What is borderline personality disorder?
The borderline personality disorder is one of the, in the DSM-IV listed, personality disorders.
The borderline name literally means "border". Earlier, it was assumed that the disorder was located in the area between neurosis and psychosis. This vision has changed, but the name remains. Within the American Psychiatric Association (APA), the psychiatric association responsible for the handbook DSM vote to change the name, such as emotion regulation disorder or a similar name because the term borderline is not clear.
Key features
No two borderline patients are the same. There are gradations in, by very livable to very violently. And just as in people without personality disorder, one can also find here extroverts and introverts. Some possible features are:
- A person with borderline personality disorder often have low self-esteem.
- Low self-esteem may lead to self-injurious behavior (self-mutilation, for example, deliberately cutting or burning oneself), sometimes in combination with manipulation.
- Some borderline patients try to shout their insecurity by contrast, provocative behavior.
- A border line patient often has a strong tendency to extreme (for) judge. For example, in relationships with friends and/or partner is often all or nothing – often first everything, and then suddenly nothing.
- Sometimes dissociation on: people with borderline can be gone, for a certain period of time no longer in reality. It seems as if they see themselves in a movie acting. Dissociation is an escape mechanism to keep the emotions under control. It usually occurs when the stress becomes too much.
- Many people with borderline to be living with the fear of being abandoned.
- Even in a group of people, people with borderline feel lonely.
- Borderline personality disorder (BPD) can also go hand in hand with short-lasting psychosis (a few hours to a few days).
Borderline personality disorder diagnosis
Because borderline only since the nineties has been included in the DSM, the disorder is sometimes considered fashion disease and is often spoken of disparagingly. On the other hand, it is understandable that the characteristics and by manifestations of this disorder, this matter is not always equally positive spoken. Bystanders are sometimes faced with the damaging behavior.
Borderline personality disorder usually manifests during adolescence (young adulthood). For the reasons there is no hard evidence, but there are indications that both genetic and environmental factors may play a role. According to the DSM is the probability of the disorder five times as large if the disease also occurs in close relatives. It is generally believed that these factors, combined with the social environment are decisive for the onset and course. It is not proven that traumatic events in childhood are responsible, but a high percentage of BPD sufferers have reported robust sexual abuse or emotional neglect in childhood (a study of Mary Zanarini gives 40-71 percent). Due to this, there are verwaarlozingen attachment disorders arise. It is striking that so many women diagnosed with borderline at four to five times as men shall be. The anti-social personality disorder is nevertheless called "borderline for men." This could be because women's emotions (including aggression) more inwards which are less visible, while men are more vent to the outside world.
DSM-IV
And DSM-IV (301.83) defines the borderline personality disorder as a persistent pattern of unstable interpersonal relationships, unstable self-esteem, unstable emotions and strong impulsiveness. The disorder manifests itself in early adulthood in different situations.
ICD-10
In the ICD-10 (F60.3) emotionally unstable personality disorder is indicated which is divided into two types:
Impulsive type (F60.30) - emotional instability, poor impulse control, emotional outbursts.
Borderline type (F60.31) - emotional instability, self-esteem, feelings of emptiness, unstable relationships, anxiety, self-destructive behavior.
The environment
Dealing with people with this personality disorder can be difficult: a sometimes stifling toeneiging is often interspersed with (periods of) absolute rejection. That may, within a very short time frame and happen very abruptly. Therefore, since a few years educating parents and other loved ones. The matter and the effects have long been known, particularly in the United States. That one years involvement and input of relatives (also called: the ' system ' of the client) in the therapy by the GGZ has ignored, has to do with the views that were dominant. In recent years, one has been given a different view. One calls precisely to the greatest possible involvement from the system. Nearest and dearest know from personal experience how someone with a borderline personality disorder behaves and how it is (daily) with a person with such a disorder to be dealing. The aim is to obtain more fame to bystanders. Since quite often kicked in the pitfalls is that as characteristic present (would) are. Provided that first of all, the diagnosis has been made good. Many bystanders call in the trade and hiking of the slutty summer and keep it correct that act in stand. Often do parent (s) that, by withholding what a child actually does. However: deception and manipulation occur regularly. If this is maintained by parents or caretakers that offers fewer opportunities to heal, even if that could be possible. In other words, the limits to make it clear, and these people also give no chance to go to avoid when it suits them but. One walks too keen of accountability away and used others literally to revamp their business on. In addition, a slutty summer much need for understanding and dedication, because many of them have learned to make no good adhesion with their carers (often the parents) during their youth.
Borderline personality disorder treatment
To a single call these people as cure nothing. Prolonged therapy and counseling are recommended. Sometimes life more bearable for people with this disorder with medication, more can be expected from a structured environment in which everyone knows where he or she stands. With psychotherapy are sometimes to achieve good results. Sometimes a person to overcome the disorder, but if this is not around the 35th year of life happened, chances are that the disorder is of a lasting nature.
A skills training to persons with a border line disorder, dialectical behavior therapy is based on principles developed by the American therapist Marcha Linehan. Border line disorder is mainly focused on learning skills that make it possible better to deal with the complaints. It can reduce symptoms but the self-destructive behavior has no deeper personality change as a goal.
Schema therapy was developed by the New York-based psychologist Jeffrey Young. He began developing it in the 80 's. In a study by Gagnon-Bloo and Arntz showed that after three years, twice a week therapy schedule-good results were achieved by 45% of the patients.
By several authors pointed out that borderline patients have a poor mentalisatiefunctie. As a result, they can not see their own and other people's behavior stems from an inner mental life of desires, intentions and thoughts. As a result, they have a lack of self and other representation. These insights led to the Apartment Aliza Based Treatment by Peter Fonagy and Anthony Bateman. It is assumed in this therapy two modes of dealing with the reality that are integrated into a normal development process. The equivalence thoughts and feelings are seen as a perfect copy of reality, what is thought and felt is real and what is really thought and felt. In the pretend mode, what is thought and felt completely detached from reality (eg. The fantasy play of the child). In a mature mentalisatiefunctie both modes are integrated. This is according to this theory in borderline patients do not avoid the case, as this defense mechanism to confront painful thoughts and feelings. As a result they find themselves either in an equivalence where some thought is real and so is too painful. They can not protect through mentalizing here (ie look for explanations for the painful experience in terms of mental states), making them concrete through impulsive behavior this physical sensation seeking to nullify. The alternative than the pretend mode is a completely unrelated to reality, which often translates to dissociate them.