Co-morbidity

A number of other psychiatric disorders can occur together with the borderline disorder. In various clinical studies, it has been found that almost all patients meet the criteria of depression at least once during their lives. Almost 90% fulfilled the criteria of an anxiety disorder and more than half had an eating disorder or drug abuse. There was also a high probability of developing another personality disorder in addition to the emotionally unstable one.

Features /Symptoms

At least five of the following nine characteristics are typical for borderliners: The people concerned can hardly bear to be alone, they want to avoid separations at all costs. This means that they feel enormous anxiety in all relationships (whether with parents, friends or partner), whether it is just when you arrive late for an appointment or forget a promised phone call. Sometimes the affected persons become “preventive” out of fear of being hurt, as if to avoid an attack from others.

Relationships that lead borderliners to other people are enormously intense but just as unstable. Here hate and love alternate very often, i.e. the partner is idealised in an exaggerated way. A short time later, however, it only takes small things to bring about a change in the emotional world.

The affected persons also have a disturbed identity, in the sense of a distorted to false self-perception. They do not really know themselves, neither their own strengths/weaknesses nor what reassures or stimulates them. People who suffer from Borderline Syndrome are very impulsive.

They have difficulties in correctly assessing losses and risks. This manifests itself in everyday life e.g. through risky sexual practices, drug and excessive alcohol consumption, excessive spending of money, “gluttony” or very dangerous sports. Borderliners are also conspicuously unbalanced, irritable and their moods fluctuate greatly.

Sometimes a wrong word is enough to make them feel violently emotional. They often feel emotionally empty and bored. This also explains another symptom, namely the tendency to hurt themselves.

Borderline patients suffer so much from themselves or their disorder and the above-mentioned numbness that they express themselves, for example, a still burning cigarette on their skin, beat themselves or scratch themselves with razor blades in order to feel themselves again. The emotional emptiness, however, increases the borderliners’ perception that only other people make their own lives meaningful. Borderliners also have a lack of impulse control in that they cannot always suppress intense anger.

Those affected can hardly bear to be alone, they want to avoid separations at all costs. This means that they feel enormous anxiety in all relationships (whether with parents, friends or partner), whether it is just when you arrive late for an appointment or forget a promised phone call. Sometimes the affected persons become “preventive” out of fear of being hurt, as if to avoid an attack from others.
Relationships that lead borderliners to other people are enormously intense but just as unstable. Here hate and love alternate very often, i.e. the partner is idealised in an exaggerated way. A short time later, however, it only takes small things to bring about a change in the emotional world.
The affected persons also have a disturbed identity, in the sense of a distorted to false self-perception. They do not really know themselves, neither their own strengths/weaknesses nor what reassures or stimulates them. – People who suffer from Borderline Syndrome are very impulsive.

They have difficulties in correctly assessing losses and risks. This manifests itself in everyday life e.g. through risky sexual practices, drug and excessive alcohol consumption, excessive spending of money, “gluttony” or very dangerous sports. – Borderliners are also conspicuously unbalanced, irritable and their moods fluctuate greatly.

Sometimes a wrong word is enough to make them feel violently emotional. – They often feel emotionally empty and bored. – This also explains another symptom, namely the tendency to hurt themselves.

Borderline patients suffer so much from themselves or their disorder and the above-mentioned numbness that they express themselves, for example, a still burning cigarette on their skin, beat themselves or scratch themselves with razor blades in order to feel themselves again. The emotional emptiness, however, increases the borderliners’ perception that only other people make their own lives meaningful. – Borderliners also have a lack of impulse control in that they cannot always suppress intense anger.

Those affected have phases in which they distrust everyone and withdraw strongly. Fatigue is an extremely unspecific symptom, it can occur in almost all mental and physical illnesses and can also occur in complete health. It is not an indicative symptom for the presence of a borderline disease.

Rather a feeling of inner emptiness is typical and is often described by affected patients. However, fatigue can of course also occur in patients suffering from borderline personality disorder. When talking about a borderline personality disorder, self-harming behaviour is probably the first thing most people associate with this disorder.

The most common type of self-injury is the skin injury known as scratching. The injuries are often inflicted with razor blades or other sharp objects, often in the area of the inner side of the forearm. Initially, the injuries are recognizable as numerous relatively straight, bloody scratches, and depending on how deep the injuries are, scars often remain.

This then shows up in the form of numerous white lines, mostly arranged crosswise. However, these injuries can also occur on all other parts of the body. Borderline patients often describe that they feel better again through such self-injuries, that they are better able to drive away the often existing inner emptiness or that they reduce inner tensions by scratching.

