People with BPD have emotions
Borderline syndrome: description
What is borderline? Borderline personality disorder (BPD) is one of the so-called "emotionally unstable personality disorders". People with this severe mental disorder suffer from their intense and uncontrollable emotions. According to the borderline definition, the main characteristics of this disorder include strong mood swings and violent outbursts of anger. A pronounced black-and-white thinking is also typical of borderliners.
The World Health Organization (WHO) distinguishes between two borderline types:
- the impulsive borderine type, which is particularly noticeable due to its low impulse control and unpredictability,
- and the borderline type, which is mainly characterized by a disturbed self-image and relationship behavior.
Typical borderline behavior is to idealize other people at first, but to devalue them strongly at the slightest disappointment. For more information on borderline patient relationships, see the Borderline Relationships section.
Who does borderline syndrome affect?
Borderline disease often develops in adolescence or young adulthood. Experts estimate that around six percent of young people or one to two percent of the total population in Germany suffer from it.
The first signs of the mental disorder can appear in childhood, but it is difficult to diagnose borderline in children. The noticeable signs in children and adolescents are often not clearly attributable to the borderline syndrome. If a borderline disease is suspected at a young age, experts speak of a borderline developmental disorder.
In the past, young women were considered to be particularly susceptible to borderline disorder. However, recent studies indicate that the gender distribution is balanced. Up to 80 percent of patients in therapy are female. Scientists assume, however, that borderline expresses itself differently in men than in women. Male borderliners are more prone to violence against others and are therefore more likely to end up in juvenile detention centers than in a therapeutic institution.
Borderline mothers and fathers
Borderline people expecting a child often have great self-doubts and worry about not doing justice to the child. However, if a mother or father suffers from borderline syndrome, it does not automatically mean that the children will also have psychological problems. Parents who are willing to seek therapeutic treatment and work on their typical borderline behavior can offer their child the necessary protection against the disease.
But even when parents have the best intentions for their children, they can overwhelm them. For example, mothers with borderline syndrome often have very high expectations of themselves and want their child to have a better life than theirs. There is a risk that they overprotect the children and that they hardly have any room to develop.
Caring for a child is always a major challenge for people with borderline syndrome. Many borderline syndrome patients were neglected or abused in their own childhood. Having a child of their own can bring back memories of traumatic events. As a result, those affected feel that they have returned to the role of children and are often unable to adequately care for their own child. The role of parenting overwhelms them and creates aggression and, in some cases, violence against the children.
School and job
Most of those affected have difficulty completing vocational training. Many spend years of their lives in psychiatric hospitals. Only around the age of thirty does the intensity of the borderline syndrome slowly decrease and the violent storms of emotion subside.
Borderline syndrome often goes hand in hand with other diseases. The majority of patients experience depression, at least temporarily. Panic disorders, post-traumatic stress disorder and alcoholism or drug addiction are also common.
Borderline: Children suffer too
If the borderline symptoms are severe, the children suffer greatly from the effects of the mental disorder. Because the children are helplessly exposed to the mood swings of their parents. The change between loving closeness and rejection unsettles the children and they lose trust in their parents.
When the children notice that their parents are unable to cope with everyday life, they take on the role of adults. Experts call this parentification. The children strive to meet the needs of the parents and put their own aside. This reversal of roles usually creates psychological problems in the children that can last for a lifetime.
Therefore, parents with borderline syndrome should definitely seek help. The therapist can accompany the family on their way. With support, parents can learn to recognize their child's needs. If the children are educated about the illness of the mother or the father, they have a better understanding of difficult situations.
Borderline syndrome: symptoms
You can read everything you need to know about the signs of borderline syndrome under Borderline Symptoms.
Borderline syndrome: causes and risk factors
Can borderline be hereditary? The borderline causes have not yet been conclusively clarified. What is certain is that a genetic predisposition and early traumatic experiences can work together and trigger the disorder. The only twin study to date has shown that genetic factors have a major influence on the development of the borderline syndrome. Thus, borderline cannot be inherited, but the predisposition for it is.
Traumatization significantly increases the risk of borderline syndrome. A large proportion of those affected were sexually abused in early childhood - especially within the family. Borderline patients have also experienced physical violence in many cases.
Mental abuse can also result in borderline syndrome. Many of the patients were severely neglected in their youth. A lack of warmth in family relationships or unpredictable caregivers increase the risk.
