Borderline disorder is more common than, for example, schizophrenia or bipolar affective disorder. However, it still remains one of the least studied. It is characterized mainly by unstable relationships with other people, severe difficulties in managing emotions, low self-esteem, and impulsiveness. People suffering from this disorder have a powerful fear of being abandoned by an object of affection, suffer from chronic feelings of inner emptiness, suicidal behavior.
Features
A. Lenglet likened borderline personality disorder (BPD) to a greasy stain that has eaten into clothes. If after washing it can disappear, then the image of this spot can be a metaphor for this neurotic disorder. Neurosis does not change the structure of the processes taking place in mental life. BPD looks like a stain that is so deeply ingrained in the tissue that it is no longer clear what color it used to be. Itinfluences the structure of the perception of reality, the peculiarities of the perception of external events.
This disorder is often associated with an atmosphere of distrust, lies in the family. Children with BPD feel that they have the right to life, but only as an object, a means to solve other people's problems. Nobody needs them as people who have their own feelings - only as a tool. When a person grows up with such experiences, this is the basis for future "splitting". The impulses of the patient with BPD are perfectly he althy, they are directed against external aggression. In other words, outside it is divided, and inside there is a constant response to this situation - this creates tension.
Main signs
The main symptoms of borderline personality disorder are as follows:
- Instability of judgments about oneself, loss of self-determination.
- Behavior that aims to avoid imagined abandonment by other people. As a rule, it is demonstrative in nature: it is an irrational waste of large amounts of money, careless driving a car to tickle your nerves, a constant change of sexual partners, alcoholism, etc.
- Vocaling suicidal thoughts and actual suicide attempts.
- Self-mutilation - burns, cuts and even fractures.
- Too strong emotional reactions - anger, irritability, constant anxiety.
- Depressive states. Feeling of inner emptiness.
- Paranoia -flashes of suspicion about the actions and intentions of others.
Character Properties
PRL contributes to the disadaptation of the individual in society and significantly reduces the quality of life. This is a fairly common disorder. They often suffer from people who, in the period from 1 to 3 years, were abandoned by their parents. In childhood, parents did not respond to their needs and requests. The cry of the child, his smile or words could be ignored. This period is very important for the normal growth and development of the individual. Omission during this period often leads to tragedy already in adulthood. Psychologists identify several character traits that are characteristic of people with BPD:
- Hypersensitivity to the events of the surrounding world. M. Linehan writes that their emotional reaction is similar to that of a person without skin. Too much sensitivity to criticism and separation from loved ones can even provoke suicide attempts. When it comes to stressful events, experiences can be so strong that they seem to destroy a person from the inside. This is especially powerful emotional pain, and the inability to control anger and aggression, and a sharp change from joy to sadness - as if on a swing.
- Unable to bear parting. One of the main features of borderline personality disorder. Sometimes the need to isolate from a loved one can be so strong that a BPD sufferer makes a suicide attempt. During this period theybehavior changes dramatically. They become angry, aggressive, distrustful. They are also acutely worried when they are rejected by a loved one. On the one hand, loy alty is very important to them. They are attached not only to people, but also to things - for example, they may not throw away their old phone until they buy a new one.
- Ambivalence of feelings. In times of stress, people suffering from BPD can love and hate at the same time. Their feelings can be characterized by both antagonism and intensity. The same person can be both a friend and an enemy for a "border guard".
- Idealization and devaluation. Another one of the characteristic tendencies. A person can simultaneously see in the other the height of perfection, and for some time completely devalue what seemed to him beautiful. In other words, adequate representation in BPD sufferers is either absent or severely reduced.
- Shame. Often such people are deeply ashamed of their own behavior or suicidal tendencies, which they cannot control. Often people around them can hear from them: “I am very ashamed of myself.”
- The inability to be in close relationships for a long time. People with borderline personality disorder experience deep anxiety and panic, and tend to withdraw from relationships. They tend to change the object of their affection frequently or to be in completely chaotic relationships.
- Low self-esteem. A person from childhood considers himself unworthy of respect. In childhood, they often experienced neglect from their own parents, and thisseriously affects their worldview already in adulthood. They can do a lot and are often gifted in some area. However, due to the peculiarities of the worldview, the lack of faith in one's own strengths and the low level of internal resources, they may not notice their capabilities.
