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Borderline personality disorder (BPD) can cause a wide range of symptoms, which can be broadly grouped into 4 main areas. The 4 areas are: Each of these areas is described in more detail below. If you have BPD, you may experience a range of often intense negative emotions, such as: You may have severe mood swings over a short space of time. It's common for people with BPD to feel suicidal with despair, and then feel reasonably positive a few hours later. Some people feel better in the morning and some in the evening. The pattern varies, but the key sign is that your moods swing in unpredictable ways. If you have suicidal thoughts: If you've been diagnosed with BPD, tell someone you trust about your condition. Give this person the contact details of your care team and ask him or her to contact the team if they become concerned about your behaviour. Different types of thoughts can affect people with BPD, including: These types of beliefs may be psychotic and a sign you're becoming more unwell. It's important to get help if you're struggling with delusions. If you have BPD, there are 2 main types of impulses you may find extremely difficult to control: If you have BPD, you may feel that other people abandon you when you most need them, or that they get too close and smother you. When people fear abandonment, it can lead to feelings of intense anxiety and anger. You may make frantic efforts to prevent being left alone, such as:
Alternatively, you may feel others are smothering, controlling or crowding you, which also provokes intense fear and anger. You may then respond by acting in ways to make people go away, such as emotionally withdrawing, rejecting them or using verbal abuse. These 2 patterns may result in an unstable "love-hate" relationship with certain people. Many people with BPD seem to be stuck with a very rigid "black-white" view of relationships. Either a relationship is perfect and that person is wonderful, or the relationship is doomed and that person is terrible. People with BPD seem unable or unwilling to accept any sort of "grey area" in their personal life and relationships. For many people with BPD, emotional relationships (including relationships with professional carers) involve "go away/please don't go" states of mind, which is confusing for them and their partners. Sadly, this can often lead to break-ups.
Page last reviewed: 17 July 2019 Synonym: borderline personality disorder This article refers to the International Classification of Diseases 10th edition (ICD-10) which depicted different types of personality disorder, including emotionally unstable personality disorder. However, the recently published ICD-11 classification does not identify the different types because of overlap between them, and instead focuses on personality traits and severity[2]. See the separate article on Personality Disorders for further details. Emotionally unstable personality disorder was one of ten personality disorders defined in the ICD-10 classification system. Emotionally unstable personality disorder is characterised by pervasive instability of interpersonal relationships, self-image and mood and impulsive behaviour. The cause of emotionally unstable personality disorder is unknown but research suggests there is an interaction between adverse life events and genetic factors. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms[3]. Emotionally unstable personality disorder causes significantly impaired functioning, including a feeling of emptiness, lack of identity, unstable mood and relationships, intense fear of abandonment and dangerous impulsive behaviour, including severe episodes of self-harm. There is a pattern of sometimes rapid fluctuation from periods of confidence to despair[4]. People with emotionally unstable personality disorder are particularly at risk of suicide[3]. Transient psychotic symptoms, including brief delusions and hallucinations, may also be present. It is also associated with substantial impairment of social, psychological and occupational functioning and quality of life. Its course is variable and, although many people recover over time, some people may continue to experience social and interpersonal difficulties. The important feature of emotionally unstable personality disorder is a pervasive pattern of unstable and intense interpersonal relationships, self-perception and moods. Impulses are poorly controlled. At times they may appear psychotic because of the intensity of their distortions. The ICD-10 classification identified two subtypes - impulsive type and borderline type. The criteria were as follows: The general criteria of personality disorder (F60) must be met. F60.30 Impulsive typeThe predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others. F60.31 Borderline typeSeveral of the characteristics of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).
Patients with the disorder can present with:
NICE guidance to inform clinical commissioning groups has been published to guide the commissioning of services for people with emotionally unstable personality disorder and dissocial disorder. This draws on prevailing guidance on a large body of resources, encompassing such issues as avoiding the integration of services, wider determinants of health and reducing the delay in the provision of care and support[6]. General considerationsCare should involve collaboration between different agencies and professionals. Teams working with people with emotionally unstable personality disorder should develop a comprehensive multidisciplinary care plan with the service user (and their family or carers, where agreed with the person). The care plan should:
Psychotherapy is a helpful mode of treatment in emotionally unstable personality disorder, although no specific type of therapy seems better than another[3]. It is important however NOT to use brief psychological interventions (of less than three months in duration) for emotionally unstable personality disorder or for the individual symptoms of the disorder outside a service that has the characteristics outlined below. Psychological treatment for people with emotionally unstable personality disorder (especially those with multiple comorbidities and severe impairment) should include:
Drug treatment
Management in primary care
The course of emotionally unstable personality disorder is variable and, although many people recover or improve over time, many continue to experience social and interpersonal difficulties. There is evidence that novel indicated prevention and early intervention programmes may be useful in reducing the risk of developing emotionally unstable personality disorder. Indicated prevention involves identifying individuals who exhibit early signs of early conduct problems and/or have an increased risk for a disorder but currently do not have a diagnosable disorder. Early intervention programmes involve a system of co-ordinated services that promotes a child's age-appropriate growth and development and supports families during the critical early years. This approach is promising but requires further research.
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