Does a Borderline Personality Disorder affect a marriage

Borderline




What is borderline?


Borderline personality disorder (BPD) or the borderline type of emotionally unstable personality disorder is a serious, cross-situation and relatively stable personality disorder. This leads to personal suffering or impaired social functioning. Borderline affects about four in 100 people in the general population. In the clinic, borderline personality disorder is the most common personality disorder.


What are the symptoms?


Internal tension is the guiding symptom of borderline, which allows the disorder to be differentiated from other mental illnesses. Borderline patients describe these states of tension as unbearable states of excitement that can occur suddenly and independently of the situation. Borderline patients can neither name the associated emotions nor initiate adequate actions in response. The only way to end the states of tension in borderlines is through dysfunctional behavior patterns, such as self-damaging or high-risk behavior.



What do borderline patients have trouble with?


Borderline patients have problems with affect regulation and impulse control. They have difficulties in social interaction and in defining their own identity.


1. Affect regulation in borderline

A disorder of affect regulation means that borderline patients have trouble controlling emotions. In addition to the above-mentioned states of tension, the disturbed affect regulation manifests itself in the form of feelings of inner emptiness or a complete lack of feeling perception up to a lack of pain perception. Several contradicting emotions can occur at the same time, for example joy and anger or disgust and excitement. As a result, borderline patients suffer, for example, from mood swings, impulsive emotional outbursts, black-and-white thinking, catastrophizing, fears of persecution, strong despair and feelings of powerlessness. Unfavorable coping strategies can be self-harm, high-risk behavior, suicidality or dissociative states (separation of certain experiences from consciousness). Six out of ten borderline patients report suicide attempts. Self-injurious and self-damaging behaviors can not only serve to reduce tension, but can also be used as a coping strategy for numbness, “to feel yourself again”.


2. Disruption of impulse control in borderline cases

A disturbance of the impulse control in borderline means that actions are carried out out of the situation and without worrying about the consequences. Typical triggers for action impulses from negative emotions, such as anger, fear and despair, are experiences of rejection or fear of abandonment. High-risk behaviors include, for example, binge eating, drug, alcohol or medication abuse, lying, stealing, reckless behavior in traffic, risky sexual or buying behavior.


3. Difficulties in social interaction with borderlines

Difficulties in social interaction, i.e. in dealing with others, are characterized by intensive, yet insecure relationships in Borderline.


What do borderline patients think of themselves?

Borderline patients have an unstable and changeable self-image. They consider themselves to be autonomous and spontaneous, while at the same time they think that they absolutely need the other person and that they cannot be alone. Borderline patients find themselves complicated, worthless, moody, and unlovable to others. The feeling of “being different from others” occurs in borderline patients from childhood or adolescence.


What do borderline patients think of others?

Borderline patients are often suspicious of others. They think others are unreliable, not trying hard, or just trying to take advantage of them. At the same time, they feel dependent on others and experience their closeness as absolutely vital and supportive. The result is a change between overvaluing and devaluing the other.


Borderline patients perceive anger in the other person's face incorrectly or more sensitively than healthy people and are more sensitive to social rejection (ostracism). From an evolutionary point of view, social exclusion poses a deadly threat. Central to borderlines, regardless of environmental conditions, is a profound, lasting feeling of loneliness. Self-devaluation, submission, seeking attachment, or aggression are the response to this feeling. Violent emotional reactions or the demonstration of helplessness and suffering, combined with the hope of obtaining support or being “saved” (“passive activity”), lead to an overload of social contacts, which often results in social rejection. With regard to social relationships, borderline patients find themselves in a vicious circle that is characterized by the constant alternation of seeking closeness and establishing distance.


4. Disturbance of identity

One of the hallmarks of borderline is a disorder of identity, which means that borderline patients have no sense of themselves and do not know who they actually are. The feeling of being a stranger in one's own body or disgust when dealing with it are an expression of a distorted self-perception. In addition to feelings of insecurity and a bad image of themselves, borderline patients find it difficult to form a stable opinion and make decisions.


Is borderline a women's disease?


Research has long erroneously assumed that women are more likely to develop borderline personality disorder than men. The idea that borderline is a woman's disease may have arisen because women are more likely to seek therapeutic help than males. Today, however, we know: the gender ratio in borderline is relatively balanced.


Do all borderliners cut themselves?


