Borderline personality disorder

Borderline personality disorder is a serious type of personality style in which a person makes impulsive actions, and has an unstable mood and self-image, and is prone to produce chaotic relationships.

Characteristics of people with Borderline personality disorder include being so emotionally overreactive that they suffer alternating bouts of depression, anxiety and anger, are interpersonally hypersensitive, and are impelled to self-destructive and even suicidal behavior.

People with Borderline personality disorder often exhibit other types of impulsive behaviors, including excessive spending, bing eating and risky sex. Borderline personality disorder often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. In fact, there is evidence that many people diagnosed with Borderline personality disorder are really suffering from Bipolar disorder.

Borderline personality disorder is found in 10 to 20 percent of people in psychiatric care, and about 10 percent of people with this condition ultimately die of suicide. Only recently have experts begun to identify underlying biological factors associated with the condition, but current research suggests the basis is biochemical and structural.

Using real-time brain imaging, a team of researchers have discovered that people with Borderline Personality Disorder (BPD) are physically unable to use those parts of the brain that healthy people use to help regulate their emotions. This may explain why  people with Borderline Personality Disorder have emotional reactions that are so extreme.

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Treatments for Borderline Personality Disorder

Treatments for Borderline personality disorder have improved in recent years, and gone are the days when a person with borderline personality was relegated to treatment with no hope of significant improvement.

Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. In the recent past antidepressant drugs were been used  for depressed and/or labile mood, but our understanding of the disorder has progressed to the point were we no longer consider the disorder just a personality disorder. We now understand that BPD has biological underpinnings and is part of the bipolar spectrum illnesses. This new understanding has lead to the use of antiseirure medications and second-generation psychotropic agents that have mood stabilizing properties. Even though these medications are NOT curative, they have the potential to eliminate the symptoms of the disorder in the same way glasses correct for vision problems (i.e. as long as the prescription is correct and they are used consistently, then the symptoms will be controlled but not cured).

Furthermore, group and individual psychotherapy are at least partially effective for many of the psychological habits patients with BPD exhibit (especially since the new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD).

Now days, with modern treatment for BPD, there is great cause for celebration.

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Brain Scans of Borderline Personality Disorder

In a 2009 study published in the journal Biological Psychiatry, researchers using functional magnetic resonance brain imaging discovered that patients with Borderline Personality Disorder (BPD) are physically unable to regulate emotion. It appears that people with Borderline personality disorder are unable activate the normal neurological networks that would help to control feelings.

According to the researchers, when people with BPD attempted to control and reduce their reactions to disturbing emotional scenes, the anterior cingulate cortex and intraparetical sulci, areas of the brain that are active in healthy people under the same conditions, remained inactive in the BPD patients. BPD patients are NOT able to use those parts of the brain that healthy people use to help regulate their emotions. This may explain why their emotional reactions are so extreme.

The biological underpinnings of these disordered emotional control systems are central to borderline pathology.

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Lamotrigine in the treatment of affective instability in borderline personality disorder

Results from a double-blind study published in International Clinical Psychopharmacology suggest that lamotrigine is an effective treatment for affective instability and for the general impulsivity characteristic of borderline personality disorder.

Patients in the lamotrigine group had significantly greater reductions in the total affective lability scores.

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Clinical features of “soft bipolarity” in Borderline personality disoder

In a study published in Psychiatry Clin Neurosci. 2006 Oct;60(5):611-5, researchers at  Teikyo University School of Medicine, Tokyo, Japan, studied 39 patients with Major Depressive Episode (15 of which were diagnosed as bipolar II disorder and 24 were diagnosed with unipolar depression).

The most prominent result was a high prevalence of borderline personality disorder (BPD) among bipolar II disorder patients, supports the theory of borderline personality disorder as a natural state of a bipolar spectrum illness.

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Oxcarbazepine in the treatment of borderline personality disorder

According to scientifically derived data concerning treatment of patients with borderline personality disorder, antiseizure medications with mood stabilizing properties have been found effective in controlling core symptoms of borderline pathology, in particular impulsive behavior and mood instability.

With this in mind, researches from the University of Turin, Turin, Italy, found that the antiseizure medication oxcarbazepine, in doses of 1200 to 1500 mg/day was found an effective and well-tolerated treatment in the management of borderline personality disorder patients. Their findings are published in J Clin Psychiatry. 2005 Sep;66(9):1111-5.

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