Borderline symptoms. Causes, symptoms and treatment of borderline personality disorder

Greetings, dear site visitors psychological help. Today you will find out what borderline personality disorder what symptoms he has, causes and how borderline disorder is treated through dialectical behavioral psychotherapy.

Borderline Personality Disorder (BPD)

BPD is often combined with anxiety disorder and mood disorder, as well as instability in the regulation of all spheres of life.

Symptoms of Borderline Personality Disorder

People with borderline personality disorder experience the following symptoms:

• The prevalence of suicidal and parasuicidal behavior.
• Emotional instability. Episodic depression, anxiety and irritability.
  Problems with expressing anger.
• Behavior regulation disorder. Marked impulsiveness. Destructive behavior towards oneself.
• Problems with cognitive functions: depersonalization, dissociation, sometimes, usually with stress, hallucinations are possible ...
• Violation of the sense of self. Feeling of inner emptiness...
• Difficulties in interpersonal communication: randomness, intensity, various problems. At the same time, BPD sufferers try their best to keep significant others near them.

Treatment for borderline personality disorder

Moreover, a “weak” psychotherapist, after treating a person suffering from BPD, may need a psychotherapist himself. And psychiatrists, often just hospitalize people with borderline disorder in a clinic for the mentally ill.

In fact, there is a well-established treatment for BPD - this is dialectical behavioral psychotherapy.
Through a psychotherapeutic conversation based on dialectical techniques, and with the help of behavior regulation techniques and learning new skills, a person suffering from borderline personality disorder gradually gets rid of this serious psychological problem.

Diagnosis of borderline disorder

According to the ICD-10 (International Classification of Diseases), borderline personality disorder belongs to the category of pathologies of a mental nature. The difficulty of diagnosing this disease is due to the similarity clinical symptoms with diseases such as psychosis and neurosis. It is important to note that the development of pathology is the cause of the appearance of suicidal tendencies, which greatly complicates therapy. In this article, we propose to consider various borderline mental disorders and their characteristic differences.

Borderline mental disorders are on the very edge between the state of health and the state of illness.

Borderline mental disorder is a complex disease that causes problems associated with a violation of the perception of the world around. This disease is characterized by changes in the behavioral model of the patient. Increased anxiety, lack of trust in others, impulsive behavior, frequent mood swings are just some of the main symptoms of this disease. According to experts, this personality disorder has a stable character and is almost not amenable to psychotherapeutic influence.

The first signs of pathology appear at school age, before entering puberty.

According to medical statistics, the percentage of prevalence of this disease is three points. Most often, signs of the disease are observed in representatives of the beautiful half of humanity. The difficulty of timely detection of pathology is explained by the fact that at the first stage, numerous manifestations of the disease are mild.

Personality disorder develops on the foundation of a borderline mental state . In psychiatry, PSP is considered as a state between the norm and a mental disorder.. Thus, this pathology is a deviation of the scales towards a serious illness. Certain signs may indicate that an individual is in a borderline state. These signs include a tendency to depression, and increased anxiety, which leads to a change in behavior. Against the background of problems associated with a violation of the perception of the surrounding reality, the patient seeks solitude and isolation from society.

At a certain stage, there are problems with an objective assessment self. Some patients demonstrate inadequately high self-esteem, which is expressed by a firm belief in their uniqueness and infallibility. In other patients, there is a tendency to self-criticism and self-abasement, which only increases the severity of the depressive syndrome. Against the background of mental disorders, there are difficulties in relationships with other people. borderline personalities tend to idealize others, after which, dramatically change their attitude in the opposite direction. In the behavioral model, impulsivity begins to predominate, which manifests itself in the form of bright emotional outbursts.

According to experts, many patients often harm their health for no good reason. The borderline state can be described as a tendency to frequent shift sexual partners, extreme sports and bulimia. The development of pathology is accompanied by increased anxiety and seizures. panic attacks. During a panic attack, the following somatic symptoms are observed:

• lack of air;
• accelerated heart rate;
• tremor of the limbs;
• bouts of dizziness and fainting;
• rapid increase in blood pressure.