Eight out of ten borderline patients report self-harming behaviors. In addition to cuts ("scratching oneself"), the following behaviors are typical self-harm in borderlines:


  • Burn yourself with cigarettes or other hot objects
  • Scalding with hot liquids
  • Cauterization
  • Inflicting stab wounds
  • Strangling
  • Hitting the head against hard surfaces

In about 80 percent of cases, analgesic conditions occur, which means that patients do not experience any pain before or during the self-harm. Not all borderline patients injure themselves. Some patients only show high-risk behaviors to regulate states of tension.


What happens in the brain with borderline?


In connection with borderline Limbic system and parts of the brain in the forehead area (prefrontal cortex) examined. These brain areas play a central role in the processing of feelings and thoughts (cognitions) and influence processing processes that have to do with motivation and movement. In borderline patients, it was found that certain areas in the brain (amygdala and hipocampus) are less pronounced. It is believed that the changes in brain structures are related to traumatic events and chronic stress. The Amygdala is part of the limbic system and participates in the development, recognition and physical reaction to fear.

Borderline patients rate negative stimuli or environmental events that have an emotional component more quickly as relevant. As a result, patients with a borderline personality disorder react to weak stimuli with physical activation (increased affective arousal). Borderline patients are therefore more vulnerable and more susceptible to stress. They show reactions that appear inappropriate to the environment. The disturbances in the evaluation of stimuli and the subsequent reactions can be traced back to the reduced activity of the prefrontal cortex.

In addition to the tendency of borderline patients to get into states of high tension, these states of tension subside less quickly than would be the case with healthy people.


How can borderline be treated?


Borderline patients can learn to deal with their illness with the help of psychotherapy. The prerequisite for this is a detailed diagnosis by an expert who, taking into account accompanying illnesses (comorbidities) and the current living conditions, develops an individual treatment plan in cooperation with the borderline sufferer.

Depending on the severity of the acute symptoms, psychotherapy can be carried out on an inpatient, day-patient or outpatient basis. Patients often receive a combination of individual and group therapy. So-called skill training is suitable for dealing with states of tension. In the process, skills are learned which, in acute states of tension, immediately relieve tension and improve symptoms, but do not harm the borderline patient in the long term.


The following therapeutic methods are suitable for the treatment of borderlines:

  • Dialectical Behavioral Therapy (DBT)
  • Schema-focused therapy (SFT)
  • Mentalization-Based Therapy (MBT)
  • Transfer-focused psychotherapy (TFP)

In addition to psychotherapy, drug treatment can be useful.


Literature:


Bohus, M. (2002). Borderline disorder. Hogrefe Publishing House.


Bohus, M., & Kröger, C. (2011). Psychopathology and psychotherapy of borderline personality disorder. The neurologist, 82 (1), 16-24. Online: http://link.springer.com/article/10.1007/s00115-010-3126-1, accessed on February 9, 2016


Bohus, M., & Wolf-Arehult, M. (2011). Interactive skills training for borderline patients. Schattauer Verlag.


Fleischhaker, C., Böhme, R., Sixt, B., & Schulz, E. (2005). Suicidality, parasuicidality, and self-harming behaviors in patients with symptoms of borderline disorder: First data from a pilot study on dialectical behavioral therapy for adolescents (DBT-A). Childhood and Development, 14 (2), 112-127.


Herpertz, S. C. (2011). Contribution of neurobiology to the understanding of borderline personality disorder. The neurologist, 82 (1), 9-15. Online: http://link.springer.com/article/10.1007%2Fs00115-010-3127-0#/page-1, accessed on February 16, 2016


Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364 (9432), 453-461. Online: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16770-6/abstract, accessed on February 16, 2016


Sendera, A., & Sendera, M. (2010). Borderline-the other way to feel: understand and live relationships. Springer publishing house. Online: http://www.springer.com/us/book/9783211997116#otherversion=9783211997109, accessed on February 16, 2016


van Elst, L. T., Hesslinger, B., Thiel, T., Geiger, E., Haegele, K., Lemieux, L., ... & Ebert, D. (2003). Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biological psychiatry, 54 (2), 163-171. Online: http://www.biologicalpsychiatryjournal.com/article/S0006-3223(02)01743-2/abstract, accessed on February 16, 2016




Important NOTE: This article contains only general information and descriptions on the topic of borderline disease. It is not suitable for self-diagnosis or self-treatment and under no circumstances can it replace a doctor's visit.

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