Borderline
Personality Disorder
Category
Personality
Disorders
Etiology
Like
most personality disorders, there are many factors that may
contribute to the development of symptoms. Because the
symptoms are long lasting, the idea that symptoms begin to
emerge in childhood or at least adolescence is well
accepted. The negative consequences of such symptoms,
however, may not show themselves until adulthood.
Symptoms
are often present in adolescence and almost always by young
adulthood. There may be a history of unstable
relationships in the person's life and there is a higher than
average likelihood of sexual abuse, family violence, and/or
neglect in the person's childhood. This disorder is
diagnosed much more frequently in females.
Symptoms
The
major symptoms of this disorder revolve around unstable
relationships, poor or negative sense of self, inconsistent
moods, and significant impulsivity. There is an intense
fear of abandonment with this disorder that interferes with
many aspects if the individual's life. This fear often
acts as a self-fulfilling prophecy as they cling to others,
are very needy, feel helpless, and become overly involved and immediately
attached. When the fear of abandonment becomes
overwhelming, they will often push others out of their life as
if trying to avoid getting rejected. The cycle most
often continues as the individual will then try everything to
get people back in his or her life and once again becomes
clingy, needy, and helpless.
The
fact that people often do leave someone who exhibits this
behavior only proves to support their distorted belief that
they are insignificant, worthless, and unloved. At this
point in the cycle, the individual may exhibit self-harming
behaviors such as suicide attempts, mock suicidal attempts
(where the goal is to get rescued and lure others back into
the individual's life), cutting or other self-mutilating
behavior. There is often intense and sudden anger
involved, directed both at self and others, as well a
difficulty controlling destructive behaviors
Treatment
Treatment
for this disorder is long term in nature since the
symptoms have been present for an extended time and interfere
with many aspects of the person's life. Insight oriented
therapy can be helpful but research is showing an increased
support for a cognitive-behavioral approach. In other
words, the individual's thoughts and actions are monitored
both by the self and therapist and specific behaviors are
counted and a plan is made to gradually reduce those thoughts
and behaviors that are seen as negative. A combined
approach may be best, but either way requires intensive time
and effort.
Prognosis
Prognosis
is difficult to assess. While the disorder is
chronic in nature, gradual improvements with work are definitely
seen. While it is difficult for anyone to change major
aspects of their personality, the symptoms of this disorder
can be reduced in both number and intensity. Long term
treatment is almost always required.
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