Borderline Personality Disorder
Dr. L.R. KHAN Introduction :
Borderline patients stand on the border between neurosis and psychosis and are characterized by extrajudicially unstable affect, mood, behavior, object relationships, and self image.
Epidemiology :
No definitive prevalence studies are allowable, but this disorder is thought to be present in about 1 or 2 percent of the population and is twice as common in women as in men. There is an increased prevalence of unibipolar depression, alcoholism, and substance abuse in first degree relatives of subjects with borderline personality.
Clinical Features :
Borderline patients almost always appear to be in a state of crisis. Mood swings are common. The patients can be argumentative at one moment, depression at another complain of having no feelings at still another time. There may be short lived psychotic episodes rather than full blown psychotic breaks, and their psychotic symptoms are almost always circumscribed, fleeting, or in doubt. The behavior of borderline personalities is highly unpredictable, consequently , they rarely achieve up to the level of their abilities. The painful nature of their lives is reflected in repetitive self destructive acts. Such patients may perform wrist slashing and other self mutilations is order to elicit help form others, to express anger, or to numb themselves to overwhelming affect. Because they feel both very dependent and hostile, borderline personalties have tumultuous interpersonal relationships. They can be very dependent on those to whom they are close, and they can express enormous anger at their intimate friends when frustrated. Borderline personalities cannot tolerate being alone, however, and prefer a frantic search for companionship, no mater how unsatisfactory, to sitting by themselves. To assuage loneliness, if only for brief periods of time, they will accept a stranger as a friend or will be promiscuous. They often complain about chronic feelings of emptiness and boredom, the lack of a cosistent sense of indetinfy and when pressed how depressed they feel most of the time, despite the flurry of their affects. Functionally, adult borderline patients disorder their resent relationships by putting every person in to either an all good or an all bad category. They see people as either nurturant and attachment figures or an hateful and sadistic persons who deprive them of security needs and theraten them with abandonments whenever they feel dependent. As a result of this splitting, the good person is idealized, and the bad person is devalued shifts of allegiance from one person or group to another are frequent.
(Author is Consultant Psychiatrist at Raahat Hospital, Aurangabad.)