Borderline syndrome or borderline disorder is a mental illness from the field of personality disorders. Those affected suffer from a lack of social skills. In particular, interpersonal relationships with other people are characterized by pathological instability. Strong mood swings also occur frequently. The view of oneself (self-image) is subject to strong distortions. Anxiety disorders, anger and despair are added.
What is borderline syndrome?
Borderline syndrome is a mental illness in which sufferers live in extreme psychological tension that is distressing and diffuse. The exact classification of the syndrome remains controversial to this day. Borderline syndrome generally means “borderline” or “borderline” and initially arose as a term because it was used to group together symptoms that doctors placed between neurotic and psychotic disorder. Initially understood as an embarrassment diagnosis, however, borderline syndrome is now recognized as an independent clinical picture. According to this, borderline syndrome is a specific personality disorder characterized precisely by instability in interpersonal relationships and extreme impulsivity, mood swings and distorted self-image. In addition to the term borderline syndrome, the terms emotionally unstable personality disorder or borderline personality disorder (or BPD for short) are also used in professional jargon.
Causes
The background of borderline personality disorder is not exactly clear. Research has so far been able to establish that the syndrome develops primarily in people who have been sexually abused over a long period of time, experienced strong rejection as a child, were emotionally neglected or were exposed to physical violence. In this respect, borderliners are severely traumatized people who are exposed to extreme states of anxiety. Who and how many people with such trauma have borderline syndrome is not certain because the condition is still not always recognized or accurately diagnosed. However, estimates suggest that 1 to 2 percent of a population is affected on average. Around 70 percent of all those affected are women. Based on this estimate, borderline would be more common than other mental illnesses such as schizophrenia. Genetic causes can also cause borderline syndrome.
Symptoms, complaints, and signs
Borderline patients have difficulty classifying and controlling their own emotions and impulses. They give in to their feelings quickly without weighing possible consequences. These include outbursts of anger, for example, for which even minor reasons are sufficient. Mood swings are also among the typical symptoms: borderliners experience strong emotional storms, which can also be of a positive nature, but are usually short-term and trigger a strong inner restlessness in them. In this context, many patients tend to engage in self-destructive behavior. They “scratch” themselves, i.e., injure their own body parts with knives or razor blades. Self-destruction may also manifest itself in heavy consumption of alcohol or drugs. Patients often take risks on the road or expose themselves to unprotected sexual intercourse. They often threaten suicide or actually attempt to take their own lives. Under stress, there is often a loss of reality. This is referred to as dissociative symptoms, which means that the patients’ perception changes. They perceive their environment as unreal and have the feeling of being alien or detached from themselves. Many patients also experience a persistent sense of emptiness – their lives seem dull and aimless. Similarly, they are often afraid of being alone and enter into relationships, but these often prove unstable due to the symptomatology.
Course
The states of tension in individuals with borderline syndrome are characterized by depression, which appears in almost all borderliners, and the feeling of inner emptiness on the one hand and strong impulsivity on the other. Borderliners have no sense of “normality”, they fluctuate between emotional extremes, live in unstable social relationships and tend to ventilate the strong inner pressure, which can appear suddenly and unfounded, through extreme behaviors. In such cases, it happens that affected persons hurt themselves or put themselves in extreme situations.Typical behaviors include excessive drug use, reckless driving, or balancing on bridge railings. Such high-risk behavior serves to re-stabilize feelings of powerlessness and establish self-empowerment. Borderline individuals are often helpless in the face of their mood swings. The social behavior of people with borderline syndrome is thus difficult to assess, since affective short circuits occur again and again and no impulse control is present, which is often not at all comprehensible to the outside world.
Complications
Physical complications are possible in borderline syndrome if the affected person engages in self-harming or self-injurious behavior. Cuts and burns are common. Due to fear, lack of self-esteem, or other reasons, sufferers do not seek help in a timely manner in all cases. As a result, the wounds can become infected or heal poorly. Damage to muscles and nerves is also possible. Borderline syndrome also carries an increased risk of suicide. Conversely, however, some borderline use such injuries to experience caring. In this case, mental dependence on medical care may develop. However, because the individual frequently seeks medical help in this case, negative consequences of care are also possible, such as hospitalism. Many people with borderline syndrome find it difficult to maintain long-term relationships with others. The symptoms of the personality disorder often lead to conflict. Some affected persons show contradictory behavior in that they want to have close people with them on the one hand, but distance themselves from them on the other. As a result, their actual emotional needs often go unmet. Social isolation is another complication that can develop from ambivalent social behavior. Psychotic or dissociative symptoms can also lead to orientation disorders or temporary inability to act in everyday life. In addition, borderline often co-occurs with other mental health problems, especially anxiety and obsessive-compulsive disorders, posttraumatic stress disorder, substance dependence or harmful substance use, eating disorders, and ADD/ADHD.