In general, people with BPD tend to be withdrawn, distrustful of others, feeling like a failure, life-threatening behavior, stress.
Social Disorder
Manifestations of emotional instability in BPD sufferers always take place in the context of their relationships with other people. For example, if a patient with schizophrenia is placed on a desert island, he will show the same symptoms as during his life in society. However, if a person with BPD finds himself all alone, then it is unlikely that he will notice any symptoms. His disorder always manifests itself in the context of interactions with other people.
Differential Diagnosis
It is not uncommon for the symptoms and signs of borderline personality disorder to be overlooked by psychotherapists. Or the pathology is completely misdiagnosed as bipolar disorder. Psychotherapists are misled by a variety of symptoms, including mood instability. At the same time, the change in emotional state in people with BPD and bipolar disorder varies in duration. If the latter have one or anotherthe emotional background can last for several weeks or months, then in patients with BPD, ups and downs can occur in a short time - for example, right at the table during dinner.
Supposedly to make the diagnosis of borderline personality disorder more difficult, the symptoms and signs of this disorder are hidden in the signals of other diseases. BPD is often complicated by depression, anxiety disorders. For example, major depression occurs in more than 80% of patients with BPD; various anxiety disorders - in 90%; bulimia and PTSD - in 26%. 21% of patients with BPD suffer from anorexia. One study showed that about 2/3 of patients with this diagnosis may use drugs or alcohol.
Lenglet emphasized that this distinguishes this disorder from neuroses. A person with social phobia or, conversely, the fear of being alone may know that something is wrong with him. However, a BPD sufferer may not believe that something is wrong with him, even if people around him tell him about it for ten to twenty years. He will perceive his reactions as perfectly normal. In this regard, a patient with a borderline type of personality disorder is close to people with another group of disorders - psychoses. But unlike the latter, he has a good connection with reality. BPD does not provoke the occurrence of hallucinations - either auditory or visual. If the psychotic lives in his own world, and other people feel it, then the patient with BPD can work effectively, have a family, hobbies.
Research
To diagnose borderline disorderpersonality, the following techniques are used:
- graphic (drawing), oral and written testing;
- blood tests that measure hormone levels;
- a long conversation with a psychologist, during which the nuances of the course of the disease, its onset, factors that cause relapse, personal fears and dreams are clarified.
Treatment
Therapy for borderline personality disorder is a process of getting rid of the patient's habitual destructive patterns of behavior. It is aimed at preventing suicidal attempts, mental self-destruction, intentional harm to oneself or others.
Typically, the following approaches are used:
- Cognitive Behavioral Therapy. Allows a person to change ideas about himself, behavior patterns, learn to control his condition.
- Dialectical. The main goal of this type of treatment for borderline personality disorder is to eliminate destructive forms of interaction with other people.
- Psychodynamic. The causes of a mental disorder are brought out of an unconscious form into consciousness so that the patient has the opportunity to overcome them.
Psychopharmacology
Several types of drugs are commonly used in the treatment of this disorder.
- Mood stabilizers. Helps reduce aggressiveness, control outbursts of aggression.
- Antipsychotics (neuroleptics). Treatment of borderline personality disorder with drugs of this group helps to reduce depressive symptoms, relievesmood swings.
- Selective MAO inhibitors help reduce anxiety, prevent anxiety attacks, increase appetite.
Necessary measures at home
It is important for someone with borderline personality disorder to provide:
- long sleep;
- regular food intake containing vitamins;
- Physical activity - this can be running, swimming, Pilates.
In addition, it is necessary to exclude alcohol, narcotic substances, all kinds of energy drinks. There must be acceptance in a relationship, emotional warmth.
The main difficulty is to prevent recurrence of the disease. The complete elimination of symptoms is a very complex and long process, sometimes it can take up to 10 years.
BRL: What is it like for loved ones?
People who have to live near the sick often use the common expression: "to walk on tiptoe." It is it that most fully describes what it is like to be around a person suffering from BPD. The emotional experiences of the patient can undergo very rapid changes. Even the most harmless comment can cause a nervous breakdown.
