Borderline Personality Disorder (BPD): Emotional Dysregulation

This condition is also called emotional dysregulation disorder. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts among the patients with this disorder.  Borderline Personality Disorder is one of the most difficult and controversial personality disorders in all of psychiatry.

Incidence

Although definitive data are lacking, it is estimated that 1 to 2 percent of American adults have borderline personality disorder. Women are much more likely to suffer from this disorder and about one in every 33 has it. On the other hand, only one in a hundred men develops this disorder. In most cases BDP won’t be diagnosed until adulthood because the angst of puberty can mimic most of its’ symptoms.

Basics of BPD condition

This disorder was originally thought to be at the borderline between psychosis and neurosis. Even though BPD is more common than schizophrenia or bipolar disorder, its mechanisams are not yet studied that well. Here are some known facts:

• The suicide rate is approximately 8-10%.
• Patients often need extensive mental health services, and they account for 20 percent of psychiatric hospitalizations.
• They often receive poor service, in part due to lack of sympathy with or understanding of self-harm

Taking emotional dysregulation as the core feature of BPD, most experts propose that the disorder arises from impaired modulation of subcortical inputs to consciousness. They hypothesize that the amygdaloid complex and its connections with thalamus, cingulate cortex and insular cortex are critical in the development and maintenance of the disorder. 

Signs and symptoms of Borderline Personality Disorder

Impaired sense of self-being
Borderline personality disorder affects almost every aspect of human behavior. People with this disorder often have an unstable sense of who they are. They typically view themselves as evil or bad, and sometimes they may feel as if they don't exist at all.

Emotional Dysregulation
People with this disorder often have highly unstable patterns of social relationships. This means that they can develop intense but stormy attachments, but their attitudes towards family, friends, and loved ones may suddenly shift from idealization to devaluation.
Relationships are usually in turmoil. This is because people with the disorder have difficulty accepting gray areas - they usually see things as either black or white.

Impulsive behavior
Patients with this disorder often engage in impulsive and risky behavior and this usually leads to self-hurting, either emotionally, financially or physically.

Suicidal thoughts
People with Borderline Personality Disorder often engage in suicidal behavior or deliberately injure themselves for some kind of emotional relief.

Other signs and symptoms of borderline personality disorder may include:

• Strong emotions that wax and wane frequently
• Intense but short episodes of anxiety or depression
• Inappropriate anger, sometimes escalating into physical confrontations
• Difficulty controlling emotions or impulses
• Fear of being alone

Possible causes of Borderline Personality Disorder

The causes of Borderline Personality Disorder are still not well understood, and, as in most mental disorders, it is likely that a number of factors are involved in its development. Some experts claim that early childhood traumatic experiences may cause the hippocampus, a part of the limbic area of the brain which is involved in learning and memory, to atrophy. 

Since the cause of BPD is still under investigation, there's no known way to prevent it.

Other possible causes include:

Genetics
Some studies of twins and families suggest that personality disorders may be inherited and that genetics could play a major role.

Environmental factors
Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.

Brain abnormalities

Research has shown that there are some changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression in patients with BPD. 

Risk factors for developing BPD

There are some factors related to personality development which can increase the risk of developing borderline personality disorder.

They include:

• Hereditary predisposition.
• Childhood abuse.
• Neglect.

What exactly is Emotional Dysregulation?

Emotional Dysregulation is one of the common symptoms of Borderline Personality Disorder. It is a term used in the mental health community to describe an individual that does not respond to a person, place, thing, or event in a manner that would generally be considered within the normal range of emotions. It could also be a part of Complex Post Traumatic Stress Disorder.

Diagnostic criteria

Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. Differentiate diagnosis between BPD and other personality disorders can be extremely difficult. It considers symptoms that fall under four main groups:

Affect

• chronic/major depression
• helplessness
• hopelessness
• worthlessness
• guilt
• anger 
• anxiety
• loneliness
• boredom
• emptiness

Cognition

• odd thinking
• unusual perceptions
• non-delusional paranoia
• quasipsychosis

Impulse action patterns

• substance abuse/dependence
• sexual deviance
• manipulative suicide gestures
• other impulsive behaviors

Interpersonal relationships

• intolerance of aloneness
• abandonment, engulfment, annihilation fears
• counter-dependency
• stormy relationships
• manipulativeness
• dependency
• devaluation
• masochism/sadism
• demandingness
• entitlement

A commonly used mnemonic to remember the features of the borderline personality disorder is PRAISE:

• P - paranoid ideas
• R - relationship instability
• A - angry outbursts, affective instability, abandonment fears
• I - impulsive behavior, identity disturbance
• S - suicidal behavior
• E - emptiness

Possible complications if left untreated

This is a very serious mental disorder which can affect almost any area of a person's life: relationships, jobs, school, social activities, self-image etc. That’s why the most common complications include:

• repeated job losses
• broken marriages
• self-injury, such as cutting or burning
• suicide
• depression
• substance abuse
• anxiety disorders
• eating disorders
• bipolar disorder
• other personality disorders

Treatment of Borderline Personality Disorder

Medications

Medication seems to be the first response to self-harm behavior, particularly when self-harm is linked to other symptoms, such as depression.
However, there was little research so far examining the effectiveness of medications for personality disorders in young people.

Antidepressants
It has been suggested that antidepressant drugs and mood stabilizers may be helpful for depressive mood, mood swings, and impulsivity, however, the affective symptoms of BPD do not respond to antidepressants in the same way as the symptoms of mood disorders.

Antipsychotic drugs
Antipsychotic drugs may be used when there are distortions in thinking or some psychotic symptoms. However, the commonly used mood stabilizer, valproic acid, may induce polycystic ovaries, so should not be used by young female BPD patients. 

Hospitalization
Although it is necessary in some severe cases, hospital admissions are expensive, and may be ineffective and even counterproductive. Brief psychiatric hospitalization may be justified for protection against suicide risk, psychotic or dissociative symptoms, dangerousness toward others or when the patient is experiencing an acute stressful life event or demonstrates symptoms of affective disorder.

Individual Therapy
The most important approach to the treatment of suicidal behavior is individual therapy. It includes:

• Psychodynamic Psychotherapy,
• Problem-Solving,
• Cognitive Behavioral Therapy,
• Dialectical Behavior Therapy,
• Interpersonal Psychotherapy.
• Dialectical Behavioral Therapy

The idea is to give patients tools to control and handle their emotions that they never acquired as children.