Curriculum · Mental Health / Psychiatry
Borderline personality disorder
What it is
Borderline personality disorder is an Axis II, Cluster B disorder. It represents a pervasive pattern of mood instability, unstable and intense interpersonal relationships, impulsivity, inappropriate or intense anger with lack of control of anger, recurrent suicidal threats or gestures, self-mutilating behavior, marked and persistent identity disturbance, chronic feelings of emptiness or boredom, and frantic efforts to avoid real or imagined abandonment. Transient paranoid ideation or dissociative symptoms may also be experienced.
Causes and risk
Most researchers believe there is a close association between childhood physical and sexual abuse and this disorder. Forty to seventy-one percent of patients report a history of sexual abuse.
How it presents
Self-mutilating behavior is often the first thing to be seen: linear scars and dime-sized burns on the arms and thighs, from cutting with a utility knife and burning with cigarettes. Such episodes occur when the person gets stressed out and agitated, above all when she perceives that people have abandoned her. A patient may deny that these are suicidal gestures yet admit that she frequently threatens to commit suicide and drives erratically to see if she might get into a life-threatening accident. Relationships are described as out of control, with constant fighting that is often violent, usually over drinking and drug use. Confiding a great deal in one doctor who is liked more than any other, while the rest are called quacks who should not be allowed to practice, is part of the same instability.