BORDERLINE PERSONALITY DISORDER

Borderline Personality Disorder (BPD) is a syndrome that begins in young adulthood and is characterized by excessive impulsivity, instability in affect and interpersonal relationships, inadequacy in self-perception, and hypersensitivity to abandonment (APA, 2013; Sargın & Sargın, 2015). Data on its incidence in the population vary between 1.2% and 6% (Grant et al., 2008). 

There is a pervasive and persistent inconsistency in sense of identity, relationships, and affect in BPD. According to this, emotional, cognitive and behavioral features such as depression symptoms, antisocial behaviors, tendency to psychoactive substances, fast life efforts, self-harm, tendency to complain about emptiness and loneliness, and not being able to stand alone are evident, and significant functional impairments are observed in these areas (American Psychiatric Association [ APA], 2013; Crowell, Bauchaine and Linehan, 2009). It is assumed that the emotional dysregulation observed in BPD is caused by a severe sensitivity, especially to negative emotional stimuli, and this emotional dysregulation is characterized by a slow return to the emotional starting point as well as increased emotional intensity (Linehan, 1993). 

Borderline Personality Disorder Diagnostic Criteria 

In order to diagnose BPD according to the DSM 5 classification of APA, the presence of 5 or more of the following 9 criteria, which manifests itself in many contexts from the beginning of early adolescence, is required (APA, 2013): 

1. Frantic efforts to avoid abandonment 

2. Inconsistent and tense interpersonal relationships between extremes of over-magnification and disgrace 

3. Identity confusion 

4. At least two self-harming impulsivity (spending money, sex, substance abuse, unsafe driving, etc.) 

5. Repetitive suicidal behaviors, attempts, or intimidation 

6. Inconsistency in affect 

7. A persistent sense of emptiness 

8. Inappropriate intense anger, difficulty in anger management 

9. Temporary suspicious thoughts or severe dissociation symptoms related to the strain 

The biosocial theory of BPD is among the etiological models that describe this pathology in the most detailed way (Crowell, Bauchaine, Linehan, 2009). According to Linehan, BPD is basically an emotional dysregulation disorder. It occurs in certain individuals as a result of the interaction of biological fragility and certain environmental conditions. individuals with BPD; have increased emotional sensitivity, are unable to regulate intense emotional responses, and return slowly to emotional baseline. 

Individuals suffering from borderline personality disorder may face very serious problems that make daily life difficult due to some of the negative symptoms that this disorder brings. The quality of life of individuals with BPD that is not diagnosed and treated is severely reduced. People with PD often exhibit extreme behaviors such as gambling, having dangerous sexual relationships, overeating, and substance use due to their high impulsivity. Since a clear and harmonious self-awareness is not developed, they may experience great difficulties in basic issues such as values, commitment and career choice. They do not want to be left alone because of their intense fear of abandonment. If abandoned, they may have tantrums, hurt themselves or others, or become depressed (APA, 2013). The case of suicide is also closely related to BPD patients, and one study showed that 7.5% of these patients committed suicide after a period of more than 20 years (Linehan and Heard, 1999). 

Treatment in Borderline Personality Disorder 

Treatments such as individual psychotherapy, group psychotherapy, pharmacotherapy, cognitive behavioral therapy, art therapy and hypnotherapy are the main approaches to be used in the treatment and therapy of borderline personality disorder. In cases where borderline personality disorder is seen together with other psychiatric disorders, psychopharmacological treatment is absolutely necessary. Antidepressants, antipsychotics or mood stabilizers are used in psychopharmacological treatment. Linehan (1993) recommends "dialectical behavior therapy", which is one of the cognitive behavioral therapy techniques based on changing negative patterns of thought and gaining new behavior and coping skills, especially in order to regulate emotional state and provide impulse control. The main treatment for borderline personality disorder is long-term psychotherapy. The aim of psychotherapy is to remove deep pathology. For this, the interpretation of the relationship between the patient's feelings, thoughts, symptoms and actions and their unconscious meanings must be discovered. Borderline patients are treated as an outpatient or hospitalized. Hospitalization criteria were frequent seizures, self-harm due to impulse control disorder, attempted suicide, random sexual intercourse, and use of addictive substances. However, fluctuations in mood and imbalances in interpersonal relationships of patients in inpatient treatment may adversely affect the treatment process. Individuals with BPD can also be treated on an outpatient basis, and the collaborative relationship of the individual with the therapist carries the treatment to a very good point. 

REFERENCES 

• İlk, G. & Bilge, Y. (2020). Borderline personality disorder and difficulty in emotion regulation. Turkish Studies- Social, 15(6), 2991-3012.https://dx.doi.org/10.47356/TurkishStudies.44179 

•Sakarya D, Çevik A. Borderline personality disorder. Turkiye Klinikleri J Int Med Sci 2007;3:40-6. 

• Gunderson, JG, Berkowitz C. A bpd brief: an introduction to borderline personality disorder diagnosis, origins, course, and treatment. New York: National Education Alliance for Borderline Personality Disorders; 2003. 

• Kutlu, M. (2018). Borderline Personality Disorder: A Review. Journal of Civilization Studies, 3(5),11-20.