Borderline/BPD

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Borderline is a personality disorder. Borderline is also called BPD (Borderline Personality Disorder). In the Netherlands, an estimated 100,000 people suffer from this mental disorder. This is less than 1% of the total population. There are probably many more borderlines, but they do not receive treatment for borderline, but for depression and anxiety. Borderline can be cured, but in most cases certain symptoms remain present to a mild extent.

What is Borderline/BPD?

Borderline is a personality disorder and therefore a recognized mental illness. People with borderline are often unpredictable. They suffer from strong mood swings and often change their minds constantly. Their self-image can be completely different from one moment to the next, which in turn affects their mood. Borderlines are very impulsive and can react very extremely to situations. They often only think in black and white and there is no middle ground. Due to the constant changes in mood, thoughts and behavior, they have difficulty maintaining relationships, which are also constantly changing. Borderlines cannot hold on to an opinion, idea, or feeling about themselves, others, or certain situations.

It is estimated that approximately 100,000 people in the Netherlands live with borderline. These are only the people who have been diagnosed with borderline. Borderline has many side effects, such as anxiety and depression. Many people are treated for these side effects and are never diagnosed with borderline. The condition is therefore not recognized in these people. Borderline is common in people who have been admitted to an institution for psychological problems and addictions. Among the admitted patients with an addiction, approximately 22% were diagnosed as borderline. In psychiatric patients this is approximately 45%. The figures on this vary widely. This is mainly due to the different methods that institutions adopt.

With proper treatment, borderline O can disappear, but this does not apply to all cases. Of all patients who were (were) admitted, 40% of them could be determined after 3 years that they officially no longer had borderline. However, in some cases symptoms remain present, or to a much lesser extent. The risk of suicide, which is common among borderlines, also decreases. Relationships and moods become more stable, especially as the borderline gets older. People who always have borderline are better able to keep the condition under control even in old age.

Symptoms of borderline

Borderline has many different symptoms. As a result, all borderlines are different from each other and cannot be placed in ‘a box’. People who suffer from borderline have at least 5 of the symptoms mentioned below.

  • Strongly varying moods and reactions to certain situations. Changing behavior.
  • Fear of being left alone. Clinging desperately to a relationship to avoid being abandoned. Also frenetic behavior in this regard when they only think about the fact that someone might leave.
  • Injuring one’s own body, threatening suicide or self-harm, attempting suicide.
  • Extremely impulsive behavior.
  • Abuse of drugs or alcohol, binge eating, frequent sexual contacts, waste of money, reckless driving.
  • A strongly changing feeling and idea about oneself. Strongly varying self-image.
  • Relationships are experienced very intensely, but are also very unstable. A relationship can go from great to bad in the space of a few minutes.
  • Just black and white thoughts. Something is either very good or very bad and there is nothing in between. Things can go from very good to very bad, or vice versa, in just a few minutes.
  • A persistent and continuously present feeling of emptiness.
  • Attacks of depression, anxiety, irritability and sadness. These attacks last at least a few hours and at most a few days.
  • Angers or tantrums. A constant feeling of anger. No control over anger and often getting involved in fights.

 

Cause of borderline

It has never been scientifically established that borderline must have a cause. It has been established that certain people have an increased risk of developing borderline. Additional risks are related to personal vulnerability, gender, age, environment and personal experiences. Below it becomes clear how these factors can increase the risk of borderline.

Personal vulnerability:

  • (Slightly) abnormal hormones or processes in the brain
  • Heredity
  • Emotional vulnerability or hypersensitivity
  • Combination of negative feelings and disinhibition, possibly as a result of a traumatic experience in childhood

Gender and age:

  • People over 50 have a smaller chance of developing borderline.
  • Borderline is more difficult to diagnose in young people up to the age of 20, because all young people are sometimes emotionally unstable and express this in their own way. These expressions may also resemble the expressions of someone with borderline.
  • It is equally common in men and women. Men develop alcohol or drug abuse more quickly, while women develop it more in the form of binge eating.
  • Women generally seek help more quickly than men. They are therefore admitted to an institution more quickly than men. Aggressive behavior and changing sexual contacts are also more easily seen as a nuisance in women than in men.

Area:

  • People who live alone.
  • Changing influences from the outside world, such as family, friends, acquaintances, neighbors or colleagues.
  • Education, living situation or work situation have little or no influence.

Personal experiences:

  • Emotional abuse
  • Physical abuse
  • Sexual abuse
  • Neglect

 

Determining borderline

It is not easy to determine for sure that someone has borderline. This requires multiple sources of information. The person in question completes a number of questionnaires. By means of these questionnaires, the person in question assesses his own situation, his own life and everything that goes with it. An interview is conducted with the person in question. This interview contains predetermined topics that (must) be discussed. Model interviews are usually used for these conversations. Furthermore, all information is collected about any admissions or other treatments for psychological disorders. Previous mental health conditions are discussed and assessed. The people who are often in the presence of the person in question are also an important source of information. Permission must be given to ask these people questions.

Treatment methods

Because there are many types of borderline, there are also many treatment methods. The different treatments can be divided into three groups. Treatment with medication, psychological treatment and shock therapy.

Treatment with medication:

  • Antidepressants
  • Antipsychotics
  • Lithium
  • Carbamazepine
  • Sodium valproate

Psychological treatments:

  • Cognitive behavioral therapy
  • Psychoanalytic treatment
  • Dialectical behavior therapy

Shock therapy:
Electroconvulsive therapy, also called electroshock or ECT, seems to be particularly helpful against extremely depressive moods. This therapy may only be carried out in specialized institutions . It is not known whether this therapy also works in the longer term. Most borderlines receive other treatments first and only as a last option, when other treatments really do not work, is electroconvulsive therapy used.

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