Borderline Personality Disorder: Emotions, Perception, Instability, Impulsivity

Personality is a person's way of thinking, feeling, and acting, which differentiates him from other people. A person's personality is shaped by experiences, environment, life situations, and inherited traits.

A personality disorder is a lasting pattern of inner feelings and behavior that deviates significantly from the specific norms of the cultural environment from which the individual comes; this model is a rigid one, it begins in adolescence or at the age of a young adult, is stable over time and brings a lot of suffering and problems in the life of the affected person. Without specialized intervention, personality disorders will not go away on their own.

"Impulsivity, instability, anger and self-harming or suicidal behavior, fear of abandonment, psychotic and dissociative symptoms, a chronic feeling of inner emptiness, intense, unstable relationships, make up the clinical picture of borderline personality, which makes this disorder quite difficult. to be managed, especially on its own.

I believe that addressing specialists as soon as possible (psychotherapist and psychiatrist) can be the premise of a functional, healthy restructuring, both for the patient and for the people around him "

There are 10 personality disorders, grouped into three categories (or clusters), depending on common characteristics and symptoms: eccentric, emotional, and anxious if we were to choose a descriptive word for each class. What all 10 personality disorders have in common is a distorted way of seeing oneself, others, and relating to the world at large.

Of all the 10 disorders, a borderline personality disorder is the most studied disorder. BPD is part of the category (cluster) B of personality disorders, along with antisocial, histrionic, and narcissistic personality disorder; people with B-cluster disorders often appear to be theatrical, emotional, or chaotic (uncontrolled).

What defines borderline personality disorder?

According to DSM-5 (the latest edition of the Diagnostic and Statistical Classification Manual for Mental Disorders), a borderline personality disorder is characterized by a pattern of instability in interpersonal relationships, unstable self-image, emotional instability, and impulsivity. accentuated.

We thus retain two keywords: instability and impulsivity. Emotional and relationship instability, instability of self-image, leading to impulsive actions.

Some specialists would give another name to this disorder because they appreciate that the border between neurosis and psychosis does not accurately describe the disorder, but a more suggestive name would be "emotional disorder". It would be a more descriptive name for people with BPD.

A day in the life of a person with BPD is, in fact, an emotional carousel. So another key term would be emotions.

The mood of a person with borderline personality disorder ranges from normalcy to sadness or hostility to the slightest challenge. Perceptions of others are inconsistent, and in romantic relationships, they oscillate between idealizing your partner and hating him overnight. Another key term is perception.

Equally unstable is their own identity, their self-perception - patients diagnosed with BPD do not have a clear idea of ​​who they are. They have no clear idea of ​​their place and role in this world. Therefore, their values ​​and interests can change and change rapidly.

Moreover, people affected by borderline personality disorder also end up with self-harm - but this self-harm would be just an attempt at emotional regulation. Out of a desire to stabilize, some people resort to causing physical pain - which has been shown to reduce the level of emotional stimulation.

People with BPD see the world in black and white, in extremes, everything is good or everything is bad. They fail to find a middle ground, a way to make room for uncertainty in their lives.

Stress can be a trigger for an episode of anger or depression. At the same time, people with BPD may be angry or suffer separation from their loved ones - a simple commute in the interest of their job can be difficult to manage by a person who lives in fear of abandonment constantly.

Because they have an image of a bad, sinful, worthless person, people with this disorder sometimes feel that they do not exist - such feelings occur in situations where the person feels that they lack a relationship or a person to It provides understanding and support.

The main causes for borderline personality disorder

As possible causes of the development of BPD, the specialists indicate two, which work together:

a biological vulnerability and a disabling environment in which the person grows and develops. And the disorder is five times more common among people who have close relatives diagnosed with BPD. Many people with BPD have reported a history of childhood abuse, neglect, or separation.

According to the DSM-V, the criteria for diagnosing borderline personality disorder are new, but at least five of them are sufficient for a diagnosis of BPD and to occur in a variety of life situations:

• desperate efforts to avoid real or imaginary abandonment;

• a pattern of unstable and intense personal relationships, relationships characterized by fluctuating states of idealization/devaluation of the other;

• identity disorders; instability of self-image or self-feeling;

• impulsivity, which must be manifested in at least two situations with self-destructive potential (substance or alcohol abuse, excessive spending, gambling, unprotected sex, compulsive eating, reckless driving, etc.);

• recurrent suicidal behavior; recurrent suicide attempts or suicidal thoughts or threats, self-mutilation (although these are only a response to inner distress, not a real desire for death);

• emotional instability caused by the reactivity of the mood (irritability, anxiety lasting several hours or, less often, several days);

• the chronic feeling of inner emptiness;

• unmotivated and intense anger or difficulty controlling one's anger;

• severe dissociative symptoms (clinical psychologists also call them micro-psychotic episodes) related to stress, disconnection from reality.

This disorder has major effects on the family life and career of the person diagnosed with BPD. The person may have lower school or professional performance in unstructured contexts.

How can BPD be kept under control?

Managing emotions is key. What are emotions? An emotion is a complex psychological state that includes three distinct components: a subjective experience, a psychological response, and an expressive/behavioral response. And it is precisely these experiences that are altered by borderline personality disorder.

And now therapy is being discussed, as the first form of treatment for BPD. And among the guidelines, cognitive therapy seems to lead to good results (works a lot with perceptions and cognitive distortions) and dialectical behavioral therapy. DBT has been developed specifically for patients with BPD.

DBT sees people affected by BPD as lacking skills. And it involves skills development techniques that target those main dimensions affected by BPD, namely:

Mindfulness

To reduce self-confusion by stimulating introspection and focus; at the same time, to encourage the observation of emotions without the impulse to manifest them.

Interpersonal skills

To help develop and maintain relationships.

Emotion regulation and control skills

For affect regulation and anger management.

Practicing tolerance to stress/suffering

To better manage impulsivity and explore alternatives to self-destructive behavior and suicide attempts.

In the background would be certain medications that play a role in relieving symptoms, such as antidepressants and mood stabilizers in episodes of depression or unstable mood swings. Antipsychotics may also be recommended in cases of major cognitive impairment.

A therapeutic approach that encourages both acceptance and change is appropriate; on the one hand, because of the extreme suffering felt, and on the other hand, because of the extreme emotional sensitivity. At the same time, for the easy introduction of the change factor, a lot of work is done to develop the therapist-patient relationship.