<p> Most people can tolerate the ambivalence of experiencing two contradictory states at one time.<br /> People with BPD, however, must shift back and forth between good and bad states.<br /> If they are in a bad state, for example, they have no awareness of the good state.</p> <h2 class=”showhide_heading” id=”Prevalence”> Prevalence</h2> <ul> <li> 2% percent of adults</li> <li> 20% of psychiatric hospitalizations</li> <li> 40-71% of BPD patients report having been sexually abused, usually by a noncaregiver</li> <li> 75% of cases diagnosed among women</li> </ul> <h2 class=”showhide_heading” id=”Symptoms”> Symptoms</h2> <ul> <li> mood instability</li> <li> intense bouts of anger, depression, or anxiety that may last only hours or, at most, a few days</li> <li> episodes of impulsive aggression, self-injury, and drug or alcohol abuse</li> <li> Distortions <p> in thoughts and sense of self can lead to frequent changes in long-term</p> goals, career plans, jobs, friendships, identity, and values</li> <li> difficulty with interpersonal relationships</li> <li> intense but stormy attachments: attitudes toward intimates suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike)</li> <li> form immediate attachments and idealize <p> another person, but when a slight separation or conflict occurs, switch<br /> unexpectedly to the other extreme and angrily accuse the other person</p> of not caring for them at all</li> <li> high rates of self-injury</li> <li> suicidal behavior</li> <li> view themselves as fundamentally bad or unworthy</li> <li> may feel bored, empty, or unfairly misunderstood or mistreated, and they have little idea who they are</li> <li> feel isolated or lacking in social support</li> <li> frantic efforts to avoid being alone</li> <li> highly unstable patterns of social relationships</li> <li> highly sensitive to rejection, reacting with anger and distress to mild separations</li> <li> even a vacation, a business trip, or a sudden change in plans can spur negative thoughts</li> <li> fears <p> of abandonment related to difficulties feeling emotionally connected to<br /> intimates when they are physically absent, so feeling lost and</p> worthless</li> <li> suicide threats and attempts may occur along with anger at perceived abandonment and disappointments</li> <li> other impulsive behaviors, such as excessive spending, binge eating, and risky sex</li> <li> often <p> occurs with other psychiatric problems, particularly bipolar disorder,<br /> depression, anxiety disorders, substance abuse, and other personality</p> disorders.</li> </ul> <p>  </p> <h2 class=”showhide_heading” id=”Definition”> Definition</h2> <ul> <li> a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.</li> <li> often disrupts family and work life, long-term planning, and an individual’s sense of identity.</li> <li> "border" of psychosis and neurosis, suffer from difficulties with emotion regulation</li> <li> greatest in the young-adult years and tend to decrease with age</li> <li> often need extensive mental health services</li> <li> with help, many improve over time and are eventually able to lead productive lives.</li> </ul> <p>  </p> <h2 class=”showhide_heading” id=”Causes”> Causes</h2> <ul> <li> unknown, possibly environmental and genetic factors</li> <li> BPD is some 5x five times more common among people with close biological relatives with BPD.</li> <li> history of abuse, neglect, or separation as young children.</li> <li> possibly, <p> a combination of individual vulnerability to environmental stress,<br /> neglect, or abuse as young children and a series of events that trigger</p> as young adults</li> <li> adults with BPD are also considerably more <p> likely to be the victims of violence, including rape and other crimes<br /> (these incidents may result from harmful environments as well as their</p> own impulsivity and poor judgment in choosing partners and lifestyles).</li> </ul> <p>  </p> <h2 class=”showhide_heading” id=”Brain_function”> Brain function</h2> <p> Neuroscience</p> <p> is revealing brain mechanisms underlying the impulsivity, mood<br /> instability, aggression, anger, and negative emotion seen in BPD.<br /> Studies suggest that people predisposed to impulsive aggression have<br /> impaired regulation of the neural circuits that modulate emotion. The<br /> brain’s amygdala, a small almond-shaped structure, is an important<br /> component of the circuit that regulates negative emotion. In response to<br /> signals from other brain centers<br /> indicating a perceived threat, it marshals fear and arousal, which may<br /> be more pronounced under the influence of stress or drugs like alcohol.<br /> Areas in the front of the brain (prefrontal area) act to dampen the<br /> activity of this circuit. Recent brain-imaging studies show that<br /> individual differences in the ability to activate regions of the<br /> prefrontal cerebral cortex thought to be involved in inhibitory activity</p> <p> predict the ability to suppress negative emotion.</p> <h2 class=”showhide_heading” id=”Regulation”> Regulation</h2> <p> Serotonin,</p> <p> norepinephrine, and acetylcholine are among the chemical messengers in<br /> these circuits that play a role in the regulation of emotions, including<br /> sadness, anger, anxiety, and irritability. Drugs that enhance brain<br /> serotonin function may improve emotional symptoms in BPD. Likewise,<br /> mood-stabilizing drugs that are known to enhance the activity of GABA,<br /> the brain’s major inhibitory neurotransmitter, may help people who<br /> experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much as people manage susceptibility to diabetes or high blood pressure.<br /> Treatments</p> <h2 class=”showhide_heading” id=”Treatment”> Treatment</h2> <ul> <li> psychotherapy, medications, and group, peer, and family support.</li> <li> psychotherapy is the first line treatment for BPD</li> <li> dialectical behavioral therapy (DBT)</li> <li> cognitive behavioral therapy (CBT)</li> <li> psychodynamic psychotherapy</li> <li> antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood</li> <li> antipsychotic drugs may also be used when there are distortions in thinking.</li> </ul> <p>  </p> <h2 class=”showhide_heading” id=”References”> References</h2> <p> National Institute of Mental Health<br /> American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised.<br /> American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<br /> US Department of Health and Human Services<br /> National Alliance on Mental Illness</p>