What is a Borderline Personality Disorder and what are problems with the term?

Borderline Personality Disorder is a psychiatric diagnosis consisting of the following:

  • Strong negative responses to real or perceived abandonment.
  • A history of volatile relationships that cycle between idealization and devaluation.
  • Reckless behavior that can include excessive spending, unsafe sex, and substance abuse.
  • Suicidal ideation and urges to self-harm.
  • Acute feelings of emptiness and boredom.
  • Extreme changes in moods that can last for hours to days.
  • Difficulty controlling feelings of anger.
  • Stress induced paranoia or dissociation.
  • Erratic changes in feelings, opinions, values, and future goals due to an unstable sense of identity.

At PCH Treatment Center we avoid the use of stigmatizing labels. “Borderline Personality Disorder” is probably one of the most stigmatizing labels in the world of psychology and psychiatry. At PCH Treatment Center, we believe interpersonal problems such as “personality disorders” are not actually disorders, but developmental problems related to significant psychological and emotional trauma.

The core symptoms of what is termed “Borderline Personality Disorder” are instability of moods (issues with regulating thoughts and emotions), behavior (recklessness and impulsivity), and relationships (intense relationships that cycle between idealization and devaluation). We believe that the psychological response to trauma often manifests as emotional and relational dysregulation. However, we do not feel that these responses should be considered personality defects or disorders. We also do not believe they are untreatable. Instead, we conceptualize personality issues as maladaptive responses to trauma (which often occurs early on in development).

What are the causes of Borderline States?

Because Borderline was officially recognized in 1980 by the psychiatric community, research on the causes and risk factors for borderline is over two decades behind when compared with other major psychiatric disorders. These preliminary data generally show that genetic and environmental factors both play a role in the development of borderline. Studies on twins have shown evidence that borderline is inherited, and further research aims to examine the links between genes associated with impulsiveness and aggression and borderline. Additionally, social and cultural circumstances are also linked with the development of borderline, such as unstable home environments or trauma.

What is the prognosis for Borderline?

Several therapies have shown promising results for treating Borderline. For instance, cognitive behavioral therapy, or CBT, aims to discover and modify the root of one’s distorted self-image and perceptions of others. Dialectical behavioral therapy, or DBT, is another useful instrument for treating borderline. This approach emphasizes mindfulness, and can help with self-control, emotional regulation, and reduction of harmful behaviors.

While there is no definitive medication regimen for all people with Borderline, medications may be used in combination with psychotherapy to help manage specific symptoms, such as aggression, anxiety, or depression.

The severity of Borderline symptoms may fluctuate, with the central characteristics of changeable moods, impulsivity, and rage being the most persistent. However, this condition is thought to improve over time, and relapse is rare after remission.

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