them. And the feeling that what is happening is amenable to control has a very positive effect on the person.
There is no exact reason why such a disease develops. It is precisely known that, as in cases with any psychological ailment, heredity and psychological trauma in childhood play a role. Each medical history contains a strong shock: someone's death, moral or physical violence, inadequacy of parents.
If once the child was not trained in the fact that he is valuable as a person, in understanding the boundaries between his interests and those of others, then he will lose the chance to show confidence in anyone, including himself.
Most often, everything goes together. So, a child from birth has certain vulnerabilities in the psyche that are inherited, and then a traumatic situation occurs, which leads to the formation of the ailment.
The most common cause of borderline disorder is child abuse. A frequent case - a girl is abused by an adult male (stepfather). He intimidates her, and for years she has not told anyone about this. And such an emotional environment leads to borderline personality disorder in the future. But sometimes parents can create it.
Sometimes a family looks outwardly prosperous, but in reality, adult members of the family observe borderline conditions when parents throw accusations at each other. When children cannot predict these sudden outbursts, they prescribe crazy traits for themselves. Violence can be moral and invisible to others.
Officially recorded cases where a borderline disorder formed in this way. The child lived with a believing grandmother, who carefully instilled in him a religious mood. He began to treat every mistake as a sin and felt guilty everywhere.
Doctors have discovered the presence of disorders in the brains of people suffering from this disease. The appearance of suicidal thoughts, anxiety and fear of loneliness is due to the fact that the body has little serotonin. Its production is broken. Due to stress at an early age, the situation is exacerbated. Therefore, impulsive actions, weakness of will and self-discipline are not the result of licentiousness, but have a biological cause.
For special biological reasons, patients are not able to control their own aggression. So, in the brain of a person suffering from PRL, the amygdala, which is responsible for emotions, is too activated. This provokes a mistake in the perception of facial expressions of the interlocutor, so he may look angry and unfriendly.
But experts noted that mental disorders can be both a consequence of this and a cause. That is, the more a person behaves impulsively, the less certain areas of the brain are involved.
Also, each person with borderline personality disorder has an increased activity of the production of stress hormones - cortisol. For this reason, they are always overly alert.
Weak activity of the prefrontal cortex, which is responsible for self-control, is noted. Therefore, it is difficult for them to look at themselves from the side.
Many patients also noticed a small volume of the hippocampus, which affected their memory. It is difficult for them to realize the history of relationships with others.
Dopamine production is impaired. So, in healthy people, this hormone causes pleasure from pleasant events and encourages you to look for pleasant things in the world around you. But in those suffering from PRD, its development is carried out from negative emotions in a relationship. Therefore, they are looking for repetitions of negative scenarios of relationships.
Among the main ways to treat this disease is behavioral psychotherapy, mentalization.
The good news is that quality therapy leads to recovery in 80% of patients within 2 years.
You need to find your own resource for the most acute periods that may occur in a patient. Psychologists, psychotherapists, and friends can help.
The life of most patients resembles a roller coaster without a goal. People who are close to such a person experience the whole complexity of the situation and get tired.
Also, a characteristic of a person with BPD is that he does not fully realize his identity, his description of himself looks contradictory and confusing. To overcome this uncertainty about themselves, these people, like actors, are in search of “good roles” and “solid characters” with which they fill themselves. They look like chameleons, adapting to external conditions and interlocutors.
A person suffering from this ailment is attracted by sex and harmful substances. In this ecstasy, he returns to a certain childhood, where he himself merges with the outside world. In periods of loneliness of extreme degree and emptiness, he goes all out with all these things, and it lasts for long days. This is similar to the fact that at a time when the battle for gaining one’s identity is already unbearable, the best solution for him is to lose it permanently or to get its illusion through a feeling of pain and numbness.
The romantic ties of people with BPD are very vivid and emotional, but do not last long. They can throw all their strength into achieving the object of love, but in a day break the relationship. Long relationships are full of exciting moments, they are amazing and look like stories from books.
A person with this ailment experiences a fear of loneliness and becomes attached to others. He is afraid of intimacy, because he does not want to be absorbed, and pushes people away from himself. He feels the need for intimacy and is afraid of it. In the end, he scares away those with whom he wants rapprochement.
It must be remembered that this ailment can be corrected with the help of psychotherapy. In its course, the patient learns to control his emotions, to realize his own thoughts and to calculate among them harmful ones. As soon as the symptoms listed in the article are detected, it will not be superfluous to consult a specialist, remembering: you can get rid of suffering.
The classification of this phenomenon as an independent personality disorder is controversial. Apparently, this term appeared due to the efforts of a number of well-known American psychologists from about 1968 to 1980, the result of which was the inclusion of a borderline personality type in DSM-III, which undoubtedly influenced its appearance, eventually, in the ICD -10. However, the theoretical work and research done by these psychologists was not devoted to justifying a qualitatively new type of personality, but to highlighting a new, intermediate between neurosis and psychosis, level of “severity” of disorders. Thus, it was supposed to put two diagnoses from DSM-III at the same time in practice: “borderline personality disorder” to describe the borderline level of functioning, and with it any other personality disorder, for a qualitative description of the diagnosis. It is impossible to find out about this from the structure of DSM-III, DSM-IV, and also ICD-10.
People with BPD may experience emotions easier, deeper, and longer than other people. A key feature of PRL is affective instability, which usually manifests itself as an unusually strong emotional response to the events of the world with a slow return to the initial emotional state. People with BPD often tend to idealize and be disappointed in others, moving from high positive ratings of people to huge disappointment in them. In the work of Marsha Lainen, the sensitivity, intensity and duration with which people with BPD experience emotions has both pros and cons. People with BPD are often overly enthusiastic, idealistic, happy, and loving. However, they can be overwhelmed with negative emotions (“anxiety, depression, guilt, shame, shame, concern, anger, etc.”), feel strong grief instead of sadness, shame and humiliation instead of a little embarrassment, rage instead of irritation, panic instead of nervousness .
People with BPD are also particularly susceptible to failure, criticism, isolation, and failure. Before they learn to deal with emotions differently, their attempts to control or avoid their very strong negative emotions can lead to emotional isolation, self-harm, and suicidal behavior. They often know the intensity of their negative emotional reactions and, since they cannot control them, they completely suppress them. This can be harmful for themselves, since negative emotions inform people about the presence of problem situations and encourage them to resolve them, but only knowledge of their problems is enough for distress in people with BPD. People with BPD may feel emotionally relieved after injuring themselves.
Although people with BPD may experience euphoria (a transient or occasional intense feeling of gaiety), they are especially prone to dysphoria (a deep sense of anxiety or displeasure, a mixture of anger and longing), depression, a sense of spiritual and emotional distress. Zanarini et al. There are 4 categories of dysphoria typical of PRL: extreme emotions, (self) destructiveness, a sense of shared or lost identity, and a sense of victimization. Within the system of these categories, the diagnosis of BPD is strongly associated with a combination of three conditions: feelings of loyalty (by someone), “feelings as if you were hurting yourself,” and feelings of loss of control. People with BPD experience a wide variety of types of dysphoria, so the amplitude of distress is a useful indicator of BPD. In addition to intense emotions, people with BPD are characterized by emotional “lability”, that is, in other words, variability. Although the term “emotional lability” implies rapid changes between depression and mood lift, the mood of people with BPD fluctuates more often between anger and anxiety and between depression and anxiety.