Borderline disorder
Aren't borderliners the ones who cut themselves? You've probably seen the pictures of young people with scarred arms, legs, and a permanently sad expression on their faces. But do you know what is often behind these acts of self-harm? It is far from being the only symptom of borderline personality disorder. Find out here how you can recognize those affected, how you can deal with them and what chances there are of recovery.
In the ups and downs of emotions
Andrea is 11 years old when she comes to a children's home for the first time. Her mother is overwhelmed with her. Within six years, she changes homes 20 times. This is due to her recurring, impulsive and uncontrollable behavior. In young adulthood, she lives alternately with friends, in residential homes and in psychiatric care. Her repeated suicide attempts always end up in closed institutions. Outside the hospital, she takes drugs, drinks a lot of alcohol and cuts herself. She says herself that she always ruins everything herself. Only when she becomes pregnant at 23 does her life take a turn. After a one-year stay in a mother-child home, she moves into her own apartment for the first time. Her biggest goal now is to be there for her daughter and to take better care of her than her own parents did for her.
Borderline personality disorder is one of the personality disorders of the "emotionally unstable" type. Personality disorders are particularly profound mental disorders that affect the whole life of the affected person and are very difficult to treat. The following three symptom groups occur in sufferers:
Uncontrollable emotions
Typical for Borderline is the interaction of a feeling of inner emptiness with unpredictable emotions. People affected by borderline are extremely sensitive. Their own reactions to certain events can surprise them. Anger up to physical violence against themselves or others is a typical reaction to upheavals. Overall, behavior is characterized by impulsivity. Self-harming behaviors such as self-injury, impulsive eating, excessive sex, drug use and gambling are part of the clinical picture. About 60% of those affected commit at least one suicide attempt.
The fear of abandonment
Borderline patients find it difficult to form and maintain relationships. They fluctuate between passionate idealization of the other person and pejorative anger. What is true at any given moment is hardly comprehensible to outsiders. Borderline patients cannot be alone with themselves. Therefore, they demand all the attention from their relationship partners and do everything they can not to be abandoned. This is countered by their strong mood swings. Thus, their relationships are intense but short and always end in an emotional catastrophe, which can be accompanied by a suicide attempt.
All just imaginary?
Borderline patients are unpredictable because they have a very unique perception of the circumstances surrounding them. For other people, their reactions are difficult to comprehend and rarely predictable. Small things can set off an emotional cascade that can no longer be stopped. In extreme cases, sufferers tend to become paranoid. They imagine that they are being followed or threatened. In stressful situations, they have the feeling of being beside themselves, of not being themselves. In general, borderline personality disorder makes it difficult for those affected to develop a coherent self-image. They are unclear about what constitutes them as a person and what their goals and preferences are.
Which mental disorders exist and what exactly constitutes them changes over time. Psychological diagnostic manuals merely label certain symptom patterns. If these prove successful in practice, they are retained. If therapists cannot work with them, they are adapted in the next edition of the manual.
Borderline as an undiagnosed disease in the background
When you read through these symptoms, you may get the idea that they apply to a person in your environment. Here it is very important to differentiate between what are merely character traits and what is actually a disease requiring treatment. Personality disorders generally combine human traits that are also present in healthy individuals. The major difference is in the extent and consistency of the traits and behaviors.
Borderline patients have a limited ability to live independently due to their clinical picture. Problems arise from the interaction of their symptoms with the outside world, which lead to great suffering. As a rule, those affected go to therapy because of superficial mental disorders such as depression, eating disorders or drug abuse. The therapist then recognizes only with time that the problems are based on a personality disorder of the borderline type.
If you suspect a person has borderline personality disorder, ask yourself the following questions:
- Have the symptoms from the three areas above always been present?
- Does the person suffer from his own behavior or the reaction of his environment to it?
- Is the person affected unable to live without support?
If you can answer all questions with "yes", a personality disorder of the borderline type may indeed be present. Ultimately, however, only an experienced therapist can make a clear diagnosis.
Borderline becomes rarer with increasing age
About 2% of all people in Germany suffer from borderline personality disorder. Statistics show that primarily people in young adulthood are affected. Borderline occurs in 5% of all 15-year-olds and in 4.2% of all 20-year-olds. In the 45-year-old age group, the rate is only 0.7%.
Conversations help more than pills
Borderline personality disorder is difficult to treat. Its causes lie in childhood and adolescence. The dysfunctional behavior patterns are therefore firmly established, and patients have little motivation on average to change them. While borderline was long considered incurable, newer therapy methods today achieve cure rates of 33%. Proven methods are the dialectical-behavioral therapy according to Linehan as well as the mentalization-based psychotherapy.
Both forms of therapy place an emphasis on the therapeutic relationship. Since borderline patients have great problems with interpersonal relationships, a solid foundation for future cooperation must first be created. Later, the main focus is on understanding the patient's own inner processes as well as those of people around him. Reactions must become understood and predictable. In addition, borderline patients are given an arsenal of skills to use when the need for self-harm or suicide takes over.
All in all, psychotherapy is lengthy and very complex. If you know someone with borderline yourself, you need to grow a thick skin. It may be better to cut off contact with that person completely if it is bothering you a lot. Otherwise, you can only offer advice and support when needed. Be the rock that takes all the waves, but doesn't change itself.
The central symptom is emotional instability. Affected individuals react unpredictably and violently, especially in the interpersonal sphere. Self-injurious behavior arises in response to emotions perceived as overwhelming. Private relationships in particular suffer from the unpredictable behavior. Complications often arise in work life as well. The behavior of borderline patients is characterized by the search for a confirmation of themselves. They do not know what makes them a person and feel empty inside. In extreme cases, borderline personality disorder can lead to delusions. Some affected persons feel strange in their own bodies. </p>
Dialectical-behavioral therapy according to Linehan and mentalization-based psychotherapy are suitable. The focus is always on building a resilient relationship between patient and therapist. Borderline patients must learn to understand their own reactions as well as those of other people. The therapist provides them with emergency techniques against self-injurious behavior. </p>
The overall prevalence is 2%. The earlier assumption that women were affected significantly more often than men is now considered outdated. With increasing age, the diagnosis is made less frequently. In the 20-year-old age group, the prevalence is 4.7%. In the 45-year-old group, borderline occurs in only 0.7% of all individuals. </p>
The term originates from the first half of the 20th century. At that time, mental disorders were divided into the two groups „psychoses“ and „neuroses“ according to the teachings of psychoanalysis. Because borderline patients exhibited symptoms from both domains, they were classified as „borderline patients“. Today, this categorization is considered to be ü outdated. </p>
The causes of borderline personality disorder always lie in the childhood and youth of those affected. As a rule, they experienced severe psychological and sometimes physical abuse. Borderline patients do not have the appropriate framework while growing up, which they need due to their sensitivity. A hereditary component is also assumed. However, no one can yet give a clear reason why a person becomes emotionally unstable. </p>
Conclusion
Borderline personality disorder is a profound personality disorder that makes it extremely difficult for those affected to live independently. Contact with affected persons is difficult. The commonly known scratching is only one of many symptoms, such as extreme mood swings, intense relationships and a disturbed self-image. The disorder is difficult to recognize even for psychotherapists, but it can be treated. One third of those affected are permanently cured.