When should you see a doctor?
Anyone who recognizes at least five of the following nine typical symptoms of borderline syndrome in themselves should see a doctor:
- Low anger threshold and uncontrollable outbursts of anger that can end in physical violence
- Self-injurious behaviors, such as scratching the skin or inflicting burns, up to and including suicide attempts, drug use, and eating disorders
- Sudden impulse to extreme risk-taking that can be life-threatening, such as speeding on the highway, climbing bridge railings, etc.
- Severe separation and loss anxiety and constant fear of being alone.
- Inner emptiness, persistent boredom and aimlessness.
- Extreme and uncontrollable fluctuations in emotions, with negative phases becoming longer and longer
- Unstable interpersonal relationships due to the constant fluctuation between clinging and rejection, black and white thinking.
- Loss of reality, due to the feeling of being in another world and experiencing feelings detached from oneself
- Identity disorders in the form of sudden uncertainty about who you are and what you can do
Treatment and therapy
There is disagreement in the medical and psychological communities about how to treat borderline syndrome. Psychotherapeutic approaches are generally not considered to have had particularly great results. More successful have been behavioral approaches, in which patients are shown how to form new behavioral patterns in extreme situations and internalize them in the long term. Again, there are different schools of thought, which are more supportive or confrontational. Since traumatic experiences of childhood are expressed in borderline syndrome, special trauma therapies are also recommended, whereby science agrees that re-traumatization should not occur. However, the choice of the right therapy method for borderline syndrome ultimately depends on the person affected. Standardized procedures rarely show the desired effect.In addition, it is always considered particularly helpful to include the social environment in a therapy. Treatments with drugs, the so-called medication, can not treat the borderline syndrome as a whole, but at most combat individual symptoms.
Outlook and prognosis
Borderline personality disorder typically persists for several years. As a rule, borderline personality disorder progresses more mildly with age. In this process, symptoms may recede to the point that the diagnostic criteria for personality disorder are no longer met. Often, however, a residue of symptoms remains. This residue, however, does not have to have a disease value, but can also form part of the normal personality spectrum. At the same time, however, older age is also considered a risk factor for suicide attempts that end in the death of the person affected. Impulsivity, depression, and abuse in early childhood also increase the statistical risk of suicide. In addition, another personality disorder may co-occur with borderline syndrome and reduce the prospect of recovery. Dependent, anxious-avoidant, and paranoid personality disorder are particularly common. If the borderline personality suffers from antisocial personality disorder, the risk of suicide is also increased. However, these are general statements – the individual course of borderline personality disorder may differ from the average. One study showed that six years after diagnosis, one third of patients still suffered from borderline personality disorder. A significant decrease was seen after only two years. The development and dissemination of specific therapies such as dialectical-behavioral therapy (DBT) has led to an improved range of help for patients over the past fifteen years.
Here’s what you can do yourself
Borderline syndrome sufferers can protect themselves from impulsive actions with negative consequences in everyday life by occasionally withdrawing from situations that encourage excessively negative or positive perceptions and actions. For this purpose, regular rest breaks can be considered, during which the affected person disengages from conversations and other interactions for a certain time. During these breaks, however, affected persons should not preoccupy themselves with their perception of events, but rather gain some distance from what has happened – whether it was something good or bad is irrelevant. Various options can be considered for this, which may include listening to loud music, massaging oneself using massage balls, or solving small puzzles. The possibilities for temporary distraction are manifold and can be explored and found by sufferers themselves. Temporarily distancing themselves from feelings about themselves and their environment helps those affected by borderline personality disorder to subsequently re-enter the social role in a more reflective and less impulsive manner. In this way, conflicts that arise – sometimes objectively groundless – can be prevented in advance. The environment of the affected person should also be involved. Communication about what is felt helps all those involved in day-to-day dealings. Regular discussions that follow a certain structure make the emotional more understandable and often allow people with borderline syndrome to better assess and reassess a situation in retrospect.
