What Is Borderline Personality Disorder?

Borderline personality disorder also referred to as BPD, is a mental health disorder in which a person has extreme difficulties in regulating their emotions and thoughts. People diagnosed with BPD have continuous distorted thinking patterns of their self-image, relationships, and behavior. Along with these negative patterns, people with BPD experience severe mood swings such as heightened anxiety, depression, and irritability. These strong instabilities often lead patients to reckless and impulsive behavior if not treated. Many people with BPD experience behavior that include substance abuse, promiscuous relationships, self-harm, and possibly suicide.
There are approximately four million people in the U.S. that are diagnosed with BPD; an estimated
1.6% of our American population (Salters-Pedneault, 2017). Of those diagnosed, approximately 75% are women however newer findings indicate that more men are being diagnosed with BPD as opposed to post-traumatic stress disorder (Salters-Pedneault, 2017).
BPD is often misdiagnosed because of its overlapping symptoms with similar mental disorders.
People unfamiliar with what they are experiencing or people misdiagnosed, may not know where to find a treatment or may receive the wrong form of treatment. This may be a possible contributing factor as to why the BPD population has such a high rate of suicidality and suicide. Recent statistics show that those with BPD have a suicidality rate as high as 70% and a suicide rate as high as 10% as opposed to those who do not have BPD (Lis, E., Greenfield, B., Henry, M., Guilé, J. M., & Dougherty, G., 2007) (Salters-Pedneault,
2017).

Contributing Factors
When concluding a BPD diagnosis there are multiple contributing factors that are all evaluated. There are specific regions and structures in the brain that coincide with a person’s genetic and environmental.
Traumatic events such as neglect from a parent or loved one, emotional abuse, physical and sexual abuse are all environmental factors contributing to BPD. In addition to a person’s environment, genetics appears to be a large contributor. On most findings, people diagnosed with BPD seem to have a genetic predisposition from a parent or sibling (first-degree relatives) with the same or similar diagnosis. This is not guaranteeing a person will develop the disorder it only means their chances will increase and increase chances of characteristics of the disorder. In newer research, however, scientists have discovered a strong genetic influence of material linked to BPD features on chromosome nine (University of Missouri-Columbia, 2008). This finding will not only help future research development but also help any future treatment plans needed for BPD patients.
Starting with the brain, the limbic system is the specific region where parts of its structure, the amygdala, and the hippocampus, process human emotion and memory.
The amygdala, shaped like an almond, is a set of nervous tissue that is located in the interior of the temporal lobe. The function of the amygdala is to regulate fear and aggression. Patients with BPD are found to have a much smaller amygdala as opposed to someone who does not, thus causing it to be overactive. The more overactive the amygdala is the higher the intensity of the emotion is experienced and the longer period of time it takes the person to calm down.
Alongside the amygdala is the hippocampus. The hippocampus, shaped like a horseshoe, associates memory and attaches an emotion to it. People with BPD may have experienced a traumatic event as a child storing these memories in their hippocampus to later be retrieved as a teen or adult causing reckless or impulsive
behavior.
Another aspect that impacts a person's behavior is their neurons. There are two neurotransmitters that are found in patients with BPD cortisol, and serotonin (Brain Biology, 2013). The first is cortisol which is a chemical released by stress and is meant to supply the body with energy during difficult moments. However, people with BPD release higher levels of cortisol and the opposite effect takes place. Their stress level and cortisol become overwhelming and the body starts to impair the immune activity. Overtime too much released cortisol will start to damage the number of cells in the hippocampus and effect a person’s ability to store new memories. The second neurotransmitter that is vital to a person suffering from BPD is serotonin. Serotonin helps regulate a person’s mood, sleep, memory, and learning. Unfortunately, people with BPD show low activity levels of serotonin in their brain to help stabilize their emotions. This low level will cause depression, anxiety, loss of appetite and suicidal thoughts. It is recommended that a person with BPD should try to increase their serotonin naturally by exercising and eating the correct foods however sometimes a person’s depression or anxiety is too great and a pharmaceutical drug is recommended to stabilize their serotonin.

Behavioral Treatment
There are several behavioral treatments for BPD, all which fall under psychotherapy also known as talk-therapy. There are two forms of psychotherapy that are found to be more effective than others; dialectical behavioral therapy (DBT) and transference-focused therapy.
DBT is a cognitive-behavioral therapy that was created by psychologist Marsha Linehan in the late 1980’s. This technique was based on a biosocial theory and was specifically designed to treat patients with BDP who displayed suicidal behavior. DBT focuses on acceptance-based strategies and problem solving-strategies to change negative thinking patterns and create positive changes in behavior. Despite DBT initially being developed to help only patients with BDP or patients with chronically suicidal behavior, this form of cognitive-behavioral therapy has since been adapted to treat numerous different types of psychological disorders.
DBT is usually performed in an outpatient program and can be provided either in a group or individual settings. Since people with BPD have trouble interacting with other people, group settings tend to help build positive social skills and trust. This treatment is ongoing for BPD patients. Result studies show if a BPD patient is to make dramatic improvements to stay with DBT therapy for at length a year and at minimum six months. Most BPD patients are also taking an antipsychotic or anti-depression drug to coincide with DBT.
The next form of treatment therapy used on patients with BPD is transference-focused therapy (TFP). TFP is a form of psychodynamic therapy that helps identify a person’s mental and emotional state through their unconscious internal images (distorted thoughts). TFP is based on the concept that patients with BPD can live out their internal images in their relationship with their therapist to help better understand their distorted thoughts and adjust them to positive thoughts. These therapy sessions may take place in out-patient setting two sessions per week in an outpatient setting. Treatments duration is a one-year minimum and focuses on the immediate interaction between patient and therapist. Can include periodic contact with the family.