Types of Borderline Personality Disorder and Treatment Options

Current estimates indicate that approximately 1.5% of the adult population in the United States is diagnosed with borderline personality disorder (BPD), with nearly 75% of these cases identified among women. The etiology of BPD is complex and not entirely elucidated, potentially involving genetic predisposition, environmental influences, and biological factors that may affect emotional regulation in the brain. Despite these uncertainties, the clinical presentation of BPD is well-characterized, and there is a range of therapeutic interventions available to manage and treat the disorder effectively. We will now examine the characteristics and treatment modalities of BPD in further detail.

What Is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is characterized by significant difficulty in emotion regulation. Individuals with BPD can experience profound emotional intensity, which can be challenging to stabilize. This condition not only affects the individual internally but also has external manifestations, including impulsive behavior, a fragile self-concept, intense emotional responses, and unstable relationships.

There are four distinct types of BPD, each defined by unique emotional coping mechanisms. It is possible for an individual to exhibit characteristics of more than one type, and the specific presentation may evolve over time. The following sections will delineate each BPD subtype and outline the general approaches to treatment.

Symptoms of Borderline Personality Disorder

Certain core symptoms are often present in those with borderline personality disorder, including a pervasive fear of abandonment and unstable interpersonal relationships. Individuals may also exhibit acute anxiety, irritability, dissociation, prolonged feelings of emptiness, episodic outbursts of anger, a compromised sense of self-identity, and engage in self-harming actions. It is imperative for anyone displaying these symptoms, or recognizing them in a loved one, to seek the guidance of a medical or mental health professional for assessment and support.

Impulsive Borderline Personality Disorder

Impulsivity refers to actions that are hastily executed without adequate consideration of potential consequences, typically characterized by a lack of foresight and a propensity for taking unnecessary risks or engaging in behaviors ill-suited to the situation at hand. Such impetuous decisions are frequently linked to negative outcomes. While impulsivity is observed within the broader population, it is notably prevalent among individuals with borderline personality disorder (BPD). Those with this condition can display a range of impulsive actions, which may include episodes of binge eating, aggressive conduct, or participation in dangerous and self-harmful activities.

Discouraged Borderline Personality Disorder

Often termed "quiet BPD," the discouraged subtype of borderline personality disorder primarily stems from a deep-seated fear of abandonment. Clinicians note its 'quiet' nature due to the internalization of its symptoms. Unlike other forms of BPD, individuals with this subtype are more prone to self-blame, exhibit suicidal tendencies, withdraw socially, and feel estranged even in communal settings. Despite these challenges, they frequently maintain a high level of functioning and achieve success, which can render their condition less visible and more challenging to identify than other BPD subtypes.

Self-Destructive Borderline Personality Disorder

Borderline Personality Disorder (BPD) with self-destructive tendencies can be challenging to identify as it often exhibits symptoms commonly associated with other mental health disorders, such as bipolar disorder. Signs to watch for include abrupt surges in energy, euphoric mood states, and reduced need for sleep.

Patients with self-destructive BPD may engage in substance misuse, participate in hazardous behaviors without due consideration for safety, and display tendencies toward self-injury. Additionally, profound experiences of self-contempt, depressive episodes, pervasive bitterness, erratic self-conception, and emotional instability are indicative of this particular manifestation of BPD.

Petulant Borderline Personality Disorder

Petulant borderline personality disorder is characterized by a constellation of behaviors typically associated with sulky or ill-tempered behavior, but manifested in adults. Individuals with this condition may exhibit irritability, impatience, stubbornness, as well as passive-aggressive tendencies and intense mood fluctuations. Such individuals often struggle with maintaining satisfying relationships and may resort to detrimental and manipulative actions.

Treatment: Psychotherapy

Psychotherapy stands as the cornerstone in the management of borderline personality disorder (BPD). The objectives of therapy remain consistent across different approaches: equipping individuals with strategies to regulate distressing emotions, minimize impulsive behaviours, and enhance interpersonal skills. Several therapeutic modalities, including Dialectical Behavior Therapy, Schema-Focused Therapy, Mentalization-Based Therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), and Transference-Focused Psychotherapy, have demonstrated efficacy to varying degrees in the treatment of BPD.

Treatment: Anti-Anxiety Medication

The administration of anti-anxiety medications in patients with borderline personality disorder (BPD) presents a nuanced therapeutic challenge. While these medications can mitigate symptoms of anxiety associated with BPD, it is important to recognize that their efficacy in treating the core aspects of the disorder remains unclear due to a lack of substantive evidence. Moreover, some studies have indicated that these medications may potentially exacerbate BPD symptoms. Consequently, the decision to use anti-anxiety medications should be made thoughtfully, in close consultation with your healthcare provider, to ensure a tailored approach to treatment is employed.

Treatment: Antidepressants

Developing an effective treatment plan for borderline personality disorder (BPD) requires careful consideration of various factors. The plan must be tailored to the individual’s symptomatic profile and the intensity of those symptoms, under the guidance of a medical professional. In some instances, the treatment strategy may incorporate medications, such as antidepressants, which can alleviate symptoms related to depression, anxiety, and emotional instability. However, it is important to note that these medications may not directly address issues of anger or impulsivity associated with BPD.

Treatment: Antipsychotics

A variety of antipsychotic medications are available to clinicians to support the management of borderline personality disorder (BPD). These medications have proven effective in alleviating symptoms such as anxiety, paranoid ideation, heightened anger, and impulsiveness. Importantly, this is beneficial even though BPD is not typically characterized by psychosis. Nevertheless, the prescription of these antipsychotics requires careful consideration due to potential side effects. Notably, long-term administration may pose a risk of tardive dyskinesia, a condition characterized by involuntary movements in various parts of the body. Therefore, it is paramount for healthcare providers to balance therapeutic benefits with potential adverse effects when considering antipsychotic therapy for patients with BPD.

Treatment: Mood Stabilizers

With an understanding of borderline personality disorder (BPD), it is evident that mood fluctuations are a core concern. Consequently, medications designed to stabilize mood are typically the treatment of choice. These pharmaceuticals directly address the emotional dysregulation characteristic of BPD and have proven efficacious, particularly when combined with psychotherapy.

Treatment: Hospitalization

Individuals with Borderline Personality Disorder (BPD) may require hospitalization when there is a substantial risk of self-harm or potential harm to others. In such situations, short-term inpatient care at a certified psychiatric facility is often recommended, as extended hospitalization has not proven to be especially beneficial for BPD treatment. The primary aim of inpatient stays is to ensure patient safety through personalized or group psychotherapy, along with appropriate medication management. Following stabilization, patients typically transition to a partial hospital program or outpatient care for ongoing treatment.

The Takeaway

Borderline personality disorder (BPD) is a complex and significant mental health condition that can have a profound impact on the lives of those affected and their support networks. Timely and professional intervention is critical to managing the disorder and mitigating potential risks. Contemporary medical approaches, including an array of psychotherapeutic strategies and pharmacological treatments, have been shown to be beneficial in alleviating symptoms and enhancing the well-being of individuals with BPD. Each case requires a tailored approach; it is essential to seek guidance from a mental health professional to determine the most appropriate course of action for oneself or someone else impacted by BPD.