BPD is characterized by impulsivity & by instability in mood, self-image, & personal relationships. It is fairly common & is diagnosed more often in females than males.

Symptoms

-Individuals with BPD have several of the following symptoms: 1. Marked mood swings with periods of intense depression, irritability &/or anxiety lasting a few hours to a few days. 2. Inappropriate, intense, or uncontrolled anger. 3. Impulsiveness in spending, sex, substance use, shoplifting, reckless driving, or binge eating. 4. Recurring suicidal threats or self-injurious behavior. 5. Unstable, intense personal relationships with extreme, black & white views of people & experiences, sometimes alternating between "all good" idealization & "all bad" devaluation. 6. Marked persistent uncertainty about self-image, long term goals, friendships, values. 7. Chronic boredom or feelings of emptiness. 8. Frantic efforts to avoid abandonment, either real or imagined.
Causes-The causes of BPD are unclear, although psychological & biological factors may be involved. Originally thought to "border on" schizophrenia, BPD now appears to be more related to serious depressive illness. In some cases, neurological or attention deficit disorders play a role. Biological problems may cause mood instability & lack of impulse control, which in turn may contribute to troubled relationships. Difficulties in psychological development during childhood, perhaps associated with neglect, abuse, or inconsistent parenting, may create identity & personality problems. More research is needed to clarify the biolological &/or psychological factors causing BPD.

Treatments-

A combination of psychotherapy & medication appears to provide the best results for treatment of BPD. Medications can be useful in reducing anxiety, depression, & disruptive impulses. Relief of such symptoms may help the individual deal with harmful patterns of thinking & interacting that disrupt daily activities. However, medications do not correct ingrained character difficulties. Long-term outpatient psychotherapy & group therapy (if the individual is carefully matched to the group) can be helpful. Short-term hospitalization may be necessary during times of extreme stress, impulsive behavior, or substance abuse. While some individuals respond dramatically, more often treatment is difficult & long term. Symptoms of the disorders are not easily changed & often interfere with therapy. Periods of improvement may alternate with periods of worsening. Fortunately, over time, most individuals achieve a significant reduction in symptoms & improve functioning.
Co-existing Disorders-Other disorders may also be present. Determining whether other psychiatric disorders may be involved is critical. BPD may be accompanied by serious depressive illness (including bipolar disorder), eating disorders, & alcohol or drug abuse. About 50% of people with BPD experience episodes of serious depression. At these times, the "usual" depression becomes more intense & steady, & sleep & appetite disturbances may occur or worsen. These symptoms, & the other disorders mentioned above, may require specific treatment. A neurological evaluation may be necessary for some individuals.

Medications-

Antidepressants, anticonvulsants, & short-term use of neuroleptics are common for BPD. Decisions about medication use should be made cooperatively between the individual & the therapist. Issues to be considered include the person's willingness to take the medication as prescribed, & the possible benefits, risks, & side effects of the meds, particularly the risk of overdose.

More info- The National Institute of Mental Health, Information Resources & Inquiries Branch, 5600 Fishers Lane - Room 7C-02, Rockville MD 20857, 301-443-4513

This article was posted by D.J. Jaffe on behalf of the Alliance for the Mentally Ill/Friends and Advocates of the Mentally Ill, a NYC Chapter of the National Alliance for the Mentally Ill. AMI/FAMI is located at 432 Park Avenue South, NY NY 10016. Call (212) 684-3264 for more information. Your support is appreciated.