The Borderline syndrome or Borderline disorder is a mental illness from the field of personality disorders. Those affected suffer from a lack of social skills. In particular, interpersonal relationships with other people are characterized by pathological instability. Strong mood swings are also common. The view of oneself (self-image) is exposed to strong distortions. Anxiety disorders, anger and despair also occur.
What is borderline syndrome?
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Borderline syndrome is a mental illness in which those affected live in extreme mental tensions that are excruciating and diffuse. The exact classification of the syndrome is controversial to this day. Borderline syndrome generally refers to "borderline" or "borderline" and was initially created as a term because it was used to summarize symptoms that doctors placed between neurotic and psychotic disorders.
Initially understood as a diagnosis of embarrassment, borderline syndrome is now recognized as an independent clinical picture. Accordingly, the borderline syndrome is a specific personality disorder that is characterized by instability in interpersonal relationships and extreme impulsiveness, mood swings and a distorted self-image.
In addition to the term borderline syndrome, the terms emotionally unstable personality disorder or borderline personality disorder (BPS for short) are also used in technical jargon.
causes
The background to the borderline syndrome is not exactly clear. So far, research has shown that the syndrome mainly develops in people who have been sexually abused for long periods of time, have experienced strong rejection as a child, have been emotionally neglected or have been exposed to physical violence. In this respect, borderliners are severely traumatized people who are exposed to extreme states of fear.
It is not certain who and how many people with such trauma show a borderline syndrome, because the clinical picture is still not always recognized or precisely diagnosed. However, estimates assume that 1 to 2 percent of a population is affected on average. Around 70 percent of all those affected are women. Based on this estimate, borderline would be more common than other mental illnesses such as schizophrenia. Genetic causes can also cause borderline syndrome.
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Borderline patients have difficulty classifying and controlling their own emotions and impulses. They give in to their feelings quickly, without weighing the possible consequences. These include, for example, outbursts of anger for which even minor reasons are sufficient. Mood swings are also typical symptoms: Borderliners experience strong emotional storms, which can also be of a positive nature, but are usually short-term and trigger a strong inner unrest in them.
In this regard, many patients tend to be self-destructive.They “cut” themselves, that is, they injure their own body parts with knives or razor blades. Self-destruction can also manifest itself in heavy use of alcohol or drugs. Patients often take risks in traffic or expose themselves to unprotected sexual intercourse.
They often threaten suicide or actually try to take their own life. Stress often leads to a loss of reality. One speaks of dissociative symptoms, which means that the patient's perception changes. They perceive their environment as unreal and have the feeling of being strange or detached from their own person.
Many patients also experience a constant feeling of emptiness - their lives seem boring and aimless to them. At the same time, they are often afraid of being alone and enter into relationships which, however, often turn out to be unstable due to the symptoms.
course
The states of tension in people with borderline syndrome are characterized by depression, which occurs in almost all borderliners, and the feeling of inner emptiness on the one hand and strong impulsiveness. Borderliners have no sense of "normality", they fluctuate between emotional extremes, live in unstable social relationships and tend to ventilate the strong internal pressure, which can suddenly and unfounded, through extreme behavior. In such cases it happens that those affected injure themselves or find themselves in extreme situations.
Typical behaviors are excessive drug consumption, daring driving or balancing on bridge railings. Such high-risk behavior serves to stabilize feelings of powerlessness again and to create self-empowerment.
Borderliners are often at the mercy of their mood swings. The social behavior of people with borderline syndrome is therefore difficult to assess, as affective short circuits occur again and again and there is no impulse control whatsoever, which is often incomprehensible to the outside world.
Complications
Physical complications are possible with borderline syndrome if the person concerned engages in self-harming or self-harming behavior. Cuts and burns are common. Because of fear, lack of self-esteem or other reasons, those affected do not always seek help in a timely manner. The wounds can become infected or heal poorly. Damage to muscles and nerves is also possible. Borderline syndrome also has an increased risk of suicide.
Conversely, however, some borderlines use such injuries to receive care. In this case, mental dependence on medical care can arise. Since the person concerned often seeks medical help in this case, negative consequences of the care are also possible, for example hospitalism.
Many people with borderline syndrome find it difficult to maintain long-term relationships with other people. The symptoms of personality disorder often lead to conflict. Some of those affected show contradicting behavior in that they want their loved ones to be with them on the one hand, but on the other hand they distance themselves from them. As a result, their actual emotional needs often remain unmet.
