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Borderline personality disorder: Difference between revisions

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{{Infobox medical condition (new)
| name = Borderline personality disorder
| image = File:Despair Edvard Munch 1894- The Brooch. Eva Mudocci - Google Art Project.jpegjpg
| image_size =280px
| caption = ''Despair[[Idealization and devaluation|Idealization]]'' by [[Edvard Munch]] (1894), who is presumed to have had borderline personality disorder<ref>{{cite book|title=Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art|trans-title=Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder|isbn=978-87-983524-1-9| vauthors = Aarkrog T |year=1990|publisher=Lundbeck Pharma A/S|location=Danmark}}</ref><ref>{{cite journal | vauthors = Wylie HW | title = Edvard Munch | journal = The American Imago; A Psychoanalytic Journal for the Arts and Sciences | volume = 37 | issue = 4 | pages = 413–443 | year = 1980 | pmid = 7008567 | url = https://www.jstor.org/stable/26303797 | publisher = [[Johns Hopkins University Press]] | jstor = 26303797 | access-date = 10 August 2021 | archive-date = 10 August 2021 | archive-url = https://web.archive.org/web/20210810104208/https://www.jstor.org/stable/26303797 | url-status = live }}</ref>▼
| alt = This is a painting featuring a figure standing on a bridge, gazing down, seemingly lost in thought. The background consists of a dramatic, swirling sky with striking red, yellow, and blue colors. The figure is dressed in dark clothing, and their posture and the expression on their face convey a sense of melancholy or introspection. The contrast between the vibrant sky and the subdued figure adds to the emotional impact of the scene. The artwork has an expressive, somewhat abstract style, characteristic of Edvard Munch's work.
▲| caption = ''Despair'' by [[Edvard Munch]] (1894), who is presumed to have had borderline personality disorder<ref>{{cite book|title=Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art|trans-title=Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder|isbn=978-87-983524-1-9| vauthors = Aarkrog T |year=1990|publisher=Lundbeck Pharma A/S|location=Danmark}}</ref><ref>{{cite journal | vauthors = Wylie HW | title = Edvard Munch | journal = The American Imago; A Psychoanalytic Journal for the Arts and Sciences | volume = 37 | issue = 4 | pages = 413–443 | year = 1980 | pmid = 7008567 | url = https://www.jstor.org/stable/26303797 | publisher = [[Johns Hopkins University Press]] | jstor = 26303797 | access-date = 10 August 2021 | archive-date = 10 August 2021 | archive-url = https://web.archive.org/web/20210810104208/https://www.jstor.org/stable/26303797 | url-status = live }}</ref>
| field = [[Psychiatry]], [[clinical psychology]]
| synonyms = {{collapsible list|title={{pad}}|{{plainlist|
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===Interpersonal relationships===
Interpersonal relationships are significantly impacted in individuals with BPD, characterized by a heightened sensitivity to the behavior and actions of others. Individuals with BPD can be very conscious of and susceptible to their perceived or real treatment by others. Individuals may experience profound happiness and gratitude for perceived kindness, yet feel intense sadness or anger towards perceived criticism or harm.<ref name="cogemo">{{cite journal | vauthors = Arntz A | title = Introduction to special issue: cognition and emotion in borderline personality disorder | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 36 | issue = 3 | pages = 167–72 | date = September 2005 | pmid = 16018875 | doi = 10.1016/j.jbtep.2005.06.001 }}</ref> A notable feature of BPD is the tendency to engage in [[idealization and devaluation]] of others – that is to idealize and subsequently devalue others – oscillating between extreme admiration and profound mistrust or dislike.<ref>{{harvnb|Linehan|1993|page=146}}</ref> This pattern, referred to as "[[Splitting (psychology)|splitting]]," can significantly influence the dynamics of interpersonal relationships.<ref>{{cite web |title=What Is BPD: Symptoms |url=http://www.borderlinepersonalitydisorder.com/understading-bpd/ |access-date=31 January 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130210110927/http://www.borderlinepersonalitydisorder.com/understading-bpd/ |archive-date=10 February 2013 }}</ref><ref name="Robinson">{{cite book | vauthors = Robinson DJ | title = Disordered Personalities| publisher = Rapid Psychler Press| year = 2005| pages =255–310| isbn = 978-1-894328-09-8}}</ref> In addition to this external "[[Splitting (psychology)|splitting]]," patients with BPD typically have internal splitting, i.e. vacillation between considering oneself a good person who has been mistreated (in which case anger predominates) and a bad person whose life has no value (in which case self-destructive or even suicidal behavior may occur). This splitting is also evident in black-and-white or all-or-nothing dichotomous thinking.<ref name="Gund2011" />
 
