How does BPD manifest?
The key feature is instability in several areas at once: emotions, relationships, self-image and behavior. The mood changes not in weeks, as with bipolar disorder, but in hours: a minor reason can cause a storm. Relationships go in a circle of “closeness - fear of rejection - conflict - distance.” In moments of intense tension, short episodes of suspicion or a feeling of unreality of what is happening occur. Many people are familiar with the feeling of inner emptiness that is difficult to fill with anything.
- Sudden changes in emotions throughout the day
- Desperate attempts to avoid separation
- Idealization and sudden devaluation of loved ones
- Unstable idea of yourself and your goals
- Impulsivity: spending, eating, driving, substances
- Self-harm and suicidal thoughts
- Chronic feeling of emptiness and outbursts of anger
Why is it developing?
The current model explains the disorder as a combination of innate emotional sensitivity and an environment in which feelings were invalidated or dangerous. A child with strong reactions does not receive help in understanding and regulating them, hears “don’t make things up”, “don’t cry” - and does not develop calming skills. Additional contributions include violence, neglect, loss of a loved one, and family instability. Heredity influences temperament, but does not predetermine the disorder: without a traumatic environment, it develops less frequently.
- Congenital high emotional sensitivity
- Devaluation of feelings in the family
- Physical, emotional or sexual abuse
- Neglect and early loss of a loved one
- Family history of mood disorders
Diagnostics and what they confuse with
The diagnosis is made only by a psychiatrist and not at the first meeting: you need to make sure that the signs are stable and appear in different situations, and are not a reaction to a crisis or a consequence of substance use. Structured interviews and questionnaires are used. The risk of self-harm is assessed separately. BPD is often confused with bipolar disorder: in bipolar disorder, moods persist for days and weeks, while in BPD, moods change over hours and are usually related to events in the relationship. Often there is depression, anxiety disorders, and addiction at the same time.
- Clinical conversation in several meetings
- Structured diagnostic interviews
- Suicide risk assessment
- Eliminating the influence of alcohol and drugs
- Differentiating between bipolar disorder and the effects of trauma
- Screening for depression and anxiety
Treatment: What Really Works
The basis is long-term structured psychotherapy. Dialectical behavior therapy is the most studied: it teaches specific skills - tolerating strong emotions, not acting impulsively, clearly expressing needs, maintaining relationships. Other specialized approaches are also used. The course usually takes from several months to a year or more. Medicines do not cure the disorder, but a psychiatrist can prescribe them for specific manifestations - severe anxiety, depression, sleep disorders. Self-selection of drugs and alcohol worsen the course.
- Dialectical behavior therapy and emotion regulation skills
- Individual and group work
- Crisis Action Plan
- Stable sleep pattern and avoidance of alcohol
- Medicines according to symptoms, as prescribed by a psychiatrist
- Psychoeducation for family and loved ones
What to do for loved ones
It is important for loved ones to understand: sharp reactions are not a way to manipulate, but a consequence of the fact that a person cannot cope with the intensity of feelings. A calm tone, recognition of feelings without judgment, and at the same time clear, pre-agreed boundaries help. You should not agree to everything out of fear of conflict or, conversely, cut off communication at the moment of aggravation. If you hear words about an unwillingness to live, this is always a reason to take it seriously and seek help, and not to check whether you are “serious”.
- Acknowledge feelings without judging them
- Negotiate boundaries in quiet times
- Don't ignore conversations about suicide
- Avoid ultimatums and abrupt breaks in communication
- Take care of your own resources
- In case of crisis, call 103 for emergency help