- Borderline syndrome: description
- Borderline syndrome: symptoms
- Borderline syndrome: causes and risk factors
- Borderline syndrome: examinations and diagnosis
- Borderline syndrome: treatment
- Borderline syndrome: disease course and prognosis
The Borderline Syndrome is a serious personality disorder. Life with the borderline disorder is characterized by impulsivity and instability. Feelings, thoughts and attitudes can change within a short time. Behind this disorder often hide traumatic experiences in early childhood. Meanwhile, special therapeutic offers offer hope for a positive course of borderline syndrome. Read how to recognize a borderline syndrome - and how to help borderline people.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. F60
Marian Grosser, Doctor
Friend today, tomorrow enemy - People with Borderline Syndrome suffer from their extremely unstable emotional world. Psychotherapy is demanding, but the most effective way to facilitate functioning relationships.
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Borderline syndrome: description
What is borderline? Borderline personality disorder (BPS) is one of the so-called "emotionally unstable personality disorders". People with this severe mental disorder suffer from their intense and uncontrollable emotions. According to the borderline definition, the main features of this disorder include strong mood swings and violent outbursts of rage. Also, a pronounced black and white thinking typical of Borderliner.
The World Health Organization (WHO) distinguishes between two borderline types:
- the impulsive Borderine type, which stands out for its low impulse control and unpredictability,
- and the borderline type, which is characterized above all by a disturbed self-image and relationship behavior.
A typical borderline behavior is to initially idealize other people, but to devalue them greatly at the slightest disappointment. For more information on borderline patient relationships, see Borderline Relations.
Who is affected by borderline syndrome?
Borderline disease often develops in adolescence or young adulthood. Experts estimate that about six percent of adolescents or one to two percent of the total population in Germany suffer from it.
The first signs of mental disorder can appear as early as childhood, but it is difficult to diagnose borderline in children. The conspicuous signs in children and adolescents are often not clearly associated with Borderline Syndrome. If borderline disease is suspected at a young age, experts speak of borderline developmental disorder.
In the past, young women were considered to be particularly vulnerable to borderline disorder. Recent studies indicate, however, that the gender distribution is balanced. Although up to 80 percent of patients in therapy are female. However, scientists assume that borderline manifests itself differently in men than in women. Male border liners are more prone to violence against others and therefore end up in juvenile detention centers rather than in a therapeutic facility.
Mothers and fathers with borderline
People with borderline, who expect a child, often have great self-doubt and concern, the child does not do justice. However, having a mother or father with Borderline Syndrome does not automatically mean that the children will also have mental health problems. Parents who are willing to seek therapeutic treatment and work on their typical borderline behavior can provide their child with the necessary protection against the disease.
But even if parents have the best intentions for their children, they can overwhelm them. Often, for example, mothers with borderline syndrome have very high standards and want to give the child a better life than their own. There is a risk that they overprotect the children and therefore they have little room for development.
Caring for a child is always a big challenge for people with borderline syndrome. Many patients with borderline syndrome have been neglected or mistreated in their own childhood. A child of one's own can evoke memories of traumatic events. As a result, the bereaved people feel that they are back in their childhood roles and are often unable to provide their own child with adequate care. The parental role overtaxes them and generates aggression and, in some cases, violence against the children.
School and work
Most sufferers have difficulty completing vocational training. Many spend years of their lives in psychiatric clinics.Only around the thirtieth year does the intensity of the borderline syndrome slowly diminish and the violent emotional storms ebb away.
Borderline syndrome often goes hand in hand with other illnesses. Thus, in a large proportion of patients, at least temporarily, depression occurs. Also common are panic disorders, post-traumatic stress disorder and alcoholism or drug addiction.
Borderline: Children are suffering
If the borderline symptoms are severe, the children will suffer greatly from the effects of the mental disorder. Because the children are helplessly exposed to the mood swings of the parents. The change between loving closeness and rejection unsettles the children and they lose confidence in their parents.
When children realize that their parents are unable to cope with everyday life, they assume the role of the adult. Experts call this as parenting. The children strive to meet the needs of their parents and put their own back. This role reversal usually causes the children psychological problems that can last a lifetime.
Therefore, parents with borderline syndrome should seek help. The therapist can accompany the family on their way. Parents can learn to recognize the needs of their child with support. When children are educated about the illness of their mother or father, they have a better understanding of difficult situations.