Early separation experiences through divorce or the death of a parent also favor the disease. In principle, mental health problems in the family such as alcohol abuse, depression or schizophrenia increase the risk of developing borderline syndrome.
As conspicuous as the accumulation of trauma in patients with borderline syndrome is, in some of the patients the personality disorder evidently develops even without harrowing experiences. So it is not always and automatically the family to blame for the mental illness.
Disorders in the brain
Researchers assume that communication between certain brain centers that control emotional processing is impaired in people with borderline syndrome. Therefore, borderliners experience all feelings much more intensely than healthy people. It is not yet clear whether this tendency is innate or whether it arises through traumatic experiences.
Impairment of the frontal lobe has been reported in some studies. This brain region is important for impulse control, among other things. Actions are planned and also inhibited there. The impaired function of the frontal lobe could be related to the impulsive actions of borderline patients.
Borderline Syndrome: Investigations and Diagnosis
The first step in diagnosing borderline personality disorder is taking a thorough medical history. The following questions are important to determine the borderline syndrome:
- Did the symptoms appear in childhood or adolescence?
- Are the symptoms typical for the person affected? (e.g. aggressive behavior not only towards the mother but also towards classmates)
- Do the symptoms occur in different life situations?
- How high is the personal suffering of those affected?
For the anamnesis, not only the patient but also, if possible, other caregivers, especially the parents, are interviewed. For the diagnosis, other mental disorders, some of which are accompanied by similar symptoms, must be ruled out. These include, for example, schizophrenic disorders and behavioral disorders.
In the case of the borderline personality, the experience and behavior of those affected deviate significantly from culturally expected and accepted guidelines ("norms") in at least two of the following areas:
- cognition: Those affected see and interpret their environment differently than other people.
- Affectivity: Your emotions are more intense than usual and they respond inappropriately.
- Impulse control: Affected people have difficulty controlling their impulses and have the urge to satisfy needs immediately.
- Relationships: Relations with other people are disturbed.
In addition, the doctor or therapist asks about the typical symptoms of borderline syndrome, for example problematic relationships, frequent life crises, aggression and self-harm.
In order to be able to make the diagnosis of a borderline personality disorder (according to ICD 10), at least three of the following characteristics must apply:
- Clear tendency to act unexpectedly and without considering the consequences (lack of impulse control)
- Clear tendency to quarrels and conflicts with others, especially when impulsive actions are prevented or reprimanded
- Tendency towards outbursts of anger or violence with inability to control the explosive behavior
- Difficulty maintaining actions that are not immediately rewarded
- Inconsistent and moody mood, mood swings (affect instability)
In addition, at least two of the following criteria, which are specific to borderline syndrome, must be met:
- Disturbances and insecurities of self-image, personal goals and preferences (including sexual ones)
- Tendency to get involved in intense but unstable relationships, often resulting in emotional crises
- Excessive efforts to avoid abandonment
- Self-harming behavior, suicide threats and attempts
- Persistent feelings of emptiness
Borderline syndrome: treatment
All important information about the treatment of the borderline symptom can be found under Borderline Therapy.
Borderline syndrome: disease course and prognosis
For a long time, borderline patients were considered hopeless cases. This picture has changed considerably with the development of therapies specially tailored to borderliners.
About 50 percent of borderline patients respond to the forms of therapy offered on their first attempt at treatment. It is unclear, however, to which type of therapy the success of the treatment is due (psychotherapy or other specific therapy) and with which treatment one meets a repeated need for therapy.
However, the fact that the borderline criteria are no longer fully met does not mean that the patients are cured. Many also have long-term problems controlling their emotions or integrating socially.
Drug or alcohol abuse patients, in particular, have a worse chance of getting their problems under control. This is followed by patients who suffer from post-traumatic stress disorder and / or who were sexually abused as children. Around five to ten percent of borderliners die as a result of suicide or risky behavior, such as risky driving or drug use. The impulsive borderline behavior decreases with age, but depressive moods often take its place.
Experts criticize that the care of borderline patients in Germany is still inadequate. There are inpatient offers at many specialist clinics. However, outpatient care is not sufficient - also because there are not enough trained therapists. In addition, the health insurances do not finance therapies that last longer than a year in all cases. Only about one in a thousand affected people receives effective outpatient treatment for this Borderline syndrome.
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