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 characterized by consistently
problematic ways of thinking, feeling, and interacting.
BPD is associated with unstable self-image, feelings, behaving, and relating to others.
BPD affects 6% of adults, men as often as women in general, women more than men in treatment populations.
Antisocial personality disorder 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, but in many countries, there is more agreement on the existence of BPD.
Like most other mental disorders, it 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.
In order to be diagnosed with BPD, the sufferer must experience at least five of the following symptoms: unstable self-image, relationships or emotions, severe impulsivity, repeated suicidal behaviors or threats, chronic feelings of emptiness, inappropriate anger, trouble managing anger, or transient paranoia or dissociation.
As with other mental disorders, there is no specific definitive test, like a blood test, to diagnose BPD. Therefore, practitioners conduct a
mental-health interview that looks for the presence of the symptoms previously described and usually explore the person's history for any medical problem or other emotional problem that may show 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 manage the illness in its entirety.
Partial hospitalization can help treat BPD by providing frequent supervision and assessment in a safe environment, while allowing the sufferer to go home each evening.
The presence of BPD tends to worsen the 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.
While they symptoms of BPD tends 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 individual's current personal relationships, whether or not the sufferer has a history of being abused as a child, as well as whether or not the individual receives appropriate treatment.
Steady employment or school status once symptoms of BPD subside (remit) tends to protect BPD sufferers from experiencing a future relapse.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 9/13/2012
No medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.
Medications can cause different side effects in different people. People who have borderline personality disorder should talk with their prescribing doctor about what to expect from a particular medication.