Borderline: crisis, symptoms, test, illness or disorder?

Borderline is a personality trouble whose diagnostic criteria were established in the DSM-5, the latest diagnostic and statistical manual used to classify mental disorders. Literally, the word “borderline” means “at the limit”. This disorder is so called because it is characterized by a fluctuation in mood, behavior or self-image, impulsivity, emotional instability, hypersensitivity in interpersonal relationships… Attention, it is different from bipolar disorder. How detect a borderline person ? How does a borderline crisis manifest? What causes this disorder? Childhood trauma? Other causes? How to treat it?

Definition: what does it mean to be “borderline”?

borderline personality disorder, also calledlimit state” Where “emotionally labile personality“is characterized by a great emotional instability as well as a impulsiveness and affects the person in their interpersonal relationships as well as in their self-image. It was so named because the disorder was originally thought to be borderline between neurosis and psychosis. We now know that it is a clearly defined disease. This personality disorder affects between 0.5 to 5.9% of the general population, men and women equally and appears after adolescence, therefore in adulthood. As with all personality disorders, its traits are permanent and stable.

What symptoms to detect a borderline person?

“No symptom is specific to borderline personality disorder in isolation, explains Dr. Jean-Victor Blanc, psychiatrist. But their association and the fact that they cause suffering for the individual sign borderline disorder. At the emotional level, “the mood is subject to a permanent roller coaster, going from angry anger to euphoric ecstasy in the same day, even from one hour to the next” exposes Dr. White. Contrary to bipolar disorder with which it can sometimes be confused, these mood swings are very fleeting and do not persist over time. “A very special feeling of”internal void“, difficult to verbalize, is often present and very distressing for those affected” adds the psychiatrist.

► At the relational level, borderline personality disorder is marked by great inner insecurity in personal relations with fear of abandonment often very present. “Relationships with others are raw, in “all or nothing” explains Dr. Blanc. That hypersensitivity and the whole character create tensions that can be difficult for those around them, evoking the isolation of people with borderline personality disorder. From then on, affective, friendly and professional relationships are punctuated by tensions, clashes, ruptures and frequent changes.

► At the behavioral level, instability is manifested by a great impulsiveness which plays on life choices (work, love life, etc.) but also affects daily life. “One of the facets of this impulsiveness is the frequent recourse to self harm“ points out Dr. White. And to add: “Scarifications occur without a suicidal aim but to bring relief to an inner tension that patients cannot manage otherwise, they are a source of great guilt.” Eating disorders, including binge eating followed by vomiting and the use of alcohol and psychoactive substances are also common. “This explosive cocktail often makes the daily lives of affected patients exhausting.”

The diagnosis of borderline must be made by a healthcare professional. According to a document from the Toulouse University Hospitalto make the diagnosis of borderline personality, it is necessary in particular only 5 of the 9 criteria below are present and they must be present for a long time and from early adulthood.

1. A very unstable and very reactive mood what is happening around you (intense emotional crises that last a few hours to a few days, panic attacks, significant irritability, intense moral pain)
2. Moments of great anger or difficulty controlling your anger.
3. A repetition ofsuicidal thoughtssuicidal behavior or self-harm.
4. A impulsive behavior which can be risky or even dangerous for you (binge eating, drug use, etc.)
5. A chronic feeling of emptiness and boredom.
6. A fear of being abandoned by those around you and a great sensitivity to the perception of separation or rejection.
7. Of the unstable relationships with an alternation between the idealization and the devaluation of people.
8. A fluctuating image of you
9. Time-limited episodes of persecutory thoughts or dissociative symptoms (e.g., feeling like you are no longer yourself or not being real).

Causes: what causes borderline personality disorder?

The causes are not well known. But it would seem that the borderline disorder would find its origin in childhood. “The childhood of patients is very often marked by traumanegligence or emotional deprivationphysical, verbal or sexual violence” notes Dr. White. What is certain is that borderline personality disorder results from the association of several factors.

When and who to consult?

It should be consulted as soon as there is pain. Ideally, it should be possible to consult before there are negative consequences in the lives of those affected such as the installation of an addiction, or suicidal acts. the psychiatrist is the specialist best able to make the diagnosis and offer treatment. Like all personality disorders, the diagnosis can only be made in adulthood, when personality traits are stable over time. It is often the distress felt and behavioral disorders, such as scarification, that will motivate the consultation.

Is borderline personality disorder serious?

Yes as long as it is linked to a risk of suicide, even if obviously not all borderlines think about it or take action. The severity of borderline personality disorder varies from person to person. Some have very severe symptoms that have a strong professional and personal impact. Others require hospitalization. Others have a relatively stable life.

Is borderline personality disorder associated with other diseases?

According to the Borderline sheet produced by the psychiatry center of the University Hospital Center of Toulouse, borderline disorder can be associated at some point in life with another mental illness such as:

• a depressive disorder,
• bipolar disorder,
• an anxiety disorder,
• post-traumatic stress disorder,
• eating disorders,
• addiction to alcohol or drugs,
• another personality disorder

What treatment to treat a borderline disorder?

The management of patients with borderline personality disorder is based on 3 axes:

► Psychotherapyin particular the cognitive-behavioural (CBT) and psychoanalytic approaches. “Schema therapy is effective and recommended.“says Dr Blanc, because “it incorporates aspects of both of these approaches”. Close monitoring is often necessary.

► Medications which can help reduce impulsiveness, anxiety or treat associated depression. There is no specific drug to treat borderline disorder, it is simply a matter of alleviating the most bothersome symptoms and thereby allowing psychotherapy. Depending on the case, the drugs most often prescribed are antidepressants, neuroleptics, anxiolytics, or mood stabilizers.

► Prevention of borderline seizures. “This is the essential axis because they are part of the evolution of the disorder. When things are not going well, knowing who to turn to, when and how, makes it possible to avoid many complicated situations. Explaining the disorder to the environment is also essential.” Finally, for the many patients with an addiction disorder, it is necessary that it be taken care of.

Thank you to Dr Jean-Victor Blanc, psychiatrist and author of “Pop & psy: how pop culture helps us understand mental disorders” at Éditions Plon.

Borderline Disorder Sheet, Psychiatry Center UNIVERSITY HOSPITAL CENTER OF TOULOUSE