Angry Outbursts? Impulsivity? Does Your Loved One Have Borderline Personality Disorder?

Does your spouse, child or parent sometimes act overly emotional for no obvious reason or behave erratically? Maybe he/she drives recklessly…drinks heavily…acts suspicious of others…becomes inappropriately intense and/or unable to control anger…or even deliberately cuts himself/herself.

Your loved one might have borderline personality disorder (BPD)—a chronic, disabling psychiatric disorder that severely impacts relationships with family, friends and coworkers and is more common than schizophrenia. Unfortunately, the condition is massively underdiagnosed…and getting the right diagnosis is challenging.

Good news: BPD used to be considered untreatable, but new major advances in treatment allow patients to live full, successful lives.

BPD RISK FACTORS

Research suggests that 60% of risk for borderline personality disorder (BPD) is due to genetic abnormalities that affect processing of emotions, impulse control and cognitive activity. These abnormalities can be inherited from someone who has BPD…or bipolar disorder, depression, substance use disorders, ADHD, post-traumatic stress disorder or a related disorder. Emotional, physical or sexual abuse during childhood and other environmental factors further increase the risk and severity of BPD.

SYMPTOMS OF BPD

The full spectrum of BPD symptoms typically appears in the teen years or twenties, but sometimes at a later age. It’s often not diagnosed until later in adulthood…and sometimes never. BPD is diagnosed based on having at least five of nine criteria, which fall into four groups of symptoms…

1. Impaired emotional responses: Periods of intense anguish, anxiety and/or panic attacks…inappropriate, uncontrolled anger…chronic feelings of emptiness.

2. Impulsive, harmful behavior: This includes excessive spending, binge eating, substance abuse,  suicidal threats/behavior, cutting oneself or impulsively damaging property.

3. Inaccurate self-perceptions and impaired reasoning: Unstable self-image, often assuming the beliefs, behaviors and speech patterns of companions while having difficulty describing one’s own values…high level of suspicion, paranoia, feeling of unreality or that surroundings are unreal…inability to think rationally under socially stressful situations.

4. Unstable relationships: Inclined toward “desperate” efforts in relationships to avoid real or imagined abandonment…having very intense, unstable relationships that vacillate between overidealizing and undervaluing the other person.

Are you or is someone you know at risk? You can take a test that measures risk for BPD on my website. At BPDDemystified.com, click on “Online BPD Test.” (You can take the test for someone who refuses to do so by answering the questions based on symptoms you’ve noticed.)

Note: When the diagnosis of BPD (and the opportunity to treat it) is missed, treatment of a co-occurring condition, such as depression or panic disorder, is less likely to succeed. Example: A person who abuses alcohol may be able to quit for a while…but unless BPD is also addressed, he is likely to relapse.

THE MOST EFFECTIVE TREATMENT

While treating BPD often includes psychotherapy, I’ve learned from clinical and research experience that medications also are needed to achieve significant therapeutic results from psychotherapy.

Medications can manage symptoms that don’t respond to psychotherapy and can quickly stabilize aggression, excessive suspiciousness, paranoia and other irrational thinking. Medications that help…

• Antipsychotic agents. This class of medications—which includes olanzapine (Zyprexa), aripiprazole (Abilify), risperidone (Risperdal) and quetiapine (Seroquel)—is commonly used to treat other mental illnesses, especially bipolar disorder and schizophrenia. Dosing for BPD is lower than for other mental illnesses. Prescribed for: Disturbed perceptions such as suspiciousness/paranoia and split (“all-or-nothing”) thinking. Note: I often prescribe the antipsychotic lurasidone (Latuda). While its effectiveness against BPD has not been studied, I find that it is equally effective and has fewer side effects (for example, weight gain and high cholesterol) than other drugs in this class.

• Mood stabilizers. These include the anticonvulsants topiramate (Topamax) and lamotrigine (Lamictal), and are often used either with or instead of antipsychotic agents. Prescribed for: Impulsivity, anger, anxiety and depressed mood.

• Antianxiety agents and sedatives. These types of medications, usually benzodiazepines such as alprazolam (Xanax) and diazepam (Valium), are prescribed with caution (because they are addictive and can make symptoms worse) when the other medications are not effective on their own. Prescribed for: Co-occurring anxiety or depressive disorder. The nonaddictive antianxiety agent buspirone (BuSpar) is also effective and can be a better alternative.

• Omega-3 fatty acids. In a study published in American Journal of Psychiatry, women with BPD (they were not taking BPD drugs) who took 1,000 mg of an omega-3 fatty acid daily for eight weeks showed a larger reduction in depression and aggression than those who took a placebo. It is thought that omega-3s work in a different way than antipsychotic drugs, so they can be used with BPD drugs—but not in place of them nor at a reduced dosage.

PSYCHOTHERAPY

Typically, someone with BPD sees a therapist once or twice a week for up to two years…and less frequently once symptoms are under control. A therapist will suggest coping mechanisms for dealing effectively with flare-ups of symptoms—such as uncontrollable episodes of anger, suicidal thoughts and intentions, etc.

To find a clinician who treats BPD: Borderline Personality Disorder Resource Center, NYP.org/bpdresourcecenter, 888-694-2273.

To find support for your family: The National Alliance on Mental Illness, NAMI.org, 800-950-6264.