It should be noted that panic attacks are not included in the list of psychopathic manifestations. However, this symptom heightened attention. The frequency of episodes and the severity of their manifestation are a strong argument for seeking specialist advice.

Reasons for development

To date, there are no scientifically substantiated facts regarding the causes of the development of borderline personality disorders. According to experts, there are many different theories that are supported by circumstantial evidence. These theories include the idea that the cause of the pathology is associated with a violation of the concentration of certain chemical components localized in the brain. Also, according to scientists, an important role in this issue is assigned to hereditary factors. According to statistics, in more than seventy percent of cases, the symptoms of the disease are observed in women.

Borderline personality disorder is a disease that is closely related to a person's character. According to experts, the conditional risk group includes people who are pessimistic about the surrounding reality, suffer from low self-esteem and increased anxiety. According to the psychologist, the cause of the development of the disease can be traumatic events experienced in childhood. Emotional, physical or sexual abuse, the death of close relatives and other shocking events can be one of the causes of pathology. However, there is a considerable risk of developing the disease in children from wealthy families.

Increased demands on the child or a ban on the expression of emotions and feelings can lead to a borderline state.

Clinical picture

The borderline state of the psyche is most often diagnosed in childhood. Symptoms emotional instability are expressed as hypersensitivity and impulsive behavior, a tendency to tearfulness, and difficulty making important decisions. The first signs of pathology appear when puberty is reached. The presence of inferiority complexes and vulnerability lead to difficulties in immersion in society. Many patients experience violent and aggressive behavior which hinders communication.

There are many clinical signs of the development of pathology. However, in order to accurately diagnose the disorder, a detailed analysis of human behavior is required. It is possible to speak about the presence of a borderline disorder only when the patient has at least four specific features diseases:

• tendency to self-flagellation and self-abasement;
• the desire for isolation and inferiority complexes;
• difficulties in building communication links;
• changeable pattern of behavior and signs of impulsivity;
• difficulty accepting one's own identity and lack of self-esteem;
• sudden mood swings and fear of loneliness;
• causeless aggression and bouts of anger;
• increased sensitivity to irritants and suicidal tendencies;
• disturbance in the perception of the surrounding reality.

Borderline personality disorder, the symptoms of which are listed above, develops gradually. All of the above clinical manifestations are an integral part of the behavior of a sick person. Due to problems associated with impaired perception, a slight influence of external stimuli can lead to depression. In such a state, a person should not be left alone with his difficulties. In order to prevent the appearance of thoughts of suicide, the patient should be given as much attention and care as possible.

It is important to note that due to low self-esteem, most patients perceive themselves negative personalities, which is the reason for the fear of being rejected by society. Suspicion, combined with incredulity, hinders the building of communicative ties and friendships. All of the above factors affect the manifestation of true feelings and emotions. The phrase: “I feel hatred for myself and others, but I need your support and attention” most accurately describes the internal state of a person with this pathology.

Differential Diagnosis

The borderline state of the psyche has many similarities with psychosis and neurotic disorder. That is why the basis of diagnostic measures is a differential examination. Borderline disorder is characterized by disturbances in the area of ​​emotional perception. The difference between this disease and neurosis lies in the fact that with the latter, the process of information processing is not affected by pathology.

Neurotic disorder is a completely reversible process that has a certain degree of influence on the personality structure of the individual. Many patients are aware of the presence of internal problems, which allows them to timely apply for medical care. In the borderline state of the psyche, the individual does not perceive the features of his behavior as something abnormal. Most of the actions and reactions of the patient are perceived as the norm, which greatly complicates the treatment process.

Neurotic disorders are the result of a malfunction nervous system, which is provided strong impact stress factors, emotional experiences and prolonged stress. Neurosis is expressed in the form obsessive states, panic attacks and hysteria.

