Psychotherapist names 8 signs of borderline personality disorder. Check yourself

psychologist, lecturer at Synergy University

“Borderline disorder is an emotionally unstable personality disorder that occurs in adulthood. This disease (PDP) is characterized by a tendency to impulsive forms of behavior, weak emotional stability, high levels of anxiety and significantly reduced self-control.”

People suffering from this pathology are prone to depression, impulsive and irrational behavior, crises, suicidal thoughts and threats, and self-harm. They also experience significant difficulties in establishing social contacts, in personal and professional self-determination.

Signs of borderline personality disorder

A prolonged period of destructive behavior of the person. In contrast to alternating episodes of exacerbations and remission in other types of disorders and neuroses. For example, in borderline disorder, compared to bipolar mental disorder, episodes of depressive and elevated mood alternate much less frequently.

A feeling of constant fatigue and emotional devastation. The person feels an inner emptiness and boredom, has great difficulty in understanding himself and his desires, sometimes it is not possible at all.

Reckless behavior with a high level of risk to themselves and loved ones. Mood swings, outbursts of rage and aggression, including from the impotence to change anything in their lives. Often sabotage their own activities when they have almost reached the goal.

Problems with self-identification of personality. Formation of their own circle of interests and opinions about any phenomena. Tend to “black and white” thinking. Quite often there are doubts when choosing a place to study or a profession. May drop out of school shortly before handing in a diploma or project.

Showing empathy and various kinds of affection. However, often misinterpret the actions and intentions of their partners, overdramatizing the contradictions, without apparent reasons to inflame conflicts.

Fear of loneliness and fear of being left without support. At the same time devalue or overly idealize the partner without good reason. Tend to manifest various forms and predilections in sexual behavior, including general sexual promiscuity.

Suicidal thoughts, as well as a tendency to self-harm. In some cases, borderline disorder is accompanied by the intake of illegal substances and addictions. Workaholism, overtime, inadequate eating behavior, depriving oneself of sleep in favor of work. All of these are also forms of harming oneself and one’s health.

Irrational interpersonal relationships. Patients with this diagnosis feel intense fear or anger when they think they have been rejected, or when someone is late for or cancels an appointment with them. In these circumstances, they begin to feel abandoned and unwanted. Abandonment leads to loneliness, which is extremely distressing for people with PWL.

They tend to show only polarities in relationships: idealization and devaluation, without the whole middle spectrum of their attitude towards their partner. Can change their point of view abruptly. Require a lot of attention and care from their chosen one. When they don’t get what they want, fall into intense anger or rage. Their thinking is black and white. They will take care of their spouse if they are only sure that he or she is always available and caring for them.

People with PRL have difficulty controlling their anger, often directing it at loved ones in retaliation for their own feelings of abandonment. After emotional outbursts, they feel shame and guilt, their own worthlessness, and become angry about it. The self-sustaining circle is complete.

The self-esteem of people with this disorder is extremely unstable and depends on external factors. When no one cares about them, they feel an inner emptiness or a sense that they do not exist at all. The mood changes of such people usually occur in response to changes in their relationships and reflect the tension in them.

Dysphoria (a disorder associated with a lowered, gloomy mood and dissatisfaction) rarely lasts more than a few days. People with this pathology are characterized by impulsivity. This is expressed in unprotected sex, gambling, addictions, overeating, risky driving, self-harm and suicide attempts.

Causes and developmental factors

One common cause of borderline disorder is a hereditary factor. For example, studies published by the American Psychiatric Association indicate that first-line relatives of PDP patients are five times more likely to have a similar disorder compared to the general population.

Decreased executive functions of the cortical regulatory areas of the brain – planning and controlling behavior, may also be one of the causes. And it is almost always observed in a significant number of individuals suffering from this disorder.

A very significant role in the development of borderline disorder is played by severe stresses that are experienced in childhood. They are most often associated with physical or sexual abuse.

Psychological abuse experienced at an early age is also a powerful trigger for the development of the disorder. Especially if it involves the loss of parents, neglect of vital needs, persistent neglect and devaluation over a long period of time.

