For 24-year-old Azra*, living with Borderline Personality Disorder is a roller coaster ride of highs and lows. One moment she feels contented and happy that people love her, and the very next moment she reacts aggressively to petty issues. Her constant state of upheaval and impulsiveness disturbs her routine life and activities and makes it difficult for her loved ones to cope with her as she pushes them away. Azra even attempted suicide once and finally her family sought professional help. However, not every person with this disorder is fortunate to escape the trauma and many end up taking their own lives.
Borderline Personality Disorder (BPD) is one of the most lethal mental ailments and according to American Psychiatrist Association approximately eight to ten per cent of patients actually commit suicide. A December 2008 study by the National Institute of Mental Health, US says that BPD is more common but lesser known than schizophrenia and bipolar disorder. Although, the right treatment is available, unfortunately the stigma associated with mental illnesses, discrimination, as well as lack of awareness stop people from getting help. As a result, majority of the patients remain untreated.
Dr Abdul Wahab Yousafzai, Consultant Psychiatrist, Aga Khan University Hospital defines Borderline Personality Disorder according to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as: ‘A pervasive pattern of instability of interpersonal relationships, problems with self image and emotions accompanied by marked impulsivity, beginning by early adulthood and present in a variety of contexts.’ Although, it is completely normal to feel moody, if the mood swings become too frequent or unbearable, then there is a dire need to recognise symptoms and seek professional help.
Patients of BPD recurrently show symptoms of extreme emotions and mood swings that can last for a few hours to a day. They are capable of inflicting injury on themselves, suffer anger fits when experiencing negative emotions, feel isolated and clueless, lack a sense of self or identity.
Moreover, they are extremely sensitive towards criticism and feel that they have been misunderstood or mistreated by those around them who they regard as enemies. They also feel abandoned when loved ones leave them even for a short period. They are prone to excessive spending, recklessness and binge eating. According to experts, 50 to 70 per cent of patients succumb to substance abuse.
Previously regarded on the ‘borderline’ of neurosis and psychosis and therefore named so, BPD often occurs alongside other mood disorders such as bipolar disorder making it very tricky for experts to diagnose the ailment and distinguish it from others. However, according to Dr Wahab, BPD shows a discernible reactivity of mood with sleep and appetite which is not hampered much. “Bipolar disorder, on the other hand, acutely disturbs both sleep and appetite patterns and is more pervasive with a marked non-reactivity of mood. Suicidal behaviour, however, is the core point of diagnosis,” he said.
Studies show that women (mostly young) are three times more vulnerable to BPD than men. This could be due to pregnancy, premenstrual syndrome, puberty, menopause, socio-cultural expectations or perceived roles. However, the disorder is not diagnosed in children or adolescents because people below 18 are still developing their personalities.
Dr Wahab while discussing the etiology of the disorder says, “Generally patients have a vulnerable temperament and might have had a history of disturbing childhood or early adulthood with traumatic experiences like sexual abuse. Environmental stress — like wrong lifestyles or partners may also play a major role.”
The first step when treating BPD is to keep a track of negative mood changes and how often they occur. Experts suggest it is better to maintain a mood diary in which activities and events can be jotted down. This will give a clear picture as to what distresses the patient and help to avoid such situations. Discussions with the consultant in order to determine the appropriate treatment also helps. The treatment can vary from person to person depending on the severity of their condition. Sometimes, simply changing diet, sleep patterns and unhealthy lifestyle make the difference.
When a patient experiences negative emotions they need to try and calm down by deep breathing, focusing either on their breathing or on the surroundings to distract themselves. If attempts fail and the condition worsens, then it is imperative to consult a specialist. Clinical treatment involves different psychotherapies, the most common being Dialectical Behaviour Therapy (DBT), medications consisting of mood stabilisers, antidepressants and antipsychotic drugs. There are other approaches as well, again depending on the condition of the patient.
Studies by the World Heath Organisation (WHO) show that sometimes the level of stigma against mental health is surprisingly higher in urban areas among the educated. However, what we need to understand is that many precious lives can be saved and people can lead happier and productive lives by regaining emotional stability, as long as it is addressed head on and the patients are not ostracised.