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How is borderline personality disorder diagnosed?
Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.
A mental health professional experienced in diagnosing and treating mental disorders can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.
The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with borderline personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.
No single test can diagnose borderline personality disorder, though scientists are looking for ways to improve diagnosis of this disorder.
What studies are being done to improve the diagnosis of borderline personality disorder?
Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness. Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative. People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder.
Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.
These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.
How is borderline personality disorder treated?
Borderline personality disorder can be treated with psychotherapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.
Below are just some of the options that may be available to a person with borderline personality disorder. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most and how best to deliver treatments.
Psychotherapy
Psychotherapy is usually the first treatment for people with borderline personality disorder.
It is important that people in therapy get along with and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with this disorder to maintain this type of bond with their therapist.
Types of psychotherapy used to treat borderline personality disorder include the following:
- Cognitive-behavioural Therapy (CBT): CBT can help people with borderline personality disorder identify and change core beliefs and/or behaviours that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviours.
- Dialectical Behaviour Therapy (DBT): This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviours and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviours.
- Schema-focused Therapy: This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that borderline personality disorder stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.
Therapy can be provided one on one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to express themselves effectively.
One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists reported that this, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviours of borderline personality disorder, relieve symptoms of depression and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.
Families of people with borderline personality disorder may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.
Some therapies, such as DBT family skills training (DBT-FST), include family members in treatment sessions. These types of programmes help families develop skills to better understand and support a relative with borderline personality disorder. Other therapies focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in borderline personality disorder. Studies with other mental disorders suggest that including family members can help in a person's treatment.
Other types of therapy not listed here may be helpful for some people with borderline personality disorder. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies or use a combination therapy.
Some symptoms of borderline personality disorder may come and go, but the core symptoms of highly changeable moods, intense anger and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare.
Medications
No medications specifically treat borderline personality disorder. However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.
Medications can cause different side effects in different people. People who have borderline personality disorder should talk with their prescribing doctor about what to expect from a particular medication.
Other Treatments
One study done on 30 women with borderline personality disorder showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilisers and had few side effects.
With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with borderline personality disorder to be patient and to receive appropriate support during treatment.
Reference:
National Institute of Mental Health (NIMH), National Institutes of Health (NIH) (Reviewed 2012, 10 January). Borderline personality disorder (NIH Pub. No. 11-4928) [Global Edit]. Retrieved 7 March 2012 from www.nimh.nih.gov