Diagnosis borderline personality disorder

10. July 2020

People suffering from borderline personality disorder experience emotions much more intensely and are subject to frequent mood swings. It is not for nothing that the disorder is also called emotionally unstable personality disorder. In addition to rapidly changing emotions, those affected suffer from low self-esteem as well as difficulties in interpersonal relationships.

Borderline: Emotional chaos the order of the day

The English term borderline means border or edge. The term fits in that the feelings and moods of patients with borderline personality disorder can tilt very quickly. From sky high to deathly sad – the feelings are in constant roller coaster. In addition, feelings are experienced more intensely. This is especially true for negative feelings such as fear, shame, anger or sadness. Patients have great difficulty extricating themselves from these emotional states because they lack self-regulation skills (Sendera & Sendera, 2012).

Symptoms of borderline personality disorder
The characteristics of borderline personality disorder include three problem areas. The first problem area describes the emotional fluctuations and self-regulation mentioned earlier. The second problem area involves the issue of self-worth. The third problem area includes difficulties in interpersonal relationships.

Area 1: Feelings and self-regulation
In borderline personality disorder, severe mood swings and intense experienced emotional states are typical. In contrast to the affected person, healthy people are able to up- and down-regulate too strong feelings on their own, be it by thinking, conscious breathing, distraction or by talking to fellow human beings. In patients with borderline personality disorder, these abilities are poorly developed. They are overwhelmed by feelings and have little chance to regulate them. In addition to strong feelings, some patients also report an unbearable emotional emptiness that can develop between outbursts of emotion.

Area 2: Self-worth
Many patients with borderline personality disorder have a low self-esteem. This is also experienced in the extreme: patients hate their bodies, their behavior, and their lives. They feel worthless and guilty. They often compare themselves with others and usually see themselves in a worse light.

Area 3: Interpersonal relationships
Interpersonal relationships are riddled with conflicts in patients with borderline personality disorder: issues such as jealousy, envy, reproaches, love withdrawal or fear of loss are the order of the day. Typically, patients virtually idolize the people around them one day and loathe them the next. Stable personal relationships are rare. Patients often lack a sense of a healthy relationship between closeness and distance.

Self-injurious behavior in the course of borderline personality disorder

Self-injurious behavior may occur in the course of borderline personality disorder. Contrary to many preconceptions, however, self-injurious behavior is not mandatory and can occur without borderline personality disorder. Experts refer to this as non-suicidal self-injury, because there is no suicidal intent behind the self-inflicted injuries (Klonsky, 2007).

Types of non-suicidal self-injury
Many are familiar with the colloquial “scratching” of the arms and legs, in which victims intentionally inflict cuts on themselves that then leave severe scarring. However, there are other more unfamiliar types of self-injury, such as burning, stabbing, scraping, scratching, vigorous rubbing, or deliberate falls.

Intent behind non-suicidal self-injury
The intent behind the injuries is not to commit suicide. Rather, the physical injury is used to release psychological pressure. The injury acts as a valve for built-up tension and leads to psychological and physical relief. The behavior is “rewarded” by this positive feeling of relief and is thus performed all the more frequently. If internal tension builds up again, an indomitable urge arises to reduce this tension through self-injurious behavior.

Excursus: Psychologists call self-injurious behavior in the face of inner tension a dysfunctional self-regulatory strategy. Dysfunctional means that the strategy works in the short term but is not a solution in the long term. The self-inflicted injuries must become increasingly severe in order to still function as an outlet for internal pressure. In addition, the injuries have a high risk of infection and can cause serious damage to health.

Causes of borderline personality disorder

The predisposition to borderline personality disorder is hereditary. However, whether the disorder actually develops has to do with environmental factors. It is considered a risk factor for developing the disorder if childhood was conflict-ridden or if there was even trauma. In addition, there are neurological features in patients with borderline personality disorder. Psychological testing may show that certain skills, such as impulse control or self-regulation, are not sufficiently present. However, whether this is the cause or consequence of borderline personality disorder is unclear (Sendera & Sendera, 2012).

Therapy of borderline personality disorder

Borderline personality disorder used to be considered difficult to treat. This has now changed completely. There are effective long-term programs that support patients very well. Dialectical Behavioral Therapy, or DBT, according to Marsha Linehan (1999) has proven to be particularly successful. It is a cognitive-behavioral form of therapy with the following content:

  • Working on problem-solving skills
  • Working on interpersonal relationships using the therapist-patient relationship as an example
  • Skill training in self-regulation of feelings
  • Psychoeducation: imparting knowledge about borderline personality disorder and teaching coping strategies
  • Self-esteem work

The program is conducted in individual and group contexts. In the group context, the main focus is on working on the so-called “skills” that are used to self-regulate feelings. These skills include, for example, internal mindfulness and distraction strategies. For example, many sufferers use physical, noninjurious stimuli to bring themselves back to themselves in emotionally overwhelming situations. One example is a rubber band on the arm that can be “flicked” as needed to relieve tension.

Living with borderline personality disorder

A study shows that a diagnosis of borderline personality disorder does not have to last a lifetime. With good medical and therapeutic connection, as well as a supportive social environment, it is possible that the diagnostic criteria (aligned with the above three domains) may no longer be met (Zanarani et al., 2004). It is important to note that other mental illnesses, such as depression, obsessive-compulsive disorder, or addictive disorders, may develop secondary to borderline personality disorder. For this reason, a detailed and thorough diagnosis is urgently required before starting therapy.

References

(1) Baumann, U., & Stieglitz, R. D. (2013). Test manual for the AMDP system: empirical studies in psychopathology. Springer-Verlag

(2) Linehan, M. M., Schmidt III, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American journal on addictions, 8(4), 279-292

(3) Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of clinical psychology, 63(11), 1045-1056

(4) Sendera, A., & Sendera, M. (2012). Skills training in borderline and posttraumatic stress disorder

(5) Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B., & Silk, K. R. (2004). Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. American Journal of Psychiatry, 161(11), 2108-2114.

Categories: Personality Disorders

Friederike Reuver
Autor:in Friederike Reuver
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