A - It is a psychiatric condition diagnosed by qualified mental health professionals when it’s felt that several areas of someone’s personality or rather their ongoing patterns of thought, feelings and behaviour are having a wide-ranging and pervasive negative impact on their everyday life.
Q - Does this mean I have a ‘bad’ or ‘flawed’ personality?
A - No, the words used surrounding these diagnoses are controversial and unfortunate as they seem to imply this but this is absolutely not the case. This is why some professionals now refer to bpd as emotional deregulation disorder.
A - Current research suggests that a combination of factors often come together for bpd to develop. BPD is the result of physiological and chemical disturbances in the brain that control specific brain functions. You may be born with these disturbances or they may be amplified by occurring events such as childhood trauma, abuse or severely stressful experiences. Children or adults can suffer from bpd.
A - BPD can be treated in two main ways, medication and talking therapies. Medication can help relieve some of the unpleasant features of bpd so that appropriate therapy can take place.
A - This is extremely difficult to determine as everyone with bpd is different. Some people may find over time that some or all of their negative behaviours and feelings subside or even disappear, others may not. There is growing evidence however that when bpd is treated effectively and consistently many individuals can make a complete recovery.
A - As with all medical conditions, do not self-diagnose. If you feel you may have bpd you should seek help immediately. You will need to be professionally assessed. You can start by visiting your GP for a chat and you may want to ask for a referral to your local mental health service.
A - Tread very carefully. Find out a bit more by looking at our website. Raise the subject with sensitivity and compassion only when the situation is appropriate. Remember, it is not for you to decide what action, if any, the other person takes.
A - Affective liability : unstable, rapidly changing emotions. Quick changes of emotions or unstable mood is rather common for everyone. So this symptom can have very different forms and severity. Mild forms are not at all a sign of a major psychiatric disorders. But we refer to people with a quickly changing emotional response who have rapid and extreme mood changes within a very short period, and without appropriate external reasons. Usually this lasts only for some minutes or hours (in contrast to longer periods of depression or mania in bipolar disorders). The most prominent forms of this problem are common among patients with Borderline Personality Disorder. Other examples of affective liability can be found in women with Premenstrual Dysphonic Disorder. It is also common among children, adolescents and adults with ADHD. Longer lasting periods of inappropriate affective reactions are also typical for organic brain disorders and severe psychiatric disorders like schizophrenia.
Q - What is idealisation and rejection? Why do Borderline-patients idealise and then reject other persons?
A - It is typical for patients with borderline personality disorder to idealize another person as being "perfect" or the "best person I ever met". Due to dichotomous thinking and splitting, people with this type of personality tend to see only extremes, like "all good" or completely bad. They are not able to realize that someone will not be able to meet all their needs or be present every minute of the day and night only for this one person, but would be willing and able to meet some of these needs and accept the person as a valuable individual. So the borderline patient tends to avoid unpleasant (realistic) aspects, feelings or experiences. Their view can rapidly shift from positive to negative and from one view to another, without being able to combine the shifting views into a complete whole. This judgement can be rather intuitive and is not based on facts or recent experiences. Very often this is more or less influenced by old schemes or dreams of the past. If something interferes seriously with this idealization of a "beloved person", very extreme behaviours may result. One possibility is the complete devaluation of the person. Now all personal qualities and behaviours of the other person are judged to be awful, harmful or are seen as a tricky way to manipulate or abuse oneself. Again, this is mainly based on old (bad) experiences, not the current situations or behaviour of the people involved.
Q - How do you describe dichotomous thinking of Borderline Personality Disorder?
A - Patients with Borderline Personality Disorder (BPD) tend to perceive and evaluate every thought or situation as
black or white
good or bad
all or nothing
This dysfunctional extreme thinking can be one source of extreme actions like leaving a partnership, quitting a job or other impulsive actions. This can be the main source of extreme reactions, mood swings and interpersonal problems. To change this dichotomous thinking a psychotherapist will point out examples of daily life to the patient and try to discuss different point of views in terms of a continuum. So the client learns a more realistic perception of his environment and personal relationships.
Q - What should I do about chronic suicidality of a patient with Borderline Personality Disorder?
A - Nearly all patients with a Borderline Personality Disorder report about chronic suicidality. We know that about 1 of every 10 patients with this severe personality disorder actually commits suicide in the course of the disorder. But clinical experience and ongoing research shows that this fatal outcome is not easily preventable by hospitalisation in a psychiatric ward and might also increase, rather than reduce, the risk for suicide. In an outpatient psychotherapeutic setting the open conversation about suicidality is very important and often as a way of communication and attempt to ask for help! Very often actual psychosocial problems or interpersonal problems can be identified as a source of real distress that is expressed in this unusual way to get the attention of the therapists or friends. So the best way to handle suicide thoughts is to analyse the origin of these thoughts and to look for actual problems or interpersonal conflicts of the patient.
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