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Unravelling Mental Illness: A New Series

Mental health is an important topic that everyone should be aware of. That’s why I'm launching a series of blogs about different mental illnesses, so you can become more educated and informed! We’ll explore the different types of mental illness over the next 9 weeks.

As part of this series, I will dive into topics such as anxiety disorders, depression and bipolar disorder. We’ll also discuss less commonly known conditions such as borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD). I believe it's vital that everyone has access to knowledge about mental health issues in order to create a society of understanding and acceptance.

This week I am going to cover BPD - Borderline Personality Disorder.

Borderline personality disorder (BPD) is a mental illness characterized by extreme and inflexible traits. People with BPD experience intense emotions, unstable relationships with other people, impulsive behaviours and an inability to tolerate being alone or in silence.

BPD affects 1-2% of the population -1 in 5 of those who have BPD suffer from severe dissociation; 1 in 10 experiences suicidal ideation; nearly half of those who commit suicide have BPD.

The symptoms of borderline personality disorder (BPD) can be divided into four main categories: emotional instability, impulsivity, interpersonal difficulties, and a distorted sense of self.

  1. Emotional Instability: Individuals with BPD may experience intense and rapidly shifting emotions, including episodes of anger, depression, and anxiety. They may also experience feelings of emptiness and a fear of abandonment.

  2. Impulsivity: People with BPD may engage in impulsive behaviors such as substance abuse, binge eating, reckless spending, and promiscuous sexual behavior. They may also engage in self-harm or suicidal behavior.

  3. Interpersonal difficulties: Individuals with BPD may have unstable and intense relationships, characterized by alternation between idealization and devaluation of others. They may also have a fear of abandonment and may engage in clingy or desperate behavior.

  4. Distorted sense of self: People with BPD may have a distorted sense of self, characterized by a lack of self-identity and self-worth. They may also have difficulty making and keeping stable relationships.

It's important to note that these symptoms can vary in severity and can be present in other mental health conditions, a professional assessment is needed for a proper diagnosis.

One-half to three-quarters of people with BPD are diagnosed with other mental health disorders at the same time as BPD. Some of these include:

  • Bipolar disorder, which causes shifts in mood and energy levels that can last days, weeks or months (the manic phase).

  • Depression, which makes you feel sad longer than normal and affects your ability to function normally. It also causes problems sleeping or eating properly; excessive crying; feelings of guilt; thoughts about suicide; low energy levels; restlessness or irritability; loss of interest in activities you once enjoyed doing (anhedonia).

  • Eating disorders such as anorexia nervosa or bulimia nervosa -- eating too little food (or none at all) so you lose weight but also causing malnutrition because your body needs nutrients from food for growth and development--or eating too much food (bingeing), sometimes over many hours until feeling uncomfortably full

People with BPD may experience unstable self-image and feelings, difficulty controlling emotions and impulses, and bouts of stress-related paranoia and severe dissociation (a disconnection from their physical surroundings and reality). Suicide attempts are common among those with BPD; the National Comorbidity Survey Replication found that 12% of people with BPD had attempted suicide at some point in their lives. Treatment is possible for this condition, but it takes time--and commitment.

The exact cause of borderline personality disorder (BPD) is not yet fully understood, but it is thought to be a combination of genetic, environmental, and psychological factors.

  1. Genetic factors: Studies have shown that there may be a genetic component to the development of BPD. Individuals with a first-degree relative, such as a parent or sibling, with BPD may be at an increased risk of developing the disorder themselves.

  2. Environmental factors: Trauma, particularly in childhood, is believed to be a significant risk factor for the development of BPD. Examples of childhood trauma include physical, emotional, and sexual abuse, neglect, and abandonment.

  3. Psychological factors: Individuals with BPD may have difficulty regulating their emotions and may have a tendency to see things in black and white. They may also have a distorted sense of self and may have difficulty with self-identity and self-worth.

  4. Brain Structure and Function: Research has found that individuals with BPD have structural and functional differences in areas of the brain that are involved in emotion regulation, impulse control, and decision making.

It's important to note that the cause of BPD is likely to be multifactorial and may involve a combination of genetic, environmental, and psychological factors. A proper diagnosis of BPD should be done by a professional mental health provider.

Borderline personality disorder (BPD) is diagnosed by a mental health professional, such as a psychiatrist or psychologist, through a comprehensive assessment that includes a clinical interview, psychological testing, and observation of symptoms.

  1. Clinical Interview: A mental health professional will conduct a detailed interview to gather information about an individual's symptoms, medical history, and personal and family history. They will also assess for any other potential mental health conditions that may be present.

  2. Psychological Testing: A mental health professional may administer psychological tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), to assess for symptoms of BPD.

  3. Diagnostic Criteria: The diagnosis of BPD is made by a mental health professional using the criteria outlined in the Diagn and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11). These criteria include:

  • A pattern of instability in relationships, self-image, and emotions

  • Impulsivity in at least two areas that are potentially self-damaging (such as substance abuse, binge eating, reckless spending)

  • Recurrent suicidal behavior, gestures, or threats, or self-harming behavior

  • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

It's important to note that it can be difficult to diagnose BPD, as symptoms can be similar to those of other mental health conditions. Therefore, it is important to consult with a mental health professional for a proper diagnosis and treatment plan. There are several treatment options available for individuals with borderline personality disorder (BPD), including psychotherapy, medication, and hospitalization.

  1. Psychotherapy: There are several evidence-based psychotherapeutic approaches that have been shown to be effective in treating BPD. These include:

  • Dialectical Behavior Therapy (DBT): This is a type of cognitive-behavioral therapy that focuses on helping individuals with BPD to regulate their emotions and improve their relationships.

  • Cognitive Behavioral Therapy (CBT): This therapy helps individuals with BPD to identify and change negative patterns of thinking and behavior.

  • Schema-Focused Therapy (SFT): This therapy focuses on helping individuals with BPD to understand and change negative patterns of thinking that developed in childhood.

  1. Medication: Medications may be prescribed to help manage specific symptoms of BPD, such as depression, anxiety, or impulsivity. Antidepressant medications, mood stabilizers, and antipsychotic medications are often used to treat BPD.

  2. Hospitalization: In some cases, individuals with BPD may require hospitalization to manage severe symptoms, such as suicidal behavior or self-harm.

  3. Supportive therapy and self-help groups: Supportive therapy and self-help groups can be beneficial for individuals with BPD to help them cope with the symptoms and to improve their overall quality of life.

It's important to note that treatment for BPD is often long-term, and it may take some time for an individual to see improvements in their symptoms. It's also important to work with a mental health professional to develop an individualized treatment plan that best meets the person's needs.

If you or someone you know may be struggling with BPD or suspected BPD, it is important to seek professional help. A mental health professional can provide a proper diagnosis and treatment plan to help manage symptoms and improve overall well-being.

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