Borderline Personality Disorder is a common, treatable condition with a variety of symptoms, most notably non-suicidal self-injury or recurrent threats of, or attempts at, suicide.
Borderline personality disorder is a common, treatable syndrome with a variety of symptoms, most notably self-injury or recurrent threats of, or attempts at, suicide. Borderline personality can be a confusing name (borderline of what?) for a condition which can cause a lot of distress for those who have it and their friends and families. The condition is sometimes misdiagnosed as a mood disorder like depression or bipolar disorder, but has its own course and effective treatments.
Borderline personality usually develops in late adolescence or early adulthood, just when college is starting. Individuals with borderline personality are usually most symptomatic when they are young, sometimes with problems with functioning or even repeated hospitalizations, but studies show the majority of individuals with this disorder get better quickly and can benefit from specific treatments.
While medications can help with certain symptoms of borderline personality disorder, unlike with mood or anxiety disorders, the medications are usually a minor part of the treatment, with the focus on psychotherapy. A number of different psychotherapies are known to help limit suicidal behavior and hospitalizations, with the promise of helping individuals develop the school, work and social life they desire.
Borderline Personality Disorder is a common psychiatric condition which causes significant distress to individuals with the disorder, and often distress to their friends and families. Patients with borderline personality disorder are disproportionately represented in almost all psychiatric and psychological treatment settings including outpatient and inpatient programs.
The symptoms of borderline personality disorder include:
• Inappropriate, intense anger
• Stress-related paranoid thinking or dissociative symptoms
• Chronic feelings of emptiness or boredom
• Recurring suicidal behaviors, threats or self-harming behavior, such as cutting or head-banging
• Impulsivity or dangerous behaviors including substance abuse, driving fast, unsafe sex, or binge eating
• Intense relationships often alternating between periods of idealization (feelings of closeness, safety) and devaluation (hatred, anger, suspiciousness)
• Marked instability in mood, usually over hours to days
• Extreme reactions to feelings of abandonment, either real or imagined
• Marked identity diffusion often manifested by unstable self-image
• As there is significant overlap between the symptoms of borderline personality disorder and bipolar disorder, it is not uncommon for them to be confused
Borderline personality disorder is not as widely known or well understood to the public as other psychiatric disorders such as depression or bipolar disorder. Many individuals with symptoms of the disorder will go years before a clinician shares the diagnosis with them or they themselves conclude that their symptoms suggest a borderline personality disorder diagnosis.
One common scenario is the individual who has been given a diagnosis of a mood or anxiety disorder who doesn’t respond positively to the treatments offered, who continues to be symptomatic with repeated hospitalization or a decline in functioning.
How can someone with borderline personality disorder get the help he or she needs?
• Start with the college or university counseling services. Ask the counselors for guidance, find out what kinds of counseling services are offered and if the clinicians have experience treating borderline personality disorder
• If you can’t access services through your college or university, ask you family doctor for guidance about how to access services in the community
• You can inquire about specialized services through community mental health centers, hospital psychiatry department’s outpatient clinics, family service agencies, or state hospital outpatient clinics
• Seek out peer support groups including “virtual” options on-line
• If you are already seeing a psychiatrist, psychologist, social worker, or counselor, talk about the diagnosis and about the treatment options available, particularly if you’re not responding well the treatments you’ve been offered
• Continue to educate yourself about the disorder – read the books available on the subject or visit the websites with up-to-date information
• Expect symptoms to improve gradually; for the most part borderline personality disorder is treated with “talk” therapy, with medications as an adjunct. Don’t expect a rapid recovery as is sometimes seen with certain medications in other disorder
• Spend time with other people you trust, confide in friends, family or teachers if you feel comfortable doing so
• Set reasonable goals; you may want to focus first on school or work before pursuing romantic relationship, particularly if romance has been destabilizing for you in the past
Having a friend who is experiencing symptoms of borderline personality disorder can be upsetting or confusing. You may not understand the changes in mood, the impulsive, self-destructive acts, or the self-injury or threats of suicide. You may not understand why a friend with borderline personality isn’t getting the help he or she needs right away, or why the medications, if prescribed, don’t seem to relieve the distress.
Here are some suggestions:
• Learn about borderline personality disorder. It can be helpful to realize that the symptoms you see in your friend reflect a disorder with a name and with specific treatments known to be of help. You can get information from websites like www.borderlinepersonalitydisorder.com or organizations like the National Institute of Mental Health at www.nimh.nih.gov.
• Don’t ignore it. You might not want to hurt your friend’s feelings by confronting them, or you might be afraid to bring up certain subjects. But ignoring the fact that your friend is suicidal and may be intentionally hurting themselves doesn’t make the situation better. While cutting or burning may feel good to the person at the time, this feeling is fleeting. Afterward, individuals feel terrible and ashamed. Also, serious injuries occur. When alcohol or drugs are added to the mix, individual are at risk for life-threatening injuries.
• Approach your friend in a compassionate way. People with borderline personality disorder often already feel embarrassed or guilty. When talking to your friend, try to understand their situation and be compassionate. Avoid getting angry, yelling, or blaming them. Don’t tell them what they’re doing is disgusting or wrong. Try not to judge or tell them to stop the behavior. Be open as you listen to your friend. Also, tell your friend you’ll be there for them, but you want them to get the care they need.
• Be there. Individuals with borderline personality disorder can isolate themselves, which only makes matters worse. Call your friend to see how they’re doing, Spend quality time with them, participating in activities you both enjoy. Basically, try to make yourself available – but within reason.
• Set Limits and Maintain Boundaries. It’s important for you to have boundaries, and to remember that you don’t have control over what your friend does. Many times people with borderline personality disorder can evoke a great impulse in others to care for and take responsibility for their well-being. While it is important to be supportive, caring and helpful, it is also important to keep to reasonable limits and maintain your own health and safety. It is important to be mindful of reasonable limits and roles that you can play to be of help. If you are finding yourself frequently acting as a therapist or staying with your friend for long periods of time to keep them safe, you need to consider getting the kinds of support outlined below.
• Encourage them to get help. Seeking treatment is the best thing someone with borderline personality disorder can do. Seeing a counselor can help them build better coping skills, learn to express their emotions in healthy ways, boost their self-esteem, and lead to a happier life overall. You can find out about on-campus resources on your own and give the information to your friend. Or you can tell your friend that you’ll be happy to look for resources together.
• Call the counseling center yourself. If you’re still not sure about the best way to approach your friend or if he or she is unwilling to get help, call the counseling center and ask to speak with a clinician. They can answer any questions your have and give you some suggestions on how to help your friend. A friend with borderline personality disorder may want to involve you in a crisis situation and you may have to set a limit by contacting a resident advisory to involve the counseling center, even if that’s not something your friend agrees to.
• If it’s an emergency, get help. Emergency situations including active drug or alcohol abuse or psychotic thinking which can worsen the condition of an individual with borderline personality disorder. If you’re concerned that a friend is actively suicidal with a plan and the intent to commit suicide, call 911.