In borderline people, emotions are often experienced with extreme intensity: joy, anger or sadness can follow one another in just a few moments.
Living with borderline personality disorder doesn’t mean the same thing for everyone. Manifestations can range from relative stability to more severe symptoms, having an impact on personal or professional life, and sometimes requiring hospitalization. This disorder, which can be serious in certain forms, is sometimes accompanied by a risk of suicide, although this is not systematic. Explanations with our psychiatrist.
Definition: what does it mean to be “borderline”?
“Borderline” characterizes a personality disorder whose diagnostic criteria were established in the DSM-5, the latest diagnostic and statistical manual used to classify mental disorders. Literally, the word “borderline” means “at the limit”. This disorder is characterized by great emotional instability as well as impulsivity and affects the person in their interpersonal relationships and in their self-image. It was so named because the disorder was originally thought to be “on the borderline” between neurosis and psychosis. This personality disorder affects men and women equally and appears has adulthood. Please note, it is different from bipolar disorder.
What symptoms to detect a borderline person?
“No symptom is specific to BPD in isolation, explains Dr. Jean-Victor Blanc, psychiatrist. But their association and the fact that they cause suffering for the individual signify borderline disorder. On an emotional level, “the mood is constantly subject to a rollercoaster, going from black anger to euphoric ecstasy in the same day, or even from one hour to the next” explains Dr. Blanc. Unlike bipolar disorder with which it can sometimes be confused, these variations of mood are very fleeting and do not persist over time. “A very particular feeling of “internal emptiness”, difficult to verbalize, is often present and very distressing for those affected” adds the psychiatrist.
“Scarifications occur without suicidal aim but to bring relief to inner tension”
► At the relational level, borderline disorder is marked by a great inner insecurity in personal relationships with a fear of abandonment often very present. “Relationships with others are raw, “all or nothing” explains Dr. Blanc. This hypersensitivity and the whole character create tensions which can be difficult for those around them, evoking the isolation of people with borderline disorder. From then on, emotional, friendly and professional relationships are punctuated by tensions, clashes, ruptures and frequent changes.”
► At the behavioral level, instability manifests itself through great impulsivity which affects life choices (work, love life, etc.) but also affects daily life. “One of the facets of this impulsivity is the frequent recourse to self-harm” points out Dr. Blanc. And to add: “Scarifications occur without suicidal aim but to bring relief to an inner tension that patients cannot manage otherwise, they are a source of great guilt.” Eating disorders, including binge eating followed by vomiting, and the use of alcohol and psychoactive substances are also common. “This explosive cocktail often makes the daily lives of affected patients exhausting.”
Causes: What causes BPD?
The causes are not well known. But it seems that borderline disorder has its origins in childhood. “The childhood of patients is very often marked by trauma, neglect or emotional deprivation, physical, verbal or sexual violence” notes Dr. Blanc. What is certain is that borderline disorder results from the association of several factors.
When and who to consult?
It is advisable to consult as soon as there is any suffering. Ideally, we should be able to consult before there are negative consequences in the lives of those affected, such as the establishment of a dependence, or suicidal acts. The psychiatrist is the specialist best able to make the diagnosis and offer treatment. Like all personality disorders, the diagnosis can only be made in adulthood, when personality traits are stable over time. It is often the distress felt and behavioral problems, such as scarification, which will motivate the consultation.
Is BPD associated with other illnesses?
According to the Borderline sheet produced by the psychiatry center of the Toulouse University Hospital, borderline disorder can be associated at one point in one’s life with another psychological illness such as:
- a depressive disorder,
- bipolar disorder,
- an anxiety disorder,
- post-traumatic stress disorder,
- eating disorders,
- an addiction to alcohol or drugs,
- another personality disorder
What treatment to treat borderline disorder?
The treatment of patients with borderline disorder is based on 3 axes:
► Psychotherapy, particularly cognitive-behavioral (CBT) and psychoanalytic approaches. “Schema therapy is effective and recommended” specifies Dr Blanc, because “it integrates aspects of both approaches.” Close follow-up is often necessary.
► Medicines which can help reduce impulsivity, anxiety or treat associated depression. There is no specific medication to treat BPD, it is simply a matter of soothing the most bothersome symptoms and thereby allowing psychotherapy. Depending on the case, the medications most often prescribed are antidepressants, neuroleptics, anxiolytics, or mood regulators.
► Prevention of borderline crises. “This is the essential axis because they are part of the development of the disorder. When things are not going well, knowing who to turn to, when and how, allows you to avoid many complicated situations. Explaining the disorder to those around you is also essential.” Finally, for the many patients who present with an addiction disorder, it is necessary that this be taken care of.
Thanks to Dr Jean-Victor Blanc, psychiatrist and author of “Pop & psy: how pop culture helps us understand psychological disorders” from Éditions Plon.
Borderline Disorder Sheet, Psychiatry Center TOULOUSE UNIVERSITY HOSPITAL CENTER
