During the course of a lifetime as many as 1 in 16 people will experience the Borderline Personality Disorder with the prevalence nearly the same in men as in women. Unfortunately the name misrepresents the underlying abnormality and leads to a fair degree of confusion as to what it actually represents. A more illuminating name, accepted in Europe and throughout the rest of the world, is Emotionally Unstable Personality Disorder.
The condition initially manifests during the late teens to early 20s. Among the major indicators are intense mood swings within minutes to hours. These occur in response to changes in the person’s interactions with others or perceived slights. The resulting anger or dislike undermines relationships at home, work or during social engagements. While these individuals demonstrate marked sensitivity to criticism, they intensely fear abandonment and often inappropriately react to situations with inappropriate rage and uncontrollable anger.
Impulsive behaviors manifest as reckless spending, unrestrained driving, excessive alcohol or substance use and perhaps indiscriminate sexual activities. They often engage in self-injurious behavior principally as “cutting” but sometime as biting or burning. Boredom and emptiness increase the risk of suicide which appears as relatively common among these individuals.
As if the core symptoms of Borderline Personality Disorder were not sufficient, these individuals experience a significant risk of anxiety, depression, substance abuse, PTSD and eating disorders. And to make matters even more dire, the majority will also manifest characteristics of other personality disorders including features suggestive of the antisocial, narcissistic, paranoid, schizoid and obsessive compulsive types.
In many the symptoms persist throughout life but may vary in intensity or may seem to wax and wane in intensity. Not all of the symptoms appear in any given individual. Diagnosis may be quite difficult since none of the symptoms are specific for this disorder and many people, especially men, never engage with a mental health professional. Even worse, the diagnosis may vary significantly between different providers.
Treatment remains problematic. Many individuals fail to view their condition as problematic and fewer still demonstrate the capacity for engaging in long term psychotherapy. Drug treatment appears minimally effective and then only for complications such as depression or anxiety. Long term dialectic behavioral therapy is the current in vogue treatment with relatively few providers available to care for these individuals. Fortunately with appropriate care, long term improvement frequently develops.