The discomfort that sufferers cause to others can lead sufferers of BPD to self-mutilate. Or they engage in some other type of impulsive behavior aimed at mental or physical self-destruction. It can be a big expense too.money, constant desire for intimate relationships, drug addiction, dangerous driving.
It is not uncommon for people who surround the patient to gradually guess that he has a borderline personality disorder. How to help a person in this case? Psychologists recommend adhering to benevolence in communication, but at the same time gently interrupting aggressive behavior. For example, the patient can be asked the question: “Do you need to behave in such an aggressive manner now? We can discuss everything in a friendly atmosphere.” At the same time, this proposal should not sound manipulative or accusatory, it should really be saturated with goodwill.
It is hard to expect that the "border guard" will be able to fully recover if he learns to control his internal impulses. However, this can give him the opportunity to calm down a little, feel safe and stable. After all, you can not only maintain contact with the patient for a long time, but also build productive relationships with him. For relatives and friends of sick people, it will be very useful to contact a psychologist and sign up for several meetings in order to learn a friendly manner of communicating with the “border guard”. Patients in the course of psychotherapy get a chance to significantly improve the quality of their lives. And close people learn one of the most important things - to be a person who knows how to accept and understand his neighbor. Even if he is significantly different in the warehouse of his psyche from the majority.
Borderline personality disorder: howhelp yourself? Advice from psychologists
A person with BPD primarily suffers from his own impulsiveness and experiences. And so many have a natural desire to make their lives more comfortable. Many of the patients are interested in: how to live with borderline personality disorder? Consider the main recommendations.
- The most important step is making the right diagnosis. It should be remembered that in very rare cases, self-diagnosis may be correct. Mood swings do not always indicate the presence of this disorder. Also, do not count on the fact that you will be able to cope with the disorder on your own. After all, the human psyche is designed in such a way that it strives to constantly avoid "sharp corners".
- It is also important to be able to accept everything that happens with you. The symptoms of borderline personality disorder are a feature of the person's psyche, not a curse, bad parenting, etc.
- It is especially important to learn how to control impulsive behavior. After all, a phase change can happen almost instantly and imperceptibly for the "border guard" himself. There is usually some moment of irritability before the change of mood, which may also be noticed by loved ones. They may make comments that a relapse might occur. However, it is important that those close to you do not use such warnings to manipulate.
- After the phase has changed, an uncontrollable surge of despair and anger can begin. This is also one of the features of the response. Here you need to learn to take control of yourself. If ait seems that “everything is wrong” and there are only ill-wishers around, it is important to remind yourself that in reality things are different.
- Mood swings usually happen for a specific reason. Typically, a person with borderline personality disorder experiences a number of such situations. It is necessary to clearly define these circumstances and develop an algorithm for working with them - to avoid or look for possible solutions.
- You need to know your feelings and train in their definition. When an emotional state is given a name, it is, as it were, "objectified" and more easily manageable. Feelings can be different in strength and meaning. A useful skill is to learn how to determine the gradation of these states.
- It is equally important to learn to relax. Meditative techniques, the progressive relaxation method, are well suited for this.
- Suffering from borderline personality disorder, it is useful to direct efforts in line with the search for oneself, the formation of one's personality. Indeed, often they seem to "borrow" part of someone else's character. Their individuality is smeared, they know little about themselves. What is important in life? What is the main goal? What role do other people play?
- Develop the ability to empathize, understand other people. Of course, the “border guard” is very good at “merging” with another person. However, one must learn to do this consciously, and in this case it will no longer be a merger, but a conscious sympathy.
- It is also useful to read specialized books. Borderline personality disorder is covered in detail in publications such aslike “House of Cards” by Irina Mlodik, “Cognitive Behavioral Therapy for BPD” by M. Lyen, “Restless Mind. My victory over bipolar disorder" Jamison Kay.
Despite all the difficulties that accompany therapy, a positive outcome is possible. But the patient must remember that this is a rather complicated and lengthy process. There is no hope for a quick improvement here. With the right choice of the method of psychotherapy, as well as the presence of a sensitive and competent psychologist, it is quite possible to achieve both large and small successes.
