All About Managing Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one such personality disorder. It usually appears during adolescence or early adulthood and is more common among women in urban areas (Kernberg O (1975).BPD is estimated to be around 1.6% but is probably much higher due to under diagnosis (National Center for Biotechnology Information). People with BPD often have rigid and unhealthy patterns of thinking, with extreme mood swings, unstable relationships and trouble controlling their emotions. They may have a higher risk of suicide and self-destructive behaviour. Borderline personality disorder is multi-factorial in its causes.

Apart from genetic predisposition the primary environmental factors can be attributed to childhood maltreatment (physical, sexual, or neglect). Infact this is a factor found in up to 70% of people with BPD. Other factors include maternal separation, poor maternal attachment, inappropriate family boundaries, parental substance abuse and serious parental psychopathology.

Symptoms of borderline personality disorder often lessen over time with the help of counselling/therapeutic approach along with medication. Tara (name changed), a 28-year-old had lived with her maternal grandparents since she was 3 years old after the death of her mother. She was pampered a lot by her grandparents and they had given her everything that she had asked for. If her demands were not met, she would throw tantrums. After marriage she had interpersonal issues with her husband; she would abuse her in-laws and threaten to harm herself. She suspected that they did not like her, did not want to keep her at home and wanted to harm her. She started having fights with her husband and kept on insisting to be sent back to her grandfather's home and even threatened to harm herself. Generally, it is difficult to manage people (patient) with borderline personality disorder. It can be burdensome even for mental health professionals, because they may have to deal with repeated suicidal threats and self-harm threats of patients. Patients with BPD have difficulty in regulating emotions and may become overly attached to their therapists. Most of the BPD patients improve with the help of parallel treatment involving medication and psychotherapy. Dialectical behaviour therapy is mostly used with such patients and is a form of cognitive behavioural therapy. This form of therapy has been effective in the management of Borderline Personality Disorder as it tries to help patients reduce impulsivity and learn to regulate their emotions.

By

Ms Nivedita Sharma

Clinical Psychologist

MIND India

Ask Dr Sangeeta Goswami

Question: My daughter who is 18 years old has a tendency of self destructive behavior like cutting her hand by a blade whenever she quarrels or gets upset with friends or family members. What do I do?

First of all, we should be worried about her safety. Make sure that all sharp objects are out of her reach and she is not alone in her room or bathroom for a long time. Cutting is the physical expression of hidden mental pain. Mental pain can be the result of built-up stress, past traumatic events, feeling of rejection by peers, abandonment by significant others, or other life stressors. Adolescents may begin cutting or engaging in other forms of self-harm when their mental pain reaches a level that they can no longer deal with. This is also a form of negative coping mechanism. It is important not to label self-harming behavior as "bad" or tell your child that they are doing something "wrong." This kind of reaction will only make the child feel ashamed and create a negative desire to cut more to get rid of thee negative feelings. Tell your child that you understand they are going through some difficult things, and that you want to find a way to help them. It is important that she has someone who she is comfortable talking to. This can be a family member, a friend, or a therapist who can discuss certain positive coping mechanisms to enhance her wellbeing.

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