Psychosis - mental pathology, which appears as inappropriate behavior caused by problems associated with the perception of the surrounding reality. This disease is characterized by a non-standard reaction to the action of external annoying factors. The disease is accompanied by the appearance of delusional ideas, bouts of hallucinations, fixation and strange behavior.

According to experts, the link between psychosis and borderline mental disorder is quite deep. The development of each of the above diseases is accompanied by mental disorders which negatively affect the level of socialization. Also, the causes of the appearance of these diseases are associated with the influence of psychotraumatic factors and bad heredity. According to experts, the lack of timely measures taken, in the event of psychosis, can lead to the transformation of this disease into a borderline disorder.

Psychosis and BPD are classified as diseases that cannot be cured. All applicable therapeutic measures allow only to stop the symptoms of pathology, which increases the duration of remission.

Therapy Methods

The treatment of borderline personality disorder is quite specific because there are no specific pharmacological agents able to eliminate the pathology. The main task of complex treatment is to eliminate the symptoms of the disease that complicate the usual life activity. In most cases, the pathology under consideration is accompanied by depressive syndrome Therefore, the course of therapy begins with taking antidepressants. Drugs from this category help to restore psycho-emotional balance and improve the patient's condition. From this category medications, it is necessary to highlight the medicines included in the SSRI group, since their action is the safest for the body.

In combination with antidepressants, anti-anxiety medications from the group of anxiolytics, mood stabilizers and antipsychotics. Part complex therapy includes a psychotherapeutic effect, which is aimed at working out internal conflicts. Working with internal problems helps to achieve emotional balance and stable remission. It is important to note that the main component similar treatment is the level of patient confidence in the doctor. Only if there is trust, the patient will be able to speak out about the feelings and experiences experienced.

The main task of the psychotherapist is to help the patient in finding his own "I", modeling situations that caused the development of pathology and finding a way out of them. Each case of borderline disorder is considered on an individual basis, where the treatment strategy is selected based on detailed analysis the patient's behavior.

The lack of timely measures taken can cause the patient to become dependent on the use of drugs and alcoholic beverages. In addition, the development of the disease can lead to obesity, diseases digestive organs, striving for loneliness and social isolation. One of the most catastrophic complications of the disease in question is the appearance of suicidal thoughts and suicide attempts.

- a mental disorder characterized by impulsivity, emotional instability, high anxiety, periods of anger, difficulties in building long-term relationships with other people, alternating idealization and devaluation. Borderline personality disorder is persistent and occurs in early age and manifest throughout life. Predisposing factors are the features of the psychological constitution, violence, abandonment or lack of care in childhood. The diagnosis is established on the basis of a conversation with the patient, an anamnesis of life and the result of special surveys. Treatment - psychotherapy, drug therapy.

Causes of Borderline Personality Disorder

Borderline disorder is a disorder that results from a variety of factors. There is a hereditary predisposition. There is a relationship with gender - women suffer from borderline personality disorder more often than men. Character traits matter, patients have low self-esteem, increased anxiety, a tendency to pessimistic forecasts and low resistance to stress. Many patients have experienced sexual, physical or emotional abuse as children, early years experienced a bereavement or separation from a parent.

The emergence of borderline personality disorder is facilitated by a lack of parental attention, a lack of sufficient emotional contacts with significant adults, a ban on the expression of feelings, conflicting or excessive demands on the child. American psychologist Marsha Linen, who studied the problem of borderline personality disorders and developed a method for treating this pathology, believes that the disease may be associated with the “emotional inferiority” of loved ones who surrounded the patient in childhood. In all cases, in response to unfavorable living conditions, stable maladaptive patterns of behavior are formed, which subsequently affect relationships with others and the assessment of one's own actions.

In borderline personality disorder, increased activity limbic system of the brain, however, it has not yet been established whether this is a primary disorder or occurs secondary, as a result of constant emotional deprivation and high level emotional discomfort. Endogenous (changes in the level of neurotransmitters) and exogenous (developed since childhood patterns of behavior) factors cause difficulties in modulating emotions. Patients with borderline personality disorder find it difficult to convey information about their own emotional state in an acceptable form, providing for the possibility of a reasonable dialogue. They react quickly, strongly and impulsively, which often leads to conflicts and exacerbates maladaptation.

