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What are the symptoms of BPD?
Individuals with BPD have several of the following symptoms:
marked mood swings with periods of intense depression,
irritability, and/or anxiety lasting a few hours to a few days;
inappropriate, intense, or uncontrolled anger;
impulsiveness in spending, sex, substance use, shoplifting,
reckless driving, or binge eating;
recurring suicidal threats or self-injurious behavior;
unstable, intense personal relationships with extreme, black and
white views of people and experiences, sometimes alternating
between "all good" idealization and "all bad" devaluation;
marked, persistent uncertainty about self-image, long term
goals, friendships, and values;
chronic boredom or feelings of emptiness; and frantic efforts to
avoid abandonment, either real or imagined. What causes BPD?
The causes of BPD are unclear, although psychological and
biological factors may be involved. Originally thought to
"border on" schizophrenia, BPD also appears to be related to
serious depressive illness. In some cases, neurological
disorders play a role. Biological problems may cause mood
instability and 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 and personality problems. More research is needed to
clarify the psychological and/or biological factors causing BPD.
The field is also actively looking at genetic vulnerabilities.
How is BPD treated?
A combination of psychotherapy and medication appears to provide
the best results for treatment of BPD. Medications can be useful
in reducing anxiety, depression, and disruptive impulses. Relief
of such symptoms may help the individual deal with harmful
patterns of thinking and interacting that disrupt daily
activities.
Long-term outpatient psychotherapy and 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. More
structured cognitive interventions like dialectical behavioral
therapy (DBT) are now widely used.
Can other disorders co-occur with BPD?
Yes. Determining whether other psychiatric disorders may be
involved is critical. BPD may be accompanied by serious
depressive illness (including bipolar disorder), eating
disorders, and alcohol or drug abuse. About 50 percent of people
with BPD experience episodes of serious depression. At these
times, the "usual" depression becomes more intense and steady,
and sleep and appetite disturbances may occur or worsen. These
symptoms, and the other disorders mentioned above, may require
specific treatment. A neurological evaluation may be necessary
for some individuals.
What medications are prescribed for BPD?
Antidepressants, anticonvulsants, and the new atypical
antipsychotics are common for BPD. Decisions about medication
use should be made cooperatively between the individual and the
therapist or psychiatrist. Issues to be considered include the
person's willingness to take the medication as prescribed, and
the possible benefits, risks, and side effects of the
medication, particularly the risk of overdose.
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