In America, 1.6 percent of the population suffers from Borderline Personality Disorder (BPD). In Canada, 2 percent of the population are effected by this "dramatic and erratic" personality disorder. Borderline personality disorder is a personality disorder characterized by intense mood swings, impulsivity and severe problems with self-worth. Borderlines also suffer from bouts of inappropriate rage, fear of abandonment, suicidal gestures, unstable relationships and chronic feelings of emptiness. Unfortunately, like most mental illnesses, BPD is often coupled with other mental illnesses, and treatment options vary from person to person.

Old Buddy, Old Pal, Old Friend!

Borderline personality disorder, like any other mental illness, quiet often has co-occuring mental illnesses that come with its diagnosis. The major subtypes for these co-occurring illnesses are: mood disorders, post traumatic stress disorder, eating disorders, attention disorders and other personality disorders.

While borderline personality disorder is classified as a personality disorder, it can also fall under the class of mood disorders. Due to the erratic nature of a borderlines' emotions, psychiatrists often treat borderline personality disorder as a mood disorder due to its proximity to bipolar disorder. Often enough, bipolar disorder, major depressive disorder, anxiety and panic disorders and dysthymia co-occur with a BPD diagnosis.

Impulsivity is one of the key symptoms of borderline personality disorder. This can cause behaviours such as reckless driving, binge-eating, suicidal gestures and drug and alcohol use. If impulsivity continues for long periods of time, substance abuse disorders and eating disorders such as anorexia nervosa and bulimia can develop alongside BPD.

Since, more often than not, personality disorders develop when psychological trauma occurs, borderlines can often expect to have post-traumatic stress disorder if they've experienced a trauma such as abuse, neglect, of familial dysfunction as a child or teenager.

Borderlines have mood swings that can change from one second to another. Their emotions and thoughts tend to be quite hyperactive. This hyperactivity often leads to a diagnosis of attention deficit hyperactivity disorder alongside their BPD diagnosis.

While p ersonality disorders are grouped into three clusters (with dissociative disorders now being their own separate entity), personality disorders often co-exist with each other . It's easier to think of personality disorder classifications like a spectrum, rather than three clusters, since some patients may have more than one personality disorder.

Although some patients may remain in the "dramatic and erratic" B cluster, those of which have more dissociative and paranoid thoughts may stray over to the "odd, eccentric and bizarre" A cluster of personality disorders. The most common to effect borderlines is schizotypal personality disorder which is characterized by paranoid thoughts,delusions, dissociative symptoms and social anxiety.

What's up Doc?

Psychotherapy, alongside pharmacotherapy, are extremely important while treating borderline personality disorder. There is a wide range of therapies available and more often than not, patients will go through multiple types of therapy in order to find the right therapy suited to their beliefs, wants and needs.

There is a wide variety of therapies for borderline patients; some to treat certain aspects of their borderline personality disorders and some to treat the personality disorder itself. The following therapies are better suited to treat borderline personality disorder more commonly used in psychiatric treatment of BPD:

Dialectical Behaviour Therapy

Cognitive Behavioural Therapy

Mindfulness Based Cognitive Therapy

The most recommended, and usually most effective, therapy for BPD is Dialectical Behaviour Therapy (DBT). DBT is a cognitive behavioural therapy that tries to identify and change negative thinking patterns and pushes for positive behavioural changes.

Cognitive Behavioural Therapy (CBT), the second most commonly used psychotherapy, is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behaviours by looking at their problems and changing the way the feel about these difficulties.

Mindfulness Based Cognitive Therapy combines the basis of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. Mindfulness is used to help treat and prevent relapses in bouts of depression and chronic unhappiness, which BPD sufferers often face which makes this a helpful type of therapy to learn if DBT and CBT aren't entirely successful.

One Pill, Two Pill, Red Pill, Blue Pill

While psychotherapy can be helpful, sometimes medication is needed to aid in the recovery and maintenance of a patients emotional well-being. In general, borderline personality disorder patients are given the "BPD trifecta" of medication; an anti depressant, an anti psychotic and a mood stabilizer.

The anti-depressant is used to treat the anxiety, suicidality and depression portions of borderline personality disorder. There are many different medications but most patients are prescribed medications known as selective serotonin reuptake inhibitors (SSRIs) due to the broad range of medications and their positive effect on those symptoms. Some SSRIs include Celexa (citalopram), Zoloft (sertraline) and Prozac (fluoxetine).

The other classes of anti-depressants include tricyclic anti-depressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical anti-depressants (AAD's) and monamine oxidase inhibitors (MAOIs). Each of these anti-depressants works differently from one another therefore, gives psychiatrists a broad range of options when searching for anti-depressants if a patient struggles mostly with mood-based symptoms.

The anti-psychotic is used to treat any psychotic like features such as paranoid thoughts, hallucinations and dissociation, but can also treat depression and manic-phases of BPD mood swings. Anti-psychotics are grouped into two classes, typical and atypical. More commonly used now, atypical anti-psychotics are the newer generation of anti psychotics and have a different chemical make up than that of its older counterpart. Some atypical anti psychotics include Abilify (aripiprazole), Seroquel (quetiapine) and Zyprexa (olanzapine).

Finally, mood stabilizers are prescribed to help manage the extreme mood swings of a borderline. Mood stabilizers are often anti seizure medications such as Topamax (topiramate), Epival (divalproex Sodium) and Lamictal (lamotrigine).

Occasionally, Anxiolytics (anti-anxiety medications) like Ativan (lorazepam) and Xanax (alprazolam) are used to treat severe anxiety or used as an emergency medication when in crisis.

In the End

To conclude, while BPD may come with other mental illnesses, there are a wide variety of medications and therapies that can be used to help manage symptoms and maintain a normal, even happy, life while living with BPD. It just takes a little bit of time and the right combination.