Historically, mental illness would be classified as neurosis and psychosis. A neurotic disorder is one in which the sufferer is distressed but doesn’t have hallucinations or delusions of any kind. Symptoms of disorders such as depression or anxiety would be considered neurological.
On the other hand psychoses is a condition where the sufferer has trouble determining what is real and what is false (in terms of beliefs (delusions) and sensory reality (hallucinations)). Psychosis is a symptom of some mental illnesses such as schizophrenia but can also be brought on by drugs, trauma, or by child birth (postpartum psychosis).
When psychiatrists were first studying what would become to be known as borderline personality disorder (BPD) they found that it didn’t fit as either neurosis or psychosis, but somewhere in between.
There are a number of symptoms that can result in a diagnosis of BPD including:
-Prominent fear of abandonment.
-Intense but unstable relationships with other people.
-Impulsiveness (in a number of areas from spending money to sex to reckless driving to binge eating).
-Self destructive behaviours which could be alcohol/drug abuse and/or self harm.
-Suicidal thoughts and idealisation.
-Frequent mood swings or intense reactions to a seemingly trivial event.
-A distorted self image.
-Dissociation
The causes of BPD are disputed. Some link it to trauma and believe that BPD and PTSD (post traumatic stress disorder) are linked. Others believe it to be caused by genetics or imbalances in the brain’s chemicals. Others believe it to be caused by unhealthy relationships and interactions with other people in childhood.
When being diagnosed in the UK, a person’s GP will want to rule out more common mental health issues such as depression first. If the GP does suspect the sufferer has BPD then they will be referred onto the community mental health team who carry out an assessment. The assessment is comprised of a number of closed (yes or no) questions which are related to the symptoms of BPD. If the sufferer answers “yes” to 5 or more of the questions then a diagnosis can be made.
There’s a large range of treatments for BPD which can be completed in both inpatient and outpatient settings.
The people I’ve met in my time with BPD say that dialectical behaviour therapy (DBT) is particularly effective. The fundamental goals of DBT are to validate the emotions that a person is feeling, but introduce healthier ways of dealing with those feelings. For instance if a person feels intense rage then the therapist would say that having that rage doesn’t make them a bad person, but there are better ways of dealing with that rage than self-harming.
Mentalisation-based therapy (MBT) is another interesting treatment. Much like cognitive behaviour therapy (CBT), MBT gets the person to think about their thoughts and urges. So, in the same example as before, a person feels intense rage and has the urge to self harm, MBT would get them to stop and question whether that urge is a healthy way of dealing with the rage.
Art therapy is often used in the treatment of people with BPD as a means of getting the person to express feelings which they may not be able to put into words.
Medications such as mood stabilisers and anti-psychotics can also be used to treat symptoms, though they don’t actually treat BPD itself.
If you’re worried about BPD please go and see your GP. If you are thinking about suicide then please also seek proper medical advice or call the Samaritans on 116-123.
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By Richard Francis
