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Nick Taylor Instructor: Malcolm Campbell English 1103 11/7/2012 Peer Reviewed by Jordan Dai What is Borderline Personality Disorder and What are Ways to Treat it? When I was in high school, Friday night was the night that my friends and I went to parties. One of the main reasons I enjoyed going to these parties was because there was always new people to meet. Back in the winter of my senior year I met a girl at one of these parties that would have a profound effect on my life. Her name was Jessica and the first thing I noticed about her was how pretty she was and that she had a fun and very outgoing personality. We talked a lot at the party and exchanged phone numbers. We talked and texted each day after that, getting to know each other better. She told me that she had gotten addicted to drugs when she was thirteen and that her parents sent her off to rehab when she was sixteen. I didnt think much of it because all that mattered to me was that she was off drugs now and she seemed to be very happy. As time went on we became extremely close friends. As I came to know her better I noticed that she would go through phases where she would be extremely depressed for no apparent reason. She would also get angry at me over little things -- things that I didnt think should make people that upset. Finally, after a few months, Jessica told me that she has a disorder called Borderline Personality Disorder and that this was the reason for her behavior. Jessica and I are now best friends and I care about her more than anything. This is why I wanted to find out more about Borderline Personality Disorder (BPD) so that I can better help her and myself. First off, what exactly is BPD? What are all of the side-effects? How does it affect the

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person who has it? In PsychCentral, John Grohol, a psychologist, broadly describes BPD as being a pervasive pattern of instability in interpersonal relationships, self-image, and emotions (Grohol). He goes on to describe those with the disorder as being impulsive, having a fear of abandonment, having an unstable self-image, and having suicidal and self-mutilating thoughts or actions (Grohol). In an article on BPD, Duncan Cartwright quotes the DSM-IV-TR describing the criteria that a psychologist or a psychiatrist would use for diagnosing someone with this disorder: 1. Affective instability due to marked reactivity (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours) 2. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 3. Chronic feelings of emptiness 4. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior 5. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) 6. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 7. Frantic efforts to avoid real or imagined abandonment 8. Identity disturbance: markedly and persistently unstable self-image or sense of self 9. Transient, stress-related paranoid ideation or severe dissociative symptoms In order for a psychiatrist or a psychologist to diagnose a patient with BPD, five of the nine listed criteria above must be met (Cartwright). Borderlines cannot properly calibrate their emotions or behavior. If something happens

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that hurts their feelings, sometimes they may become inconsolable or extremely angry, even if the thing that hurt their feelings was something small (Cloud). I can think of many times when Jessica has gotten upset or angry at me when I may had said something jokingly that was meant to be funny but it hurt her feelings and made her angry instead. There was one instance where I did something that I probably shouldnt have done but it wasnt anything major, at least it wasnt anything major in my eyes. But to Jessica it was a huge deal and she didnt talk to me for a few weeks as a result. A great quote about the sensitivity of people with BPD comes from Marsha Linehan who is a psychologist from the University of Washington. Linehan says, "Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering" (Cloud). The suffering that Linehan addresses often causes borderlines to become depressed. From what I have witnessed with Jessica, depression can be triggered extremely fast. It is similar in the way that people with Bipolar Disorder (BD) go from being extremely happy to extremely being depressed. There is a difference between Borderline Personality Disorder and Bipolar Disorder, however. Manic episodes fluctuate more rapidly in those with BPD. Whereas a person with BDs mood swings last for an extended period of time, a person with BPDs mood swings can change many times throughout a day. Also, people with BD have self -destructive behavior that is precipitated by euphoria or happiness, whereas people with BPD have self-destructive behavior as a result of trying to stop unbearable pain, usually unbearable emotional pain (Cloud). Jessica has described to me what this unbearable emotional pain feels like. She told me to imagine my mother, father, and sister all dying in the same day then multiply the pain you feel by ten. I couldnt even imagine that feeling.