Social isolation is another complication that can develop from ambivalent social behavior. Psychotic or dissociative symptoms can also lead to disorientation or a temporary inability to act in everyday life.
In addition, borderline often coexists with other mental health problems, especially anxiety and obsessive-compulsive disorder, post-traumatic stress disorder, substance addiction or harmful use of substances, eating disorders, and ADD / ADHD.
When should you go to the doctor?
Anyone who recognizes at least five of the following nine typical symptoms for borderline syndrome should see a doctor:
- Low anger threshold and uncontrollable outbursts of anger that can result in physical violence
- Self-harming behavior, from scratching the skin or causing burns to attempting suicide, drug use and eating disorders
- Sudden impulse to take extreme risk, which can be life-threatening, such as B. Lawn on the highway, climbing on bridge railings, etc.
- Strong fear of separation and loss and constant fear of being alone
- Inner emptiness, constant boredom and aimlessness
- Extreme and uncontrollable emotional fluctuations, the negative phases of which become longer and longer
- Unstable interpersonal relationships due to constant vacillation between clinging and rejection, black and white thinking
- Loss of reality through the feeling of being in another world and experiencing feelings detached from oneself
- Identity disorders in the form of sudden uncertainty about who you are and what you can do
Doctors & therapists in your area
Treatment & Therapy
There is no consensus in medicine and psychology on how to treat borderline syndrome. Psychotherapeutic approaches are generally not considered to have particularly great results. Behavioral therapeutic approaches have proven to be more successful, in which the patient is shown how they can develop new behavioral patterns in extreme situations and internalize them in the long term.
There are again different schools that are more supportive or confrontational. Since the borderline syndrome expresses traumatic experiences of childhood, special trauma therapies are also recommended, although science agrees that this should not lead to re-traumatisation.
The choice of the right therapy method for borderline syndrome ultimately depends on the person affected. Standardized procedures rarely show the desired effect. In addition, it is always seen as particularly helpful to include the social environment in therapy. Treatments with drugs, the so-called medication, cannot treat the borderline syndrome as a whole, but at most combat individual symptoms.
Outlook & forecast
Borderline personality disorder typically lasts for several years. Borderline syndrome usually becomes milder with age. The symptoms can recede so far that the diagnostic criteria for the personality disorder are no longer met. Often, however, some of the symptoms remain. However, this remainder does not have to have a disease value, but can also form part of the normal personality spectrum.
At the same time, however, older age is also considered a risk factor for suicide attempts that ended in the death of the person concerned. Impulsiveness, depression, and abuse in early childhood also increase the statistical risk of suicide. In addition, another personality disorder besides borderline syndrome can occur and reduce the chance of improvement.
The dependent, anxious-avoidant and paranoid personality disorder occur particularly frequently. If the borderline personality suffers from antisocial personality disorder, the risk of suicide is also increased. However, these statements are general statements - the individual course of the borderline personality disorder can deviate from the average.
One study showed that six years after diagnosis, a third of patients still suffered from borderline syndrome. A clear decline was already evident after two years. The development and spread of specific therapies such as dialectical behavioral therapy (DBT) has led to an improved range of help for patients over the last fifteen years.
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Those affected by borderline syndrome can protect themselves from impulsive actions with negative consequences in everyday life by occasionally avoiding situations that favor excessively negative or positive perceptions and actions. Regular rest breaks come into consideration for this, in which the person concerned disengages himself from conversations and other interactions for a certain time.
During these breaks, however, those affected should not concern themselves with their perception of the events, but rather gain a little distance from what happened - whether it was something good or bad is irrelevant. There are various possibilities for doing this, including, for example, listening to music loudly, massaging yourself with massage balls or solving small puzzles. The possibilities for temporary distraction are manifold and can be explored and found by those affected.
The temporary distancing from feelings in relation to themselves and their environment helps those affected by borderline personality disorder to return to their social role in a more reflective and less impulsive manner. In this way, conflicts - sometimes objectively groundless - can be prevented in advance.
The environment of the people concerned should also be included. Communication about what is felt helps everyone involved in everyday dealings. Regular discussions that follow a certain structure make the emotional aspect easier to understand and often enable people with the borderline syndrome to better assess and reassess a situation afterwards.
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