Despite a strong desire for intimacy, individuals with BPD may exhibit insecure, avoidant, ambivalent, or fearfully preoccupied [[Attachment theory#Attachment patterns|attachment styles]] in relationships, complicating their interactions and connections with others.<ref>{{cite journal | vauthors = Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF | title = Attachment and borderline personality disorder: implications for psychotherapy | journal = Psychopathology | volume = 38 | issue = 2 | pages = 64–74 | year = 2005 | pmid = 15802944 | doi = 10.1159/000084813 | s2cid = 10203453 }}</ref> Family members, including parents of adults with BPD, may find themselves in a cycle of being overly involved in the individual's life at times and, at other times, significantly detached,<ref name="parents">{{cite journal | vauthors = Allen DM, Farmer RG | title = Family relationships of adults with borderline personality disorder | journal = Comprehensive Psychiatry | volume = 37 | issue = 1 | pages = 43–51 | year = 1996 | pmid = 8770526 | doi = 10.1016/S0010-440X(96)90050-4 }}</ref> contributing to a sense of alienation within the family unit.<ref name="Gund2011">{{cite journal | vauthors = Gunderson JG | title = Clinical practice. Borderline personality disorder | journal = The New England Journal of Medicine | volume = 364 | issue = 21 | pages = 2037–2042 | date = May 2011 | pmid = 21612472 | doi = 10.1056/NEJMcp1007358 | hdl = 10150/631040 | hdl-access = free }}</ref>
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====Dissociation====
Researchers disagree about whether dissociation, or a sense of [[emotional detachment]] and physical experiences, impacts the ability of people with BPD to recall the specifics of past events. A 1999 study reported that the specificity of [[autobiographical memory]] was decreased in BPD patients.<ref name="Startup">{{cite journal | vauthors = Jones B, Heard H, Startup M, Swales M, Williams JM, Jones RS | title = Autobiographical memory and dissociation in borderline personality disorder | journal = Psychological Medicine | volume = 29 | issue = 6 | pages = 1397–1404 | date = November 1999 | pmid = 10616945 | doi = 10.1017/S0033291799001208 | s2cid = 19211244 | df = dmy-all }}</ref> The researchers found that decreased ability to recall specifics was correlated with patients' levels of dissociation, which 'may help them to avoid [[episodic memory|episodic]] information that would evoke acutely negative [[affect (psychology)|affect]]'.<ref name = "Startup" />
 
====Lying as a feature====
Some theorists argue that patients with BPD often lie. However, others write that they have rarely seen lying among patients with BPD in clinical practice.<ref name="Linehan 1993, p.17">{{harvnb|Linehan|1993|page=17}}</ref>
 
===Gender===
{{seealso|Gender differences in suicide}}
 
In a clinic, up to 80% of patients are women, but this might not necessarily reflect the gender distribution in the entire population.<ref>{{cite book |title=Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice |vauthors=Paris J |publisher=The Guilford Press |year=2008 |page=21}}</ref> According to Joel Paris, the primary reason for gender disparities in clinical settings is that women are more likely to develop symptoms that prompt them to seek help. Statistics indicate that twice as many women as men in the community experience depression. Conversely, men more frequently meet criteria for [[substance use disorder]] and [[psychopathy]], but tend not to seek treatment as often. OtherAdditionally, researchersmen haveand suggestedwomen thatwith differencessimilar insymptoms gendermay preponderancemanifest ofthem BPDdifferently. mayMen emergeoften dueexhibit tobehaviors mensuch beingas moreincreased likelyalcohol thanconsumption womenand tocriminal beactivity, diagnosedwhile withwomen othermay overlappinginternalize anger, leading to conditions like depression and self-harm, such as ASDcutting <ref>{{citeor journal|overdosing. volumeHence, =the 57|gender issuegap =observed 2|in pages[[antisocial =personality 181–196|disorder]] vauthorsand =borderline Gillettpersonality Gdisorder, Leaveswhich L,may Patelshare A,similar Prisecaruunderlying A,pathologies Spainbut D,present Happedifferent Fsymptoms |influenced titleby =gender. TheIn prevalencea ofstudy autismexamining spectrumcompleted disordersuicides traitsamong andindividuals diagnosisaged in18 adultsto and35, young30% of the suicides were attributed to people with personalityBPD, disorders:with Aa systematicmajority review|being journalmen =and Austalmost Nnone Zreceiving Jtreatment. Psychiatry|Similar access-datefindings =were 29reported Augustin 2024|another yearstudy.<ref name="Paris 2023|J url2008 =21–22" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9896258/}}</ref>.
 
Additionally, men and women with similar symptoms may manifest them differently. Men often exhibit behaviors such as increased alcohol consumption and criminal activity, while women may internalize anger, leading to conditions like depression and self-harm, such as cutting or overdosing. Hence, the gender gap observed in [[antisocial personality disorder]] and borderline personality disorder, which may share similar underlying pathologies but present different symptoms influenced by gender. In a study examining completed suicides among individuals aged 18 to 35, 30% of the suicides were attributed to people with BPD, with a majority being men and almost none receiving treatment. Similar findings were reported in another study.<ref name="Paris J 2008 21–22" />
 
In short, men are less likely to seek or accept appropriate treatment, more likely to be treated for symptoms of BPD such as substance use rather than BPD itself (the symptoms of BPD and ASPD possibly deriving from a similar underlying etiology); more likely to wind up in the correctional system due to criminal behavior; and, more likely to commit suicide prior to diagnosis.
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=== Awareness ===
Awareness of BPD has been growing, with the [[U.S. House of Representatives]] declaring May as Borderline Personality Disorder Awareness Month in 2008.<ref>{{cite news|url= http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml |title= BPD Awareness Month – Congressional History |work= BPD Today |publisher= Mental Health Today |access-date= 1 November 2010 |url-status=dead |archive-url= https://web.archive.org/web/20110708083602/http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml |archive-date= 8 July 2011 |df= dmy-all }}</ref> People with BPD will share their personal experiences of living with the disorder on social media to raise awareness of the condition. <ref>{{cite news|url= https://bpd-aware.com/when-is-bpd-awareness-month/ |title= When is BPD Awareness Month? |publisher= BPD-Aware}}</ref>

Public figures like South Korean singer-songwriter [[Lee Sunmi]] have opened up about their personal experiences with the disorder, bringing further attention to its impact on individuals' lives.<ref>{{cite web|vauthors=Kim E|date=16 December 2020|title=선미 고백한 '경계선 인격장애' 뭐길래?|trans-title=What is the 'borderline personality disorder' that Sunmi confessed to?|language=Korean|url=https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|publisher=[[Naver TV]]|access-date=16 December 2020|archive-date=6 February 2021|archive-url=https://web.archive.org/web/20210206162916/https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|url-status=live}}</ref>
 
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