What Is Borderline Personality Disorder?

My psychiatrist, Rosalie, asked me how I felt about Borderline Personality Disorder when I saw her this last week. I told her it's been tough to take in. She wisely talked to me about how it's hard to put a human being into a diagnosis like that, or any diagnosis really. We're such complicated creatures, especially our minds, that to lump people into one category or another is almost unfair. But simply to provide better and more effective treatment, we do. One of my dearest friends, Jen, commented on facebook that one of her grad professors said we all have second axis traits. (Axis two is for assessing personality disorders; depression is on axis one.)

So what is a personality disorder? And what is Borderline Personality Disorder? This is what I know:

A personality disorder is an enduring pattern of inner experiences and behaviors that go against the norm of the individual's culture. They're inflexible and pervasive across a myriad of situations, social, personal, etc . Personality disorders generally develop in childhood and so aren't generally diagnosed until early adulthood, even into the 30s, like where I'm at.

In a grand nutshell, Borderline Personality Disorder is a mood disorder characterized by unstable moods, behavior, and relationships. It generates a significant amount of emotional instability, which in turn leads to many other mental and behavioral problems, such as depression. People with BPD have a severely distorted self image and feel worthless and fundamentally flawed.  They are very sensitive to environmental circumstances and have an insecure sense of self. Often, people with this disorder find it more difficult to distinguish between reality from their own misconceptions of the world and their surrounding environment. This may seem like a delusion disorder, but it is actually related to their emotions overwhelming regular cognitive functioning.

Other symptoms of BPD include:

*Frantic efforts to avoid real or imagined abandonment. I talked some in my last post about abandonment, and how much I struggle with it. The unstable pattern of interacting with others has persisted for years, and is so closely related to one's self image and early social interactions. The perception of impending separation or rejection, or loss of external structure, can lead to profound changes in self image, affect, cognition, and behavior. The perceived abandonment can leave the one with BPD feeling that they are inherently bad.

*A pattern of unstable and intense interpersonal relationships

*Identity disturbance

*Impulsivity

*Recurrent suicidal behavior

*Emotional instability

*Chronic feelings of emptiness

*Transient, stress related paranoid thoughts

Unfortunately researchers today don't know exactly what causes Borderline Personality Disorder. There are theories, however, about possible causes. Genetics may play a role. Some studies suggest personality disorders may be inherited or strongly associated with mental disorders among family members. Environmental factors also play a key role. Many people with BPD have a history of childhood abuse and neglect, and separation from caregivers or loved ones. Another theory is brain abnormalities. Some research shows change in certain areas of the brain involved in emotion regulation and impulsivity. Also certain brain chemicals that help to regulate mood may not function properly.

Treatment usually involves long term psychotherapy with a therapist trained in treating BPD. Medications may also be prescribed to help specific symptoms, but no medication treats Borderline Personality Disorder.

All I know is that I have a long, hard road ahead of me. But with it will come relief. I'm relieved to know I'm not alone, the there are people out there who have spent their lives studying the disorder, who have brought with them great wisdom and strength. I am relieved to have a name to put to the overwhelming emotions and moods and scary, dark places in my head. I am relieved that the depression is being treated effectively finally. I am hopeful for a light to begin to shine soon.

We'll stop there, with that sentence: I am hopeful.