This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.
2002 First Paper
Individuals with Borderline Personality Disorder (BPD) live a difficult existence. These are people for whom maintaining normal interpersonal relationships, controlling anger, suffer from extreme self-doubt and drastic mood swings, among other symptoms. They comprise only 2% of the population, but have a disorder which the psychiatric and scientific communities have trouble acknowledging, and great difficulty treating. (4)
Individuals suffering from BPD suffer a range of symptoms which include the following: dramatic mood changes, depression, irritability, uncontrollable anger, negative impulsiveness (which includes reckless sex, substance abuse, binging), suicidal feelings, self-mutilation, extreme self-doubt about one’s capabilities. (6)(3) They also experience a kind of heightened awareness of their environment and thus are overly stimulated by it. (1) In addition to these and other symptoms, individuals with BPD often suffer from other mental disorders – such as depression, bipolar disorder, anxiety disorders – as well, making their BPD difficult to diagnose. (4) There is a great mystery surrounding the causes of all mental disorders, and this is also the case with BPD. Psychologists and scientists believe that it is both a biological and psychological disease, and that BPD as an illness is closely related to depression more than schizophrenia, which had been the previous though. Experts have also believe that attention-deficit disorders could be a cause factor, as well as childhood abuse or neglect. (6) Many people suffering from BPD experience very strong feelings of abandonment by parents, family and friends, that can be triggered by an incident that would be perceived as relatively insignificant by the outsider. (4)
Borderline Personality Disorder by definition is very difficult to treat. This is due to the fact that the nature of this psychological disorder affects the patient’s interpersonal skills, which is the basis of therapeutic treatment. Psychiatrists and psychologists find it near impossible to work with patients suffering from BPD because they have little ability to maintain a stable working relationship with anyone (and certainly not a therapist) and their intense mood swings and anger control issues, among other characteristics, are "...likely to lead to clinician burnout...". (3) This is an obvious frustration for any family member or friend of a BPD individual, who wants nothing more than to have their loved seek out and be successful at getting help to treat their disorder. The is also evidence that medication diagnosed for specific symptoms of the individual with BPD can help, however, the administering and monitoring of psychotropic drugs is usually done in conjunction with some form of psychotherapy, which remains the problem site of treatment. (6)(3)
Because of the difficulties in treating BPD patients, there are very few psychotherapists and psychologists who will work with them. Also, there is still relatively little known about this disorder and little research has been conducted in comparison with other severe mental disorders. (3)
There has been one breakthrough in treatment, however, by Dr. Marsha Linehan, a Professor of Psychology at the University of Washington. Her method of treatment – called Dialectical Behavior Therapy or DBT – is on its way to becoming the standard treatment for BPD patients. DBT’s is comprised of one-on-one psychotherapy and a skills training group. "The goals of skills training are to change behavioral, emotional and thinking patterns that cause personal misery and [interpersonal] distress." (7) The results of Dr. Linehan’s treatment have been positive. During the period of treatment (typically one year), patients undergoing DBT develop fewer thoughts of hopelessness and suicide, were more likely to stick with the treatment and not drop out, and reported that they felt less anxiety and more success in changing behavioral patterns then with traditional forms of psychotherapeutic treatments and medication. (7)
More recently there has been an initiative by the National Institute of Mental Health and the Borderline Personality Disorder Research Foundation to bring neuro- and behavioral scientific researchers together to compare findings on mechanisms of BPD. (5) Some of this research shows that
"...people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. ...Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion." (4)
Despite the fact the discouraging facts that BPD is difficult to diagnose and treat and relatively little research has been done on this disorder, there are a growing number of support networks currently in existence, as well as support groups for families of BPD individuals, and books being published on the disorder. (1, 2) Through this steadily growing awareness there is some hope that eventually more will be discovered about Borderline Personality Disorder and as a result new treatment options will be developed to help patients.
1) BPD Sanctuary , One of the leading resources and support sites on BPD
2) BPD Central , Another leading site with resources and basic information on BPD
3) The Borderline Personality Disorder Research Foundation
4) National Institute of Mental Health, BPD article "Raising Questions, Finding Answers"
5) National Institute of Mental Health , BPD article "Concept for Borderline Personality Disorder Initiative in FY 2003" research initiative
6) National Alliance for the Mentally Ill site on BPD
7) Dr. Linehan’s DBT course of treatment ("A Promising Treatment...")
8) More basic information on BPD
9) More information on DBT (treatment)
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