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My Mental State

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD),[7] is a long-term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[4][5] There is frequent dangerous behavior and self-harm.[4] People may also struggle with a feeling of emptiness and a fear of abandonment.[4] Symptoms may be brought on by seemingly normal events.[4] The behavior typically begins by early adulthood, and occurs across a variety of situations.[5] Substance abuse, depression, and eating disorders are commonly associated with BPD.[4] Approximately 10% of people affected die by suicide.[4][5]

BPD's causes are unclear, but seem to involve genetic, brain, environmental, and social factors.[4][6] It occurs about five times more often in a person who has an affected close relative.[4] Adverse life events also appear to play a role.[8] The underlying mechanism appears to involve the frontolimbic network of neurons.[8] BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.[5] Diagnosis is based on the symptoms while a medical exam may be done to rule out other problems.[4] The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.[5]

Borderline personality disorder is typically treated with therapy, such as cognitive behavioral therapy (CBT).[4] Another type, dialectical behavior therapy (DBT) may reduce the risk of suicide.[4] Therapy may occur one-on-one, or in a group.[4] While medications do not cure BPD, they may be used to help with the associated symptoms.[4] Some people require care in hospital.[4]

About 1.6% of people have BPD in a given year.[4] Females are diagnosed about three times as often as males.[5] It appears to become less common among older people.[5] Up to half of people improve over a ten-year period.[5] People affected typically use a high amount of healthcare resources.[5] There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline.[4] The disorder is often stigmatized in both the media and psychiatric field.[9]

Signs and symptoms

Borderline personality disorder may be characterized by the following signs and symptoms:

Markedly disturbed sense of identity
Frantic efforts to avoid real or imagined abandonment and extreme reactions to such
Splitting ("black-and-white" thinking)
Impulsivity and impulsive or dangerous behaviors
Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation
Unstable and chaotic interpersonal relationships
Self-damaging behavior
Distorted self-image[4]
Dissociation
Frequently accompanied by depression, anxiety, anger, substance abuse, or rage
The most distinguishing symptoms of BPD are marked sensitivity to rejection or criticism, and intense fear of possible abandonment.[10] Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Fear of abandonment may lead to overlapping dating relationships as a new relationship is developed to protect against abandonment in the existing relationship. Other symptoms may include feeling unsure of one's personal identity, morals, and values; having paranoid thoughts when feeling stressed; depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.

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People with BPD may feel emotions with greater ease, depth and for a longer time than others do.[11][12] A core characteristic of BPD is affective instability, which generally manifests as unusually intense emotional responses to environmental triggers, with a slower return to a baseline emotional state.[13][14] People with BPD often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them.[15] In Marsha Linehan's view, the sensitivity, intensity, and duration with which people with BPD feel emotions have both positive and negative effects.[14] People with BPD are often exceptionally enthusiastic, idealistic, joyful, and loving.[16] However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.[16]