Post-traumatic stress disorder is found in a large number of individuals with an established borderline personality disorder.

Diagnosis of borderline personality disorder

There are a number of features in making a correct diagnosis.

1. Age of manifestation (detection, manifestation) of the disorder. It is important to realize that even at an early age, experienced psychiatrists can see clear signs of PDP. However, most often in children this disease is not established due to the age-related peculiarities of mental development.

The diagnosis is called at the end of adolescence, in order to exclude incorrect interpretations of conditions caused not by the disease, but by the peculiarities of maturation of the psyche and other organs and systems of the body in this period.

2. Correct differential diagnosis. It is especially important not to confuse borderline personality disorder with other diseases, i.e. to make a competent differential diagnosis.

Bipolar, hysterical and narcissistic personality disorder are the most similar types of disorders in terms of symptomatology. They can affect the diagnosis and can be an obstacle to qualified care.

Unlike bipolar disorder, the periods of activity and decline are much more protracted. These periods are accompanied by a very low emotional tone and rare but vivid outbursts of emotion.

What distinguishes borderline mental disorder sufferers from hysterical and narcissistic disorder is that they see themselves as bad. Also adept at feeling and showing empathy, they may have an acute sense of inner emptiness.

3. The manifestation of a whole symptom complex of characteristics. With the advent of the internet and the availability of medical reference books, people often misdiagnose themselves based on one or more of the less significant characteristics.

The combination of a constant tendency toward instability in relationships, self-esteem, and emotions (i.e., emotional dysregulation) and pronounced impulsivity with at least five other key characteristics of the disorder is very important for proper diagnosis.

Treatment of borderline disorder

For the past 30 years, dialectical behavior therapy has been considered one of the most effective psychotherapeutic techniques for treating the disorder. This technique allows to realize and accept a variety of forms of solutions for hopeless (in the opinion of the patient) situations, to reduce the strength of manifestation of inadequate emotional reactions to various stressful events. It also allows you to reduce the likelihood of suicide, keep under control aggressive or autodestructive forms of behavior.

Dialectical behavioral therapy is used in combination with meditative techniques and training in effective communication.

However, borderline personality disorder is not only treated with psychotherapy, but also in combination with medication. In consultation with a psychiatrist, various drugs may be prescribed, such as antidepressants, which have the ability to inhibit serotonin reuptake, as well as mood stabilizers – normotimics.

In some cases, neuroleptics are used to reduce aggressive behavior, anger and rage, regulation of sleep and wakefulness, the work of the cognitive sphere. In consultation with a specialist, anxiolytics, that is, tranquilizers, can also be used to reduce anxiety and general sedation.

Neuropsychologists and rehabilitation therapists may also be involved in the treatment of this disease. Additional specialists are involved on the basis of analyzing the causes of the disease or to eliminate the already occurring consequences and associated conditions.

psychiatrist, psychotherapist

“In the treatment of PPL the main method is psychotherapy. A combination of group and individual psychotherapy is ideal. Therapy should be prolonged and regular.”

The therapeutic target is the way of organizing relationships with people. The therapist, no matter which direction he or she belongs to, will move the patient with this diagnosis toward greater awareness of the motives for his or her emotional reactions and behavior toward others and self.

CPT (cognitive-behavioral therapy), Gestalt therapy, and family therapy are suitable. In a psychotherapy group, people with PPL will be able to notice and adjust their ways of interacting with others. The recommended duration is three to five years.

Mentalization is also effective. This is the skill of thinking about and understanding one’s own and others’ state of mind. Such treatment helps patients to regulate their emotions and feelings, to realize their influence on life. As a result, qualities such as empathy and compassion are developed.

You can also turn to schema-oriented therapy. It combines cognitive-behavioral therapy, attachment theory, psychodynamic concepts and emotion-focused therapy. This method allows you to work effectively with destructive patterns of thinking and behavior.

Here the therapist acts as a parent.

Supportive psychotherapy is recommended for people diagnosed with PPL. Its goal is to establish an emotional, encouraging and supportive relationship with the patient so that he develops healthy defense mechanisms in interpersonal relationships. Because a person with this condition has great difficulty in building communication.