February 10, 2013
Borderline Personality Disorder
“Borderline personality disorder is characterized by marked instability in self-image, mood, and interpersonal relationships. People with this disorder tend to act impulsively and often, self-destructively. They feel uncomfortable being alone and often manipulate self-destructive impulses in an effort to control or solidify their personal relationships”. (Morris, Maisto, 2010). Many people who receive therapy for a personality disorder do not enter therapy because they have interpersonal problems. They may see a clinician because they have another co-occurring disorder, such as substance abuse, depression, or anxiety. Many people will never seek therapy for personality disorders because they do not see the need, for instance they do not recognize that their behavior could be causing all the trouble or dysfunction within their relationships. An important criterion for a personality disorder to be present, though, is that a person`s interpersonal relationships must create significant functional difficulties or stress for themselves, and possibly others.
Furthermore, this does not mean that a person who annoys you by the way they talk, or they may be a “nosey” person, or someone you do not get along with. Another important diagnostic criterion for a personality disorder to be present is that the behaviors and resulting stress must occur in multiple areas of life. This does not mean a person having difficulty in school has a personality disorder, but when they have consistent and otherwise unexplainable troubles in several areas over an extended period of time (months or years), then there may be something there to be concerned with. Many people with personality disorders will actually wind up surrounding themselves with people who minimize the negative aspects of their behavior. “A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms”. (1)
Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed, and no single test can diagnose borderline personality disorder. Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness.(3,4) Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative.(5) People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder. (6,7)
Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.(8) These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder. Types of psychotherapy used to treat borderline personality disorder are: (1) Cognitive behavioral therapy (CBT). CBT can help people with borderline personality disorder identify and change core beliefs and behaviors that underline inaccurate perceptions of themselves, and problems with interacting with others. (2) Dialectical behavior therapy (DBT). This type of therapy