Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Borderline personality disorder is a personality disorder of emotional dysregulation that involves the sufferer consistently exhibiting abnormal self-image, ways of feeling and interacting, leading to difficulties with interpersonal relationships.
BPD affects men as often as women in general and women more than men in treatment populations.
Antisocial behavior in adults, substance-abuse problems in men, eating disorders in women, and anxious and odd personality disorders in adolescents tend to co-occur with BPD.
There has been some controversy about whether or not BPD is its own disorder or a variation of bipolar disorder.
Like most other mental disorders, borderline personality disorder is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model).
BPD sufferers are more likely to have a learning problem or certain temperaments as children, or come from families of origin where divorce, neglect, sexual abuse, substance abuse, or death occurred.
To be diagnosed with BPD, the sufferer must experience at least five of the following symptoms: unstable self-image, relationships or emotions, severe impulsivity that results in engaging in risky behaviors, repeated suicidal behaviors or threats, chronic feelings of emptiness, inappropriate anger, trouble with anger management, or transient paranoia or dissociation.
As with other mental disorders, there is no specific definitive test, like an X-ray, to diagnose BPD. Therefore, mental-health professionals conduct a mental-health interview that looks for the presence of the previously described symptoms and often explore the person's history of any medical problem or other emotional problem that may share symptoms of the disorder.
Psychotherapy approaches that have been helpful in treating BPD include dialectical behavior therapy, cognitive behavioral therapy, interpersonal therapy, and psychoanalytic psychotherapy.
The use of psychiatric medications like antidepressants, mood stabilizers, and antipsychotics may be useful in addressing some of the symptoms of BPD but do not entirely manage the illness.
Partial hospitalization can help treat BPD by providing frequent supervision and assessment in a safe environment, while allowing the sufferer to go home each day.
The presence of BPD tends to worsen the overall emotional instability and other symptoms of other mental illnesses and increase the risk for self-mutilation, as well as for attempting or completing suicide.
People with BPD are at somewhat higher risk for engaging in violent behavior. That risk is further increased when the individual with BPD also is suffering from antisocial personality disorder, has a previous history of violent behavior, frequently uses sedative medications, or experiences several changes in their psychiatric medications.
Although the symptoms of BPD tend to diminish over years for many people, how well or poorly people with BPD progress over time seems to be influenced by the severity of the symptoms, the person's current relationships, whether or not the sufferer has a history of being a victim of child abuse, as well as whether or not the individual receives appropriate treatment.
Steady employment or school enrollment once symptoms of BPD subside (remit) tends to protect BPD sufferers from experiencing a relapse.
Impulsivity is the tendency to act on impulse -- that is, without forethought about the appropriateness or consequences of the action. Impulsivity can be manifested in an action or in interrupting a discussion, blurting out answers, or the inability to wait one's turn at an activity. Impulsivity is often accompanied by symptoms such as restlessness, hyperactivity, inattention, problems doing quiet activities, problems with executive function, talking excessively, and fidgeting.