Borderline patients are said to have a tendency to lie. This fits into the overall concept that affected people tend to manipulate their environment in order to achieve the goal they have set themselves. Especially for the maintenance of a relationship, borderline patients often use lies to avoid being abandoned, which they often fear so much.

Talking about lying and manipulation here sounds like something very deliberate. However, it is not uncommon for these behaviours to be backed up by a strong fear that leads to the use of such means. A therapy with a psychologist or psychiatrist is absolutely necessary in case of a borderline disease.

Unfortunately, it does not ‘cure’ the affected person in a short time (there is no medication against the borderline syndrome either, only individual symptoms/phases of the illness such as depression or similar can be alleviated by medication). Psychotherapy is the method of choice in this context, but often only brings lasting improvement for those affected after a long period of time, when the causes and triggers of the disease have been identified and dealt with. In the large field of psychotherapy there are many different types of therapy, several of which can also be considered for borderline disease: One therapy of choice in the case of borderline is behavioral therapy.

In this therapy, the focus is on guiding the patient to the point where he learns to understand what triggers his complaints. In concrete terms, this means that the patient is made aware that behaviour is determined by recognising and assessing things and situations. If, for example, a patient reacts to a non-toxic snake with hysteria and excessive fear, this is due to an exaggerated assessment of the snake’s danger.

The central theme of behavioural therapy is that the person concerned faces up to his or her fears or situations that he or she is trying to avoid (often only in simulated moments) and that the wrong assessment is forgotten. In this way, the affected person gains the self-control he needs to be able to face these unpleasant situations. Help can also bring conversational psychotherapy to people suffering from Borderline Syndrome according to C. Rogers.

Here, less conflicts from childhood are dealt with, but more everyday situations and problems of the affected person are brought into focus. The basic assumption of this form of therapy is that a major source of everyday suffering in the lives of these people comes from the fact that their desired image of themselves and their desired appearance/behaviour (so-called self-concept) collides or does not coincide with unwanted behaviour patterns in certain situations (e.g. enormous excitement and embarrassment when meeting a celebrity). The aim here is to make it clear to these people that a so-called incongruity (i.e. a difference) between self-concept and actual occurrence in some situations is completely normal and not pathological.

The therapy form of analytical psychotherapy is used very often. Like classical psychoanalysis, it is based on the assumptions of the famous Sigmund Freud. The basic idea of analytical psychotherapy is that conflicts experienced in childhood have not been completely processed and can still lead to problems and behavioural problems in adulthood.

Here, therefore, childhood development is traced and illuminated very precisely with the aim of coming to terms with unresolved conflicts. In contrast to this, classical psychoanalysis assumes, however, that the behaviour patterns once learned in childhood for interpersonal relationships and also for conflict resolution are stored in the subconscious and cannot be modified in adulthood. Another possible form of therapy is psychotherapy based on depth psychology.

It is also based on assumptions of psychoanalysis, but focuses not so much on conflicts from childhood but on current problems and changes in behaviour in everyday life. The most important pillar in the treatment of borderline personality disorder is psychotherapy. However, additional drug treatment is also possible and is used for most patients.

However, there is no medication for the treatment of borderline personality disorder with which the symptoms can be completely suppressed. There are, however, different drug options. Which of these is most suitable depends strongly on which symptoms are the most important in the context of the disease for the individual patient.

In Germany, no drugs are officially approved for the treatment of borderline disorders. This does not necessarily mean that there are no medications that can help, but rather that the number of studies on the positive effects of drug therapy has not been sufficient. Since there are no officially approved drugs, the use of drugs in the disease is called off-label use.

For the drug treatment of the borderline personality disorder over a longer period of time, psychotropic drugs from the group of mood stabilisers are mainly used. These include active ingredients such as lamotrigine, topiramate and valproate/valproic acid. The antipsychotic drug aripiprazole is also said to be effective in the treatment of borderline disease.

Antidepressants from the group of the so-called SSRIs were used more frequently in the past, but studies have shown that they are not sufficiently effective unless there is also a depressive component, so that this group of drugs should no longer be used. However, it should be emphasised that all psychotropic drugs listed here should – if at all – be used exclusively in combination with disorder-specific psychotherapy in order to achieve satisfactory treatment results. Furthermore, the success of treatment varies greatly from patient to patient, so that different treatment concepts must be tested in some cases. However, psychotherapy is currently still the first line of treatment for borderline personality disorder.