Symptoms of Borderline Personality Disorder

The first signs of the disorder can be seen in early childhood. Children are emotionally unstable, restless, often demonstrate emotional reactions that do not correspond in strength to the pathogen that caused them. There is impulsive behavior. However, these symptoms are not enough to make a diagnosis, because as living conditions change and as the child grows older, the child's behavior may change. Usually, clinical picture borderline personality disorder develops around age 25.

A kind of identity disorder is revealed. The image of one's own "I" is unstable and can change greatly depending on mood or external circumstances. Patients are constantly afraid of being abandoned (sometimes this fear corresponds to the real situation, sometimes not). To stabilize the image of their own "I" and eliminate fear, patients with borderline personality disorder try to find "complement and reflection of themselves" ideal relationships that reproduce the child-parent fusion.

In the relationship of two adults, such a merger is impossible. Periods of idealization of a partner, arising from unjustified expectations, alternate with periods of depreciation, provoked by severe disappointment. The relationship of a patient suffering from borderline personality disorder becomes tense, unstable, based on unrealistic demands in relation to a partner. The situation is exacerbated by the impulsiveness of the patient and sudden mood swings with a tendency to severe anxiety or dysphoria. Impulsive behavior in borderline personality disorder can include not only intemperance in relationships, but also overeating, unwise spontaneous spending of money, casual sex, and substance use. Threats and suicide attempts are possible.

The patient constantly feels empty. It is difficult for him to control his own emotions in communication with other people. Violent sudden quarrels, bright outbursts of anger or constant anger, frequent fights, irritability, etc. are possible. In stressful situations, patients suffering from borderline personality disorder develop paranoid ideas, which, unlike similar ideas in paranoia, are character. There may be manifestations of dissociation. The whole complex of symptoms listed above becomes an obstacle, both for building personal relationships and for a normal life in society.

Psychotherapist Young identified a group of maladaptive schemas that emerge in the early years and are associated with the emotional rejection of a significant adult. Patients with borderline personality disorder constantly experience fear of loss or rejection, which is expressed in the belief: "I will not find a loved one and will always be alone." They put themselves in a subordinate position, believing that the desires of others are more significant than their own. Patients do not believe in their ability to solve problems on their own and feel dependent on other people. They are convinced that they do not have the necessary volitional qualities, they cannot control their own lives and control their own behavior.

Patients with borderline personality disorder consider themselves bad people. They think that those around them will turn their backs on them if they find out what they really are, and believe that they deserve punishment. Patients suffer from incredulity and suspicion, they do not feel trust and security in relationships, they are afraid that they will be used for their own purposes. The belief “my feelings and desires are insignificant to others” is accompanied by a fear of showing emotions.

People with borderline personality disorder constantly make unrealistic demands on themselves, believing that they must constantly control their own feelings. This entails the suppression of experiences. Patients withdraw from their grief, resentment, loss and disappointment. Experiences fall into the zone of the unconscious, and feelings get out of control at the most inopportune moment, for example, with a slight change in plans or failure to fulfill a small request.

With borderline personality disorder, quite long periods of stability can be observed. During crises, patients turn to psychologists and psychotherapists in the hope of solving their problems, but after the condition improves, they often quit therapy, because the fear of confronting their own actual feelings and negative old experiences becomes stronger than the fear of not coping with their lives in this period of time. As a result, by middle age, patients with borderline personality disorder often have a complicated history of contact with specialists and form the belief "psychologists are useless, they cannot help me."

Borderline personality disorder often co-occurs with other psychiatric disorders, including panic disorder, generalized anxiety disorder, depression, obsessive-compulsive disorder, manic-depressive psychosis, paranoid, dependent, narcissistic, avoidant, and schizotypal personality disorders. Often there is alcoholism and drug addiction. Repeated suicide attempts and a tendency to self-harm are possible.

