Between the Everything and Nothingness of Emotions: Understanding Borderline Personality Disorder

Constantly living on a roller coaster of feelings — this is how unstable borderline personality disorder is characterized. The term, which in English translation means something like border or border line, can be replaced by borderline, which, in this context, also shares the same meaning: a fine line between everything and nothing.

According to psychiatrist Rodrigo Martins Leite, from the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, USP, the disorder is related to the so-called nuclei of impulsivity, exaggerated behavior and instability in relationships, and usually manifests between late adolescence. and early adulthood.

“[Pacientes com borderline] they are people who have great difficulty in maintaining stable relationships throughout their lives, go through many ruptures and may have a higher risk of suicide attempt. Borderline disorder is a pattern that is maintained over time, it does not fluctuate, so there is a very marked difficulty in interpersonal and social interaction,” he explains.

According to the MSD Manual, there is also a tendency towards self-destructive acts, which makes the risk of suicide among patients with a borderline to be 40 times higher compared to the general population, with between 8% and 10% of them dying by suicide.


Diagnosis

Although the borderline has striking characteristics, the diagnosis is not simple and can be confused with other disorders, such as bipolar disorder, for example. To be diagnosed, the patient is analyzed by his clinical and life history since childhood.

“We know that the disorder has a strong association with childhood events, experiences of abuse, not only sexual, but emotional, and various neglects, in addition to patterns of difficult relationships with parents. So, in general, the disorder emerges from this scenario of a more unstable and more difficult childhood. We make the diagnosis by anamnesis [lembrança] person”, explains the psychiatrist.

Despite having similar traits, borderline personality disorder and bipolar disorder differ in terms of time, as the specialist points out.

Borderline disorder is characterized by chronic instability throughout life, especially in the face of frustrations, whereas bipolar disorder has well-marked phases of mania, hypomania and depression.


“This hypersensitivity to frustration is a very important mark of the borderline personality. But, in practice, it is not so simple to differentiate, because the two conditions can appear together in the same individual, and sometimes it is difficult to characterize by psychic examination if we are facing a phase of bipolar disorder or if it is the oscillation of a personality. unstable”, says the expert.

In addition, the borderline patient may also suffer from other disorders, such as depression and anxiety, or even face chemical dependency problems.

In some cases, the difficulty of social interaction can be so intense that it also impacts the doctor-patient relationship, making it even more difficult to identify the problem.

“In general, people go through several professionals until they reach a diagnosis. Another problem is that, many times, the specialist ends up not verbalizing this to the patient, because in a way it is like saying that the person’s personality is the one who has a disorder, and often she sees her attitudes as something natural or understandable in the face of the that she suffers, but she doesn’t have the criticism of realizing that the way she reacts and relates is the problem”, emphasizes the psychiatrist.


Treatment

Treatment for borderline personality disorder is essentially pharmacological and non-pharmacological, according to the expert. Medications are used to control impulsivity to some extent or to treat other disorders that may be associated with it, such as depression and anxiety.

Even so, the psychiatrist emphasizes that psychotherapy is the main ally of the person with borderline. In this case, the treatment is long-term and seeks a self-reflection of the patient.

“It is a difficult psychotherapy, because the person has to understand the consequences of their actions, understand how much of their behavior generates the difficulties they have, which, in general, are perceived only as [dificuldades] outside the person. The core is a robust psychotherapy, with medication acting in a more satellite way”, says Leite.

It is worth noting that the diagnosis of the disorder must be made by a specialized health professional, as well as the treatment.


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