Between emotions and nothingness: Understanding borderline personality disorder

Constantly living on a roller coaster of feelings – this is characterized by an unstable borderline personality disorder. In English translation, a term that means something like an edge or a boundary line can be replaced by a boundary line, in this context it has the same meaning: a fine line between everything and anything.

Psychiatrist Rodrigo Martins Leite believes that the disorder is linked to the so-called nuclei of impulsivity, excessive behavior and relationship instability at the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, USP, and usually appears in late adolescence. and early adulthood.

“[Pacientes com borderline] they are people who have difficulty maintaining stable relationships throughout their lives, who go through many fractures, and may be at greater risk for suicide attempts. Border disorder is a model that is maintained over time, it does not change, so there is a significant difficulty in interpersonal and social interaction, ”he explained.

According to the MSD Handbook, there is also a tendency for self-destructive actions, which increase the risk of suicide among patients with a limit 40 times higher than in the general population, with between 8% and 10% of them dying. suicide.

Diagnosis

Although borderline has striking features, the diagnosis is not easy and can be confused with other disorders, such as bipolar disorder. The diagnosis is made based on the patient’s clinical history and life from an early age.

“We know that the disorder has a lot to do with childhood events, abuse, not only sexual experience, but also emotional and various neglect, as well as patterns of difficult relationships with parents. So in general, the disorder arises from this scenario of a more unstable and difficult childhood. We make the diagnosis through anamnesis [lembrança] people, ”explains the psychiatrist.

Despite similar characteristics, borderline personality disorder and bipolar disorder differ over time, the specialist noted.

Borderline disorder has chronic instability throughout life, especially in the face of frustration, while bipolar disorder has well-marked phases of mania, hypomania, and depression.

“This hypersensitivity to frustration is a very important brand of borderline personality. But in practice, it is not so easy to distinguish, since the two conditions can appear together in the same individual, and it is sometimes difficult to characterize by psychological examination whether we are facing a phase of bipolar disorder or whether it is an oscillation. an unstable personality, ”says the expert.

In addition, borderline patients may experience other disorders, such as depression and anxiety, or even chemical addiction problems.

In some cases, the difficulty of social interaction can be so intense that it also affects the relationship between the doctor and the patient, making it even more difficult to identify the problem.

“In general, people go through various professionals until they come to a diagnosis. Another problem is often that the specialist does not end up saying this to the patient verbally, as it is somehow like saying that the person’s personality has a disorder, and often because they see their attitude as something natural or understandable. in the face of what he is suffering from, but he is not critical of the way he reacts and relates to the problem, ”the psychiatrist points out.

Treatment

The treatment of borderline personality disorder is essentially pharmacological and non-pharmacological, according to the expert. Medications are used to some extent to control impulsivity or to treat other disorders that may be associated with it, such as depression and anxiety.

However, the psychiatrist emphasizes that psychotherapy is the primary ally of the person with the limit. In this case, the treatment is long-term and seeks the patient’s self-reflection.

“Psychotherapy is difficult because people need to understand the consequences of their actions, because they need to understand how difficult their behavior is, and these are generally perceived as unique. [dificuldades] out of person. The core is strong psychotherapy, which works with a more satellite-based medication, ”says Leit.

It is important to note that the diagnosis of the disorder must be made by a specialist healthcare professional, as well as the treatment.

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