psychiatric disorders
Borderline Personality Disorder (BPD)
Symptoms and Signs of Borderline Personality Disorder
When patients with borderline personality disorder feel that they are being abandoned or neglected, they feel intense fear or anger. For example, they may become panicky or furious when someone important to them is a few minutes late or cancels an engagement. They think that this abandonment means that they are bad. They fear abandonment partly because they do not want to be alone. These patients tend to change their view of others abruptly and dramatically. They may idealize a potential caregiver or lover early in the relationship, demand to spend a lot of time together, and share everything. Suddenly, they may feel that the person does not care enough, and they become disillusioned; then they may belittle or become angry with the person. This shift from idealization to devaluation reflects black-and-white thinking (splitting, polarization of good and bad). Patients with borderline personality disorder can empathize with and care for a person but only if they feel that another person will be there for them whenever needed. Patients with this disorder have difficulty controlling their anger and often become inappropriate and intensely angry. They may express their anger with biting sarcasm, bitterness, or angry tirades, often directed at their caregiver or lover for neglect or abandonment. After the outburst, they often feel ashamed and guilty, reinforcing their feeling of being bad. Patients with borderline personality disorder may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, values, opinions, careers, or friends. They may be needy one minute and righteously angry about being mistreated the next. Although they usually see themselves as bad, they sometimes feel that they do not exist at all—eg, when they do not have someone who cares for them. They often feel empty inside. The changes in mood (eg, intense dysphoria, irritability, anxiety) usually last only a few hours and rarely last more than a few days; they may reflect extreme sensitivity to interpersonal stresses. Patients with borderline personality disorder often sabotage themselves when they are about to reach a goal. For example, they may drop out of school just before graduation, or they may ruin a promising relationship. Impulsivity leading to self-harm is common. These patients may gamble, engage in unsafe sex, binge eat, drive recklessly, abuse substances, or overspend. Suicidal Behavior , gestures, and threats and Dissociative episodes, paranoid thoughts, and sometimes psychotic-like symptoms (eg, hallucinations, ideas of reference) may be triggered by extreme stress, usually fear of abandonment, whether real or imagined. These symptoms are temporary and usually not severe enough to be considered a separate disorder. In most patients, dissociative symptoms lessen over time, and the relapse rate is low. However, functional status does not usually improve as much as the symptoms. 1.Pompili M, Girardi P, Ruberto A, et al: Suicide in borderline personality disorder: A meta-analysis.Nord J Psychiatry59(5):319-324, 2005. doi: 10.1080/08039480500320025 