Emotionally unstable personality disorder, borderline type or borderline personality disorder as it is sometimes known, is a difficult concept to understand easily. The condition has its roots in childhood and adolescence and is common in both sexes, but more frequently found in females.
Someone who shows severe difficulties regulating his or her emotions may have a personality disorder. They may also experience episodes of depression, anxiety, anger, irritability and feelings of helplessness, hopelessness and despair. There is often a chronic feeling of emptiness. Suicidal and self-harming behaviours, including alcohol and drug misuse are common, and there is often a history of emotional, physical and sexual abuse, as well as the presence of associated eating disorders.
Relationship difficulties are common in patients with a personality disorder, and individuals frequently choose ‘damaged’, unstable people with which to form co-dependent partnerships. This can have major consequences if children are involved, and often social services can be called upon to assist with the supervision of children. Other agencies, such as the police may also become involved as crime also increasingly features in this group, with drugs and alcohol misuse, violence and even murder occurring in the most severe cases.
Treatment for patients with borderline personality disorder revolves around the three “T’s” – time, talking and tablets. Medication alone does not resolve the root cause of the condition, but it is frequently used. This can take the form of anti-depressants, benzodiazepines (which are addictive), beta blockers, Pregabalin, mood stabilisers and anti-psychotic agents.
Long term treatments can include individual and group psychodynamic psychotherapy, either in an outpatient, day patient or inpatient setting. For some patients, therapeutic communities can provide appropriate treatment for the most severely affected individuals.
MBCT (Mindfulness Based Cognitive Therapy) and Dialectic Behaviour Therapy (DBT) in particular, can be effective in treating this condition. DBT is a combination of intensive Cognitive Behavioural Therapy (CBT), life restructuring, mindfulness and meditation.
However, none of these treatments can be considered to be totally effective in isolation. The whole process of recovery should be a combination of therapy, medication and the maturation of the personality with time and support. Most people with the condition do improve with age.
Dr Adrian Winbow and Prof Tony Hale specialise in the diagnosis and treatment of this condition. To make an appointment, please get in touch.