Borderline: Disorder Symptoms, Causes and Treatment

People with borderline syndrome live on a constant rollercoaster of emotions. They cannot control their emotions. Find out more about typical symptoms, how borderline personality disorder affects relationships, and which therapy can help.

Borderline Personality Disorder: What is Borderline?

It is estimated that around two out of every hundred people suffer from borderline personality disorder. Those who are suffering are in real emotional turmoil. They have trouble regulating their emotions. Therefore, they react impulsively and tend to take short actions – this is also reflected in their relationships.

Borderline Syndrome is one of the emotionally unstable personality disorders. These diseases are characterized by rapid emotional changes: mood can change from minute to minute. Even a small chance is enough.

Emotionally unstable personality disorders are divided into two types:

Impulsive type: People with the impulsive type suffer from strong mood swings and are very moody. They are also characterized by a lack of impulse control. In other words, your emotions are so strong that you cannot control them. This can lead to aggressive behavior, for example.

Borderline type: Borderline people (borderline disorder) also suffer from severe mood swings and lack of impulse control. In addition, they repeatedly get into emotional crises. Their social relationships are unstable: on the one hand they are very clingy, on the other hand they easily feel hurt and rejected, which is why they break the bond. Your self-esteem is low. They also lack a clear self-image. Many borderline people tend to harm themselves.

  Why is it called the "Line of Demarcation"?

  Under the term borderline, experts summarized a number of diseases whose symptoms varied between neurotic and psychotic diseases. The word borderline comes from the English and means something like "border area". Today this approach is considered outdated: borderline is considered an independent personality disorder - but the term "borderline" has survived.

  Borderline: Symptoms of the Disorder

  Typical symptoms of borderline personality disorder are severe mood swings and uncontrollable, impulsive behavior that is often suicidal.

People with borderline syndrome have an unstable self-image. They vacillate between self-love and self-hate, and have nagging doubts again and again. They have no long-term goals or clear preferences.

Rapid mood swings

The emotional state of people with personality disorders is very volatile. They repeatedly experience bouts of intense excitement, anxiety, depression, or despair.
Even the smallest event can change the mood. Rapid mood swings often indicate a tendency to react very quickly and extraordinarily quickly to relationships.

Unstable relationships.

  Sometimes the other is the greatest - then the "last": The mood swings experienced in borderline syndrome also manifest themselves in relationships with friends or partners. At the beginning of a relationship, borderline personalities tend to idealize their partner very strongly: everything the other does or says is great in their eyes. However, even in the smallest situation, enthusiasm quickly turns into devaluation.

“. They have not yet learned that opposing feelings and perceptions can also be united in one person. If these structures are not overcome, the result is that those affected cannot correctly assess their behavior and even their identity, even as adults.

Borderline personalities may have grown up in an environment where behavior and people were always viewed as either "all good" or "all bad." For example, a typical learned behavior might be never to be angry like a "good" child. Difficult situations or negative emotions could not learn to deal with difficult situations appropriately. Experiences of abuse are common.

Many people with personality disorders experienced significant childhood trauma. Those affected have experienced sexual abuse particularly frequently: This applies to up to seven out of ten people with a restricted personality. But physical abuse and severe neglect are also possible causes.

The perpetrator is often an important reference person, for example a parent. Those involved are faced with the contradiction that the loved one they need to protect is the same person they need to protect themselves from. In this contradiction, it is difficult for those affected to perceive and express their anger and disgust towards the caregiver. With borderline personality disorder, these negative feelings can then be turned against oneself, with the abuse then being justified by one's "bad personality."
  Experiences of abuse can also have a decisive effect on the further development of a relationship, because incompatible feelings are experienced at the same time: for example, the tenderness of a person combined with the simultaneous fear of it. In addition, a feeling of superiority, but also intense shame. This emotional dissonance later causes those affected to oscillate back and forth between extreme poles when dealing with other people.

Neurobiological factors

From a neurobiological point of view, borderline people show signs of a disturbance between means of communication (transmitters) in certain brain regions (brain stem, limbic system). In addition, isolated diffuse lesions were found below the cortex. Borderline syndrome: diagnosis

In general, borderline personality disorder should not be diagnosed until adolescence, since individual personality traits continue to develop during adolescence. It is only a personality disorder if the observable behavior has been present (almost) continuously since childhood or adolescence and is not limited to a specific period of time.