Diagnosis and treatment of borderline personality disorder

Diagnosing the disorder presents a challenge for professionals in the field of psychology and psychiatry. This is due to the instability and variety of symptoms, as well as the frequent combination with other mental disorders. The diagnosis of "borderline personality disorder" is made on the basis of psychological testing, conversations with the patient and certain signs that appear in the patient's complaints, his interpersonal relationships and the process of therapy. Characteristic features when presenting complaints are a variety of problems, a feeling of emptiness, confusion in feelings, goals and sexual orientation, a tendency to self-destructive behavior and behavior that the patient himself subsequently considers as unproductive and inadequate.

In interpersonal relationships, there is a deficit of stable intimacy, confusion between intimacy and sexuality, and sharp fluctuations from idealization to devaluation. In the process of therapy, there are expectations of a special approach, frequent phone calls, excessive emotional reactions to breaks and meeting time changes. Many people with borderline personality disorder have difficulty with eye contact, touch, and reduced physical distance. Significant resistance to change.

Treatment of borderline personality disorder involves discussing and rethinking existing problems, developing skills to control one's own emotions and behavior, improving social skills, developing defense mechanisms helping to cope with anxiety and stress. Most effective methodology treatment for borderline personality disorder is dialectical behavioral therapy. The treatment plan is drawn up taking into account the characteristics of the character, personality and level of compensation of a particular patient and includes individual therapy and group sessions.

According to indications, tranquilizers, antipsychotics and antidepressants are prescribed. The prognosis for borderline personality disorder is determined by the age of the patient, the level of social, professional and personal compensation, family relationships and the patient's readiness for long-term regular therapy. When treated at a young age, with an active attitude and internal psychological readiness to endure stresses caused by the awareness and living of feelings of disappointment, loss, rejection and loneliness, stable compensation is possible. In other cases, patients with borderline personality disorder often "roam" from one psychotherapist to another, without making significant progress.

A PHOTO Getty Images

For many of us, borderline personality disorder is a diagnosis vaguely familiar from the wonderful film Girl, Interrupted, starring Winona Ryder and Angelina Jolie 1 . Unfortunately, this diagnosis is increasingly common not at all in the cinema, but in life. According to researchers, borderline personality disorder (aka borderline personality disorder - BPD) affects 2-3% of the world's inhabitants 2 . At the same time, many psychologists and psychiatrists note that PCR is not given enough attention. For example, in the International Classification of Diseases ICD-10, used Russian doctors, there is no clear definition of borderline personality disorder, it is considered as a type of emotionally unstable disorder. In the American Manual of Diagnostics and Statistics mental disorders The DSM-5 definition of borderline personality disorder is present, however, and American experts believe that borderline personality disorder is deprived of attention. They believe that PHD exists "in the shadow" of a somewhat similar bipolar personality disorder. In the latter case, research is funded much more generously, and progress in this area is already evident. Bipolar disorder was included in the list of disorders whose negative impact on society is being studied as part of the international program Global Burden of Disease (“Global Burden of Disease”), and borderline personality disorder is not on this list. Meanwhile, in terms of severity and ability to provoke suicide, borderline personality disorder is not inferior to bipolar 3 .

The diagnosis of PCR also faces serious difficulties; a single and generally accepted description does not yet exist. However, there are at least 6 signs, the severity and frequency of which suggests that a person suffers from borderline personality disorder.

1. Instability of personal relationships

Those who suffer from PCR can be called "flayed people." They are incredibly sensitive to the slightest emotional impact. A word or a look that most of us would simply ignore becomes the cause of serious trauma and painful experiences for them. According to psychologist Marsha Linehan, the author of his own method of treating PHR - dialectical behavioral therapy, "they exist with constant pain, which others underestimate and try to explain with the wrong reasons. It is easy to understand that maintaining the stability of relations in such a situation is almost impossible. And people with borderline disorder's perception of even their loved ones can change from "I love you" to "I hate you" in just a few seconds.

