Borderline Personality Disorder ( BPD) is one of the most complex challenges that a clinician has to face. It is a disorder in which fundamental functional areas are affected, such as:
• cognition
• affectivity
• interpersonal activity
• and impulse control
The term ” borderline ” was popularized by Adolph Stern (1938) when he characterized the limit between neurosis and psychosis. It appeared in the DSM in 1980, in its third revision. With this definition, it was constituted as a picture with its entity and not as a limit between two disorders.
Currently, due to the confusion that the term “borderline” generates in the community and among professionals, a review is underway in favor of the use of “emotion regulation disorder” (ERD).
How does it manifest?
The essence of BPD is the persistent instability that appears in all the indicated areas.
This pattern of instability translates into high mood reactivity, extreme impulsiveness, recurrent behaviors of self-mutilation or suicide, ambivalent thoughts and attitudes towards oneself, chaotic and intense interpersonal relationships, and feelings of emptiness and boredom. BPD has a vital prevalence of between 1 and 2% in the general population, between 6 and 10% among patients who attend mental health centers, and 20% among hospitalized psychiatric patients.
BPD comorbidity
This personality disorder presents high comorbidity with other mental disorders, mainly:
• Mood disorders
• Problems Related to Substance Use
• Impulse Control Disorders
• Attention Deficit Disorders,
• Eating disorder
• Post Traumatic Stress Disorder
• And other Anxiety disorders.
This pattern of functioning is highly dysfunctional and causes great discomfort. The chronic emotional instability that characterizes these patients makes them find themselves in a state of almost constant suffering.
Possible causes
According to the literature, it seems that these individuals have not been able to form an integrated set of schemas about themselves, which may be related to failures in early attachment processes.
Persistent instability and impulsiveness may explain why these patients live in constant uncertainty about their own identities. Borderline patients can range from helpless and unable to take charge of their lives, to fully competent. The problem is that both extreme patterns can occur in the same individual, but it is difficult to find an intermediate point. This is one of the essential characteristics to take into account to understand the pathology of BPD and its dichotomy.