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Depression in borderlines is an extremely serious issue because most borderlines are very impulsive. From my experience with Jessica, impulsivity seems to be the most prevalent sideeffect. For example, about a month ago she, all of a sudden, wanted to get her tongue pierced. So I went with her to get it pierced. Like this situation, impulsive behavior isnt always a bad thing. But when borderlines are experiencing depression, these impulsive tendencies are very dangerous because of the threat of suicide. Suicide is an unfortunate fate for many with Borderline Personality Disorder. Statistics show that 75% of BPD sufferers hurt themselves and 10% of them commit suicide (Cloud). Along with depression, most borderlines experience feelings of emptiness and very bad self-image. Whenever Jessica is depressed or sad she always seems to blame herself for all the bad things that have ever happened to her even though most of these things she had no control over. She beats herself up over these things. When you put depression and bad self-esteem together, many times substance abuse is the result. Many people with borderline either are or have at some point abused drugs. They resort to drugs as a way numb the emotional pain they feel. Their impulsivity is a big factor that leads to this which, in doing so, may lead to overdosing. Also, most people with BPD have a fear of abandonment so they will sometimes use drugs as a way to fit in or be accepted by others (Oliver). Jessica turned to drugs when she was very young. Luckily, she was able to get help and get clean. Like all recovering addicts, she still has urges to get high, especially when she is depressed or struggling. Thankfully she has been strong and has been able to stay clean. So its clear that having BPD is no easy thing to have to deal with. But how do these people get BPD? Are they born with it? Or is it triggered or developed in life? What areas of the brain are affected by it? Aisling ONeill from the Department of Psychiatry at Trinity College in

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Dublin, Ireland, along with his colleague, Thomas Frodl, conducted a study on the brain structure of people with Borderline Personality Disorder. They wanted to see if there were any differences or alterations in the brains of people with BPD compared with those without the disorder. They found that one of the most common brain alterations of those with BPD was that the size of their hippocampi was consistently smaller than those of the control group. The hippocampus is the part of the brain that is responsible for forming new memories. Depression has been linked to the shrinking of the hippocampus so it makes sense that BPD sufferers have smaller than average ones (ONeill). ONeill and Frodl also found that there was exaggerated activity in the amygdala of those with BPD in response to negative emotional stimuli. They also found the size of the amygdala to be slightly smaller than those who didnt have the disorder. The amygdala is a tiny area in the temporal lobe of the brain that is responsible for emotional regulation and emotional memory. It is believed that the small amygdalae in borderlines are the cause of their inability to regulate their emotions (ONeill). The last finding of the studies was that there was a 19% reduction of N-acetyl aspartate (NAA) concentrations in the brains of those with BPD. Low NAA concentrations have been shown to reflect neuronal damage that precedes cell death. The physical effects on the brain from Borderline Personality Disorder seem to be a little clearer than what exactly causes the disorder in the first place. There have been many studies that have been conducted as an effort to find a single-cause of BPD but, so far, none have been conclusive. It is, however, speculated from most scientists and psychologists that there is a combination of things that may cause or trigger BPD. They believe that both genetics and childhood trauma play key roles in the development of the disorder.

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A major breakthrough that has helped link BPD with genetics was discovered by Timothy Trull, a University of Missouri researcher, and a Dutch team of research collaborators back in 2008. They found that genetic material on chromosome nine was linked to features of BPD. The team found this information by conducting a study on 711 pairs of twins and 561 parents in order to attempt to find genetic traits that influence the development of BPD. After doing genetic linkage analysis on all the families, Trull and his team found chromosomal regions that influenced the manifestation of BPD with the strongest evidence of this on chromosome nine. Although this study has shown genetic linkage to BPD, more research needs to be done in order to back this evidence up. Until then, scientists cant be totally sure that genetics plays a role in the development of the disorder (Nauert). Many studies have been done to see what kind of effect childhood trauma has on people with BPD. Based on these studies, it widely accepted by most psychologists and psychiatrists that childhood trauma plays a major role in the development of BPD later in the childs life. A study of 358 BPD patients found that 91% of them reported instances of childhood abuse (physical and/or sexual) and 92% of them reported instances of neglect throughout their childhood. A later study found a significantly high correlation between the severity of reported childhood abuse of 290 BPD patients and the severity of the patients disorder (ONeill). From all the information I have gathered, it seems that Borderline Personality Disorder is more than likely triggered from some type of childhood trauma in most patients. In addition to the childhood trauma, it seems that most BPD patients also have a genetic predisposition to the disorder that increases their chances of developing it. Since psychologists and psychiatrists have a pretty good theory as to what causes borderline, they should be better able to identify the best forms of treatment for it. There is no