2. Black and white thinking

Eternal throwing between love and hate is a particular manifestation of a more general problem. People who suffer from borderline disorder generally hardly distinguish halftones. And everything in the world for them looks either very good or terribly bad. They extend the same attitude to themselves. They either perceive themselves as the most beautiful people in the world, or as the most insignificant creatures who are unworthy of living. This is one of the sad reasons why up to 80% of patients with this diagnosis sometimes think about suicide 4 . And 5–9% eventually, alas, realize this intention.

3. Fear of being abandoned

Because of this fear, borderliners often come across as unabashedly manipulative, tyrannical, or simply selfish. However, everything is much more complicated. They cling to the relationship again and again, strive to spend all their time in the company of those they love, and may even physically try to prevent them from leaving just for the store or for work, for the reason that parting is unbearable for them. Fear of parting (real or self-imagined) with loved ones can provoke attacks of panic, depression or anger in those suffering from PCR - typical symptoms listed in the certificate of the National Institute mental health USA 5 .

4. Impulsive, self-destructive behavior

We all do stupid things from time to time. But it's one thing - a spontaneous purchase of an unnecessary thing or a sudden refusal to go to a party where they are waiting for us, and quite another - habits that clearly threaten our health and life. Among these habits of people with borderline personality disorder are addiction to alcohol and drugs, deliberately risky driving, unprotected sex, bulimia, and many other not-so-pleasant things. It is curious that the Russian researcher Tatiana Lasovskaya refers to such self-destructive behavior and the tendency to tattooing. She estimates that PCR can occur in almost 80% of people who get tattoos. At the same time, those suffering from the disorder most often remain dissatisfied with the result and in 60% of cases return to apply a new drawing. And in the tattoos themselves, the theme of death often prevails in them 6 .

5. Distorted self-perception

Another typical feature of PCR patients is a distorted perception of themselves. Their strange and unpredictable behavior is often determined by how good or bad they think they look in this moment. Of course, the assessment can be infinitely far from reality - and change suddenly and also for no apparent reason. This is how actress Lauren Oceane, who has suffered from PPD since she was 14, describes it: “At times I feel caring and gentle. And sometimes I get wild and reckless. And it also happens that I seem to lose all personality and cease to exist. I sit and can think about everything in the world, but at the same time I don’t feel anything at all” 7 .

6. Inability to control emotions and actions

After all of the above, it is hardly surprising that people with borderline personality disorder find it very difficult (and often impossible) to control their thoughts, their emotions, and the way they express them. The result is unprovoked aggression and outbursts of anger, although symptoms such as depression and paranoia are also possible. obsessions. Lauren Ocean remarks: “One of the most annoying things about LRP is how it affects my behavior towards other people. I can exalt a person to the skies. But I can not put him in a penny - and the same person!

People with borderline personality disorder suffer no less from their illness than those who have to endure their endless mood swings, outbursts of anger and other severe manifestations of the disease. And although it is not easy for them to decide on treatment, it is absolutely necessary. the best way the fight against PHR today is considered psychotherapy. There is no cure for this disease, and medication is recommended only for those patients whose borderline disorder is complicated by comorbid problems, such as chronic depression.

1 Girl, Interrupted, directed by James Mangold, Columbia Pictures, 1999.

2 M. Swartz et al. "Estimating the prevalence of borderline personality disorder in the community". Journal of Personality Disorders, 1990, vol. 4.

3 M. Zimmerman et al. "Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: a comparative study". The British Journal of Psychiatry, October 2015.

4 M. Goodman et al. "Suicidal risk and management in borderline personality disorder". Current Psychiatry Reports, February 2012.

5 www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

6 T. Yu. Lasovskaya, S. V. Yaichnikov, V. E. Sakhno, N. G. Lyabakh “Borderline Personality Disorder and Tattooing”. Network scientific publication "Medicine and Education in Siberia", 2013, No. 3.

7 Her short story "What It's Like To Live With Borderline Personality Disorder" is published on elitedaily.com.