The border can go unnoticed for a long time. Experienced psychological or psychiatric professionals are usually able to identify the disorder during treatment. However, many patients stop treatment after a short time or change their habits, which can delay diagnosis.
limit test

Various standardized tests can be used to find out whether a personality disorder can occur and in what form it can express itself. Checklists and structured interviews, for example, can be helpful here.
A special borderline test is the diagnostic conversation about borderline syndrome (DIB). In the two-hour discussion, we will try to gather information on different areas through questions and observations. Depending on the patient's statement or reaction, individual areas and the entire limit test can be evaluated using a point system (“scores”). The results can be used to assess whether it is a borderline disorder.

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), at least five of the following nine criteria are met for the diagnosis of borderline syndrome:

Desperate attempts to avoid feared or actual rejection (not: self-harming behavior or suicide attempts/threats)
unstable but intense relationships, often oscillating between extreme idealization and devaluation of the other
Identity disorder in the form of a pronounced and persistently unstable self-image or self-image
High level of impulsiveness in at least two potentially self-harming areas, such as substance abuse, eating disorders (not: suicidal behavior or suicide attempts/threats)
Self-harm, suicide attempts, or threats
an unstable emotional world (affective instability) with extreme emotional experiences and sudden, often violent mood swings that can be triggered by even the smallest events.
A constant feeling of inner emptiness
inappropriate, intense anger or difficulty controlling anger, transient paranoid thoughts, or dissociative feelings such as alienation from stressful situations.

Other conditions aside, what else could it be?

Some illnesses can resemble those of borderline personality disorder in their symptoms. Therefore, it is important to rule out such disorders before making a borderline diagnosis.

These include e.g. B.

Post-traumatic stress disorder
simple schizophrenia, a mild form of schizophrenia
Cyclothymia, a milder form of bipolar disorder with frequent mood swings
Schizoid personality disorder: Those affected appear strange, cold, ivalid, withdrawn and withdrawn Alcohol dependence and other addictions Dissociative disorder, in which thoughts, perceptions, memories, and actions are not perceived as coherent (eg, in depersonalization disorder)
early childhood brain damage.

What is a possible border treatment?

Personality disorders such as borderline usually require long-term treatment, which can last several years.

The most appropriate treatment method also depends on the patient's preferences. However, one particular form of therapy has proven to be particularly effective: dialectical behavioral therapy. Dialectical Behavioral Therapy (DBT)

In the 1980s, a highly structured program was developed specifically to treat people with borderline personality disorder. Dialectical Behavioral Therapy (DBT) is considered the best scientifically proven treatment for BPD.

Different treatment methods are combined in DBT. These include behavioral therapy, talk therapy, hypnotherapy and elements of Zen Buddhism. Treatment can be individual or group therapy.

With the help of exercises, borderline personalities need to learn how to improve their behavior and deal better with difficult situations. For example those suffering in therapy.
learn to deal with stress better
learn to better control your emotions
Develop relationships/improve relationships
improves body awareness

The dialectic behavioral therapy for borderline disorders was developed as an outpatient treatment method. Under certain circumstances, such as an acute risk of self-harm, institutionalization is recommended, at least temporarily.

In addition to Dialectical Behavioral Therapy (DBT), there are other approaches to treating BPD, e.g.

schema therapy
Mindfulness-Based Therapy (MBT)
Translocation Focused Therapy (TFP)
medical therapy

Music, play, or movement therapy can also be used at the border.

Borderline disorder: a possible course

A personality disorder can be very different. As a rule, those affected already show typical personality traits in childhood and adolescence, which become established in young adulthood.
Most BPDs experience recurring crises in their lives that include severe mood swings, threats or attempts at suicide, self-harm, or other self-injurious behaviors. This can be a significant burden not only for the patients but also for those around them.

A person's personality traits remain largely the same into old age. However, the intensity of stressful characteristics often decreases with increasing age, so that many of those affected feel psychologically more stable in their private and professional lives in adulthood.

Many people with borderline personality disorder also have other mental illnesses, such as depression. Psychotherapy can positively influence the course of borderline syndrome.

Von: Wiebke Posmyk (Medizinjournalistin, Diplom-Pädagogin, M.A. Media Education) , Romina Enz (Medizinredakteurin und Biologin)

• Online-Informationen der Fachorganisationen gemeinsam aufgeführter Berufsverbände für Neurologie, Psychiatrie und Psychotherapie, Psychosomatik sowie Kinder- und Jugendpsychiatrie in Deutschland: Was ist eine Borderline-Persönlichkeitsstörung (BPS)? https://www.neurologen-und-psychiater-im-netz.org/psychiatrie-psychosomatik-psychotherapie/stoerungen-erkrankungen/borderline-stoerung/ (Abruf: 04/2022)
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