There is no shortage of misunderstood and misdiagnosed mental health issues. Positively, the conversation about mental health is expanding and the inherent negative stigmas are lifting. Conversely, in this increased conversation many terms, diagnoses, and symptoms are inadvertently distorted by those who are opening the dialogue. One extremely misunderstood mental health diagnosis is borderline personality disorder. With symptoms that mimic a number of other mental health issues, it is often misdiagnosed. It has become almost trendy for young people to create an identity within a perceived or self-diagnosed mental illness. True borderline personality disorder can be difficult to treat and taxing on those affected. With a mental health disorder that can be hard to understand and tricky to diagnose, it begs the question, on the borderline of what?
Understanding the Basics
Borderline personality disorder is marked most commonly by extreme emotional instability, impulsive behaviors, an unstable self-image or sense of self, and viewing all things in extremes. The challenging thing about borderline personality disorder is that its diagnostic criteria, of which there are 9, is full of markers that, in the right combination, could appear to be anything from premenstrual dysmorphic disorder to substance use disorder to bipolar disorder. In order to be diagnosed, a person must hit 5 of the 9 markers which include:
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance use, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
The other issue when it comes to diagnosis is that most adults, women in particular, might experience anything from 2 – 4 of these symptoms. It can be difficult to diagnose and treat any mental health disorder that has such varied and changing symptoms.
What Does Treatment Look Like?
For a long time, borderline personality disorder has been considered difficult to treat. However specific forms for psychotherapy have been shown to be helpful in the management of the emotional instability experienced by those with the disorder.
Dialectical Behavioral Therapy – This type of therapy was developed specifically for the treatment of borderline personality disorder and focuses on teaching the patient to recognize and exercise control over their emotions by:
- Using mindfulness techniques
- Bringing attention to the present and awareness to the body
- Practicing radical acceptance of feelings and situations
Cognitive Behavioral Therapy – This therapy focuses on helping to shift core beliefs and behaviors that perpetuate a negative or unstable perception of self.
- Reducing the range of mood swings
- Building a more positive self-perception
- Reducing self-harm behaviors brought on by emotional stress
Both of these therapies have been found effective in helping individuals with borderline personality disorder but the work to maintain a healthy emotional world is extensive and exhausting. Although in some cases medication is used to help treat depression or anxiety-like symptoms, there is not a routine or commonly used prescription treatment. Rigorous behavioral therapy, sometimes repeated on a regular basis, is the best form of treatment. In some cases, if symptoms have spiraled out of control, intensive inpatient treatment is the best course of action.
One issue with the symptoms of borderline personality disorder is that many people experience two or three of them regularly. Looking for an explanation to compulsive or unstable behaviors, many turn to the internet and self-diagnose based on their search results. Those who truly struggle with borderline personality disorder know that the illness is incredibly difficult to battle day to day. Those diagnosed must work diligently in behavioral therapy, often choosing to continue to stay in it for years. In addition, their loved ones sometimes need to seek professional help to learn how to best navigate life with someone who has borderline personality disorder. It’s important to seek the advice of a professional to diagnose and treat mental health symptoms.
If you feel you may be struggling with the symptoms of a mental health disorder, seek the help of a professional to learn more about what challenges you might be facing. If borderline personality disorder co-occurs with a substance use disorder, this should always be taken into account with a treatment plan. There is hope with determination that the symptoms of borderline personality disorder can be well managed.
Ashley Addiction Treatment is an innovative treatment program located on Maryland’s Chesapeake Bay. Ashley provides support for professionals seeking help with addiction. We are able to help people with co-occurring disorders and offer confidential treatment programs to meet your needs. Please reach out to us today at (800) 799-4673.