The exact causes of borderline personality disorder are not known yet but specialists are trying to understand it better.
So far there is no consent about what causes the BPD and it might be a combination of factors that might include childhood trauma, brain abnormalities, neurobiological factors, genetics and environmental factors. Childhood abuse is also suspected to be a major cause of BPD.
Neuroimaging studies have shown that some parts of the brain such as hippocampus and amygdala are smaller in people with BPD. Also the activity in prefrontal cortex seems to be reduced in people with BPA.
A clinical assessment should be performed by a trained mental health professional who will determine if the criteria for the borderline personality disorder are met.
According to DSM V, in order to receive a diagnosis of borderline personality disorder a person should meet 5 of the 9 criteria:
- Serious efforts to avoid imagined or real abandonment
- Intense and unstable interpersonal relationships
- Identity problems
- Suicidal behavior
- Chronical feelings of emptiness
- Emotional instability
- Intense and inappropriate anger
- Paranoid thoughts related to stress
Some doctors prefer not to tell their patients about their diagnosis. The diagnosis is based on the patient’s report and clinical observations.
Laboratory tests might help the doctor rule out other possible diagnosis or causes.
In ICD – 10 the borderline personality disorder is called emotionally unstable personality disorder and has two major subtypes: Impulsive type and Borderline type.
Comorbidity and Differential Diagnosis
People with BPD might also meet the criteria for other disorders that might also co-exist with BOD such as:
- Mood Disorders
- Substance Abuse
- Anxiety Disorders
- Eating Disorders
- Dissociative Disorders
- Somatoform Disorders
The first line of management for BPD is psychotherapy. The medication might also help treating comorbid disorders. In cases of severe symptoms the patient might need hospitalization.
The psychotherapy might include transference-focused therapy, dialectical behavior therapy and mentalization-based therapy.
The medication includes antipsychotics such as haloperidol, flupenthixol and aripiprazole. Mood stabilizers such as valproate semisodium, lamotrigine and topiramate might also be used. The antidepressant that could be also used include fluvoxamine, mianserin, phenelzine and fluoxetine.
The therapy requires some time to get the desired results. Studies revealed that 34.5% of the people with BPD found relief within two years of treatment. With 4 years of treatment almost 50% achieved remission and the percent of people who reached remission reached 68,6% after 6 years of treatment. Another study revealed that 86% of the people with BPD found relief after 10 years of treatment.
It is estimated that BPD affects between 1% and 2% of the population and it seems that 20% or psychiatric hospitalizations are due to BPD.
The credibility of the disorder was often questioned because there was found that the prevalence of dissociation episodes is pretty high among people with BPD. Also it seems people with BPD often tend lie.
Stigma is another problem of people with BPD as people often think they are prone to violence to others and they are also thought to be manipulative, difficult and attention seeking.
When seeking specialized help of a mental health specialist for personality problems, people might want to go along with a friend or a family member as the doctor might be reluctant to tell the diagnosis to the patient.