PATCHS PROGRAM PUBLIC HEALTH NURSING ADVOCATES TEACHING CHILD HEALTH AND SAFETY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC)
Volume 1, Issue 26		JAN 2007

Medical Information Fact Sheet

Borderline Personality Disorder:

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms:
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans.
These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex.

BPD is often called the “unspecialized” personality because of its vague name and because it is often too easily applied to patients that appear difficult or do not fit the profiles of other personality disorders. Instead the personality traits of BPD seem to be a combination of histrionic personality, narcissistic personality and antisocial personality.
Histrionic personality includes:

• Self-dramatizing
• Self-indulgent
• Demanding
• Excitable
• Vain

Narcissistic Personality includes:

• Narcissistic
• Intolerant of criticism
• Self-important
• Lacking in empathy
• Envious
• Constantly demanding special favors

Antisocial personality includes:

• Callous
• Reckless
• Impulsive
• Irritable
• Deceitful
• Emotionally shallow

Causes

Researchers commonly believe that BPD results from a combination that can involve genetic vulnerability and environmental stress, neglect or abuse as young children and maturational events during adolescence or adulthood.

Treatment

Despite an estimated 20% of psychiatric patients having BPD, there are no strong guidelines for treatment. Controlled research on the treatment of personality disorder is difficult: personality is often very difficult to change, and patients may regard attempts to change as brainwashing or punishments.

However, treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

National Institute of Mental Health. (2001). Borderline Personality Disorder. Retrieved on January 21, 2007from the World Wide Web: http://www.nimh.nih.gov/publicat/bpd.cfm
Internet Mental Health. (2007). Fact Sheet: Borderline Personality Disorder. Retrieved on January 21, 2007 from the World Wide Web: http://www.mentalhealth.com/

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HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!   Happy New Year! Some sad news for those involved with Public Health Nursing. Judy Halstead Earp, Director of Public Health Nursing, retired in December. We wish her the best. She will be missed.

 

Editor: Kristen Thompson, PHN
Contributors: Nicole Boyd, PHN, Assistant Nurse Manager and
Hermia Parks, MA, Interim Director of Public Health Nursing.