Borderline syndrome: symptoms
For all the hallmarks of borderline syndrome, see Borderline Symptoms.
Borderline syndrome: causes and risk factors
Is borderline available? The borderline causes have not yet been finally clarified. It is certain that a genetic predisposition and early traumatic experiences can work together and trigger the disorder. The only twin study so far has shown that the genetic factors have a major impact on the development of borderline syndrome. Thus borderline is not inheritable, the predisposition but already.
Trauma greatly increases the risk of borderline syndrome. A large proportion of those affected have been sexually abused in early childhood - especially within the family. Borderline patients have also experienced physical violence in many cases.
Mental ill-treatment can also lead to borderline syndrome. Many of the patients were severely neglected in their youth. Lack of warmth in family relationships or unpredictable caregivers increase the risk.
Even early separation experiences through divorce or death of a parent favor the disease. Basically, mental illnesses in the family such as alcohol abuse, depression or schizophrenia increase the risk of developing a borderline syndrome.
As striking as the accumulation of trauma in patients with the borderline syndrome is - in some patients, the personality disorder evidently develops without shattering experiences. So it's not always and automatically the family is to blame for the mental illness.
Disorders in the brain
Researchers believe that the communication of certain brain centers that control the emotional processing is disturbed in people with borderline syndrome. Therefore, Borderliner experience all feelings much more intense than healthy. Whether this tendency is innate or only arises through traumatic experiences is not yet clear.
In some studies, frontal brain impairment has been reported. This brain region is important for impulse control, among other things. Actions are planned and inhibited there. The limited function of the frontal lobe may be related to the impulsive actions of borderline patients.
Borderline syndrome: examinations and diagnosis
The first step in diagnosing the personality disorder borderline is a thorough history. The following questions are important to determine the borderline syndrome:
- Did the symptoms occur in childhood or adolescence?
- Are the symptoms typical of the affected person? (eg aggressive behavior not only towards the mother but also against classmates)
- Do the symptoms occur in different life situations?
- What is the personal suffering of those affected?
For the anamnesis, not only the patient but also possibly other caregivers are interviewed, especially the parents. For the diagnosis of other mental disorders that are associated with some similar symptoms must be excluded. These include, for example, schizophrenia and disruption of social behavior.
In the borderline personality, the experience and behavior of those affected differ significantly from culturally expected and accepted guidelines ("norms") in at least two of the following areas:
- cognition: Those affected see and interpret their environment differently than other people.
- affectivity: Their emotions are more intense than usual and they are inappropriate.
- impulse control: Affected people can control their impulses poorly and have the urge to satisfy needs immediately.
- Relationships: Relations with fellow human beings are disturbed.
In addition, the doctor or therapist asks about the typical symptoms of borderline syndrome, for example, problematic relationships, frequent life crisis, aggression and self-harm.
In order to make a diagnosis of borderline personality disorder (according to ICD 10), at least three of the following characteristics must therefore apply:
- Significant tendency to act unexpectedly without taking into account the consequences (lack of impulse control)
- Significant tendency to quarrels and conflicts with others, especially when impulsive actions are suppressed or blamed
- Tendency to anger or violence with inability to control the explosive behavior
- Difficulty maintaining actions that are not directly rewarded
- Unstable and moody mood, emotional fluctuations (instability of instinct)
Additionally, at least two of the following criteria specific to Borderline Syndrome must be met:
- Disorders and uncertainty of self-image, personal goals and preferences (including sexual)
- Tendency to engage in intense but unstable relationships, often resulting in emotional crises
- Excessive efforts to avoid abandonment
- Self-injurious behavior, suicide threats and attempts
- Persistent feelings of emptiness
Borderline syndrome: treatment
For all important information about the treatment of borderline symptoms, see Borderline Therapy.
Borderline syndrome: disease course and prognosis
For a long time, borderline patients were considered hopeless cases. This picture has changed significantly with the development of therapies specifically tailored to borderline therapies.
Approximately 50 percent of borderline patients respond to the offered forms of therapy during the first treatment attempt. It is unclear, however, to which type of therapy the treatment success is due (psychotherapy or other specific therapy) and with which treatment one meets a repeated need for therapy.
However, the fact that the borderline criteria are no longer fully met does not mean that the patients are