Borderline personality disorder is a mental illness that negatively affects emotions and interpersonal relationships. These people lack self-esteem and place unrealistic expectations on those closest to them to help fill in the gaps. When people around them are unable to live up to these high expectations, the borderline will see it as a betrayal. Underneath the diagnosis of “borderline” is a series of stand-alone emotional disorders that, if experienced by a healthier patient, would be treatable or, at the very least, controllable.
Medical professionals have discovered that one of the core defects in borderline personality disorder is a severe lack of self-esteem. In order to compensate, a borderline will look rely on others for assurance that she is a worthwhile individual. When things are going well in a relationship, the borderline will be overly happy or euphoric. However, the patient then becomes fearful that person will lose interest or leave, resulting in a constant state of severe anxiety or worry. When the pressure placed on the other party causes the relationship to inevitably break down, it can leave the borderline feeling depressed.
Anxiety is a debilitating enough condition on its own, never mind coupled with BPD. Anxiety can manifest in different ways but, thankfully, it is usually treatable with therapy or medications (or both). Examples of anxiety-driven responses include generalized worry, phobias, panic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder.
Because the emotions of someone with borderline personality disorder are constantly changing, often dramatically, the situation can quickly lead to a full-blow mood disorder, which occurs when a person loses the ability to control their emotions. The main mood disorders are depression and bipolar disorder (manic-depression).
Depression manifests in a low mood, low self-esteem or lack of interest in activities. Full-blown depression is often acute, with periods of relief. A lesser form of depression, called dysthymia, can result in just a low mood but tends to be more chronic with fewer periods of relief. Bipolar disorder, on the other hand, is characterized by periods of dysthymia or depression, alternating with periods of mania (which can run the gamut from being in a good mood to feeling euphoric). Symptoms in the manic phase can become dangerous such as poor judgment, racing thoughts, insomnia and impulsiveness. Both stand-alone depression and bipolar disorder are rarely accompanied by life events that would account for the particular behavior. In borderline patients, however, the mood swings are often triggered by actual events that are perceived to be more dramatic than they really are.
Borderline personality disorder is not easy to treat. Although it is possible to reduce the anxiety and mood swings that plague these patients, there is no magic pill that will give them self-esteem. There has been success with behavioral therapies, but that type of treatment requires a lot of hard work and dedication. Cognitive behavior therapy (CBP) can help minimize the dramatic mood swings and anxiety experienced by patients with borderline personality disorder but it seldom eliminates them.
Due to its intractability, many people with borderline personality disorder will self-medicate with alcohol or drugs to escape the dramatic mood swings and anxiety. However, this substance use often leads to dependence, an entirely independent and no-less-serious mental disorder that will likely require medical intervention. For this reason, a physician-supervised regimen of drugs for treatment of anxiety, bipolar disorder and depression can also play an important role in the treatment of borderline personality disorder. However, especially when it comes to treating anxiety, medical professionals must be vigilant that the patient does not become addicted to the medication. Because borderline personality disorder itself is so difficult to treat, long-term relief from the underlying mood or anxiety disorders can require long-term reliance on prescription drugs. Benzodiazepines, such as Valium and Xanax, are incredibly addictive and can lead to inadvertent prescription drug dependence.