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medication that can cure BPD but there are some patients that use medication to treat certain symptoms caused by BPD such as depression, anxiety, and aggression. There is still research that needs to be done on the best treatments for BPD, but it is widely accepted by most psychologists and psychiatrists that psychotherapy is the best course of action for patients. There are three types of psychotherapy used to treat the disorder (Borderline). The first type of psychotherapy is cognitive behavioral therapy (CBT). CBT aims to help people with borderline identify and change their core beliefs and behaviors that cause them to have inaccurate perceptions and thoughts about themselves and about other people. In doing so, CBT may reduce mood swings, anxiety, and suicidal and self-harming behavior in BPD patients (Borderline). The second type of psychotherapy for borderline patients is schema-focused therapy. This type of therapy is similar to cognitive behavioral therapy but it incorporates other forms of psychotherapy in order to change the way the patient negatively views his or herself. This type of therapy is based on the idea that, borderline personality disorder stems from a dysfunctional self-imagepossibly brought on by negative childhood experiencesthat affects how people react to their environment, interact with others, and cope with problems or stress (Borderline). The last form of psychotherapy for borderline patients is dialectical behavior therapy (DBT). DBT is considered the most effective form of treatment in patients with BPD (Cloud). This type of therapy teaches BPD patients to be mindful, aware, and attentive to each situation. Through this, DBT teaches patients skills that help them control intense emotions which can reduce self-destructive behavior and improve relationships. Some DBT therapists offer DBT family therapy which can help teach the family members of BPD patients techniques to better understand and support their family member (Borderline).

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The main thing that I have discovered through doing this research and through my own personal experience is that Borderline Personality Disorder is a very real and extremely difficult disorder to cope with for both the person with BPD and the family and friends that are in close relationships with the person with BPD. Thankfully, there is hope for these people through psychotherapy which has been proven to be very effective. An important life lesson I have learned through having a friend with BPD is that you cannot judge people. We are all dealing with different obstacles and different problems in our lives but at the end of the day we are all the same we are all people! This is why we need treat every person with love and kindness because you never know what each person is going through. That one hurtful thing that you say to someone could be the thing that pushes that person over the edge. But that one nice thing you say or act of kindness toward someone could be the thing that helps bring that person out of the dark place in their life and give them much needed hope.

Very well written. Couldnt really find anything mechanical with the paper I would say to change or work on, you map it out in the intro, address the points and kept me interested because, while you did have a lot of information, it seemed like you had a personal experience to add to the academic points. Fix the small things and I think this paper will turn out really well for you.

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Work Cited "Borderline Personality Disorder." National Institute of Mental Health. N.p., n.d. Web. 14 Oct. 2012. Cartwright, Duncan. "Borderline Personality Disorder: What Do We Know? Diagnosis, Course, Co-Morbidity, And Aetiology." South African Journal Of Psychology 38.2 (2008): 429466. Academic Search Complete. Web. 25 Oct. 2012. Cloud, John. "Minds On The Edge." Time 173.2 (2009): 42-46. Academic Search Complete. Web. 12 Oct. 2012. Grohol, John M. "Borderline Personality Disorder." PsychCentral.com. 2012. Web. 13 Oct. 2012. Nauert, Rick, PHD. "Genetic Link to Borderline Personality Disorder." Psych Central.com. N.p., 2008. Web. 19 Oct. 2012. Oliver, David. "Substance Abuse and Borderline Personality Disorder." Borderline Central. N.p., n.d. Web. 25 Oct. 2012. O'Neill, Aisling, and Thomas Frodl. "Brain Structure And Function In Borderline Personality

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Disorder." Brain Structure & Function 217.4 (2012): 767-782. Academic Search Complete. Web. 10 Oct. 2012.