April 19, 2014

Medina
Mostly clear
38°F

Malicious Attraction: Borderline Personality Disorder

Dr. Ranjan

Dr. Ranjan

Just before Shannon, 22, took an overdose of every pill in her parents’ medicine cabinet, she was overcome by a profound feeling of emptiness. She felt as though she did not exist or could not exist and did not deserve to exist. Her parents had been aware that she was having almost daily arguments with her boyfriend of about three months. Just the other day, they had overheard her yelling on the phone, “I want to hurt you so bad!! But maybe I’ll just kill myself!!”

Shannon never wanted to be alone and always had a need to have a man in her life. She felt very low if she did not get any compliments from guys. She had numerous boyfriends from the time she was fourteen years old. However, none of her relationships lasted longer than a year. Even those relationships were full of ups and downs. Typically, she started out adoring the man she wanted to date, but that adoration quickly turned to possessiveness. Sooner or later she would start questioning his fidelity and be insecure. Her mood would fluctuate rapidly based on what she perceived people thought of her. Her mood ranged anywhere from elation to deep despair to uncontrollable anger. Shannon had a history of being very vengeful even towards people she hardly knew.

Since teenage years, she had gone through a series of drastic makeovers with hairstyles, hair color, excessive tanning and tattoos. She never felt she fit in with any group of people. She did not even feel connected to her parents who did love her. As a child, however, Shannon had a very cold relationship with her mother who was normally not a very warm person.

Following the overdose, Shannon was admitted to the psychiatric ward of a local hospital. She was treated with an antidepressant and discharged after four days.

As an outpatient, Shannon began seeing a psychiatrist and a therapist. However, the next six years of her life were punctuated by several stormy relationships and suicide attempts as well as gestures. She was treated with a host of antidepressants to no avail. The feelings of emptiness, feeling defective and a sense of despair never left her.

During this time, she was diagnosed with various conditions such as dysthymic disorder, cyclothymic disorder, bipolar disorder, post-traumatic stress disorder etc.

At age 28, a psychiatrist suspected Shannon had Borderline Personality Disorder (BPD) and referred her to a therapist specializing in DBT (Dialectical Behavior Therapy.)

Today at age 32, Shannon is finally feeling as though she is on the right track for the first time. But it could not have happened without her families’ relentless support and her commitment to therapy. She is much better able to modulate her emotions and to function in general.

The Enigma of Borderline Personality Disorder
BPD is one of the most enigmatic and difficult-to-manage psychiatric illnesses. The story of Shannon should ring a bell to about 2% of adults in this country who suffer from symptoms of BPD and also to millions of other people who have a family or friend with this disorder.

Core symptoms of BPD
These include problems with self-image, interpersonal relationships (see-saw between idealization and devaluation), fear of abandonment, modulation of feelings (despair, out-of-control anger, frequent suicidal attempts/gestures), impulse control and stress management (occasional paranoia in response to stress).

What causes BPD?
Childhood trauma or neglect seems to be the most common factor. As with other psychiatric illness, genetics play an important role.

What kinds of help are available?
As always, the first step is to receive a thorough psychiatric evaluation from a competent psychiatrist. Accurate diagnosis or BPD and any co-morbid conditions are paramount.

• Psychotherapy: this is the cornerstone of treatment.
There are two types of psychotherapy which are most useful.

• Dialectical behavior therapy
(DBT): focuses on teaching skills helpful in regulating ones mood, management of stress and management of relationships.

• Transference -focused psychotherapy
(TFP): this utilizes the relationship between the therapist and the patient as a workshop for understanding emotional aspects of relationships.

• Psychotropic medications:
No medication is known to drastically reduce the core symptoms of BPD. However, antidepressants, anti-anxiety medications, mood stabilizers and anti-psychotic medication can all be useful in treating certain symptoms in some patients.

The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peerreviewed journal articles and book chapters on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for the NAMI of Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at askthedoctor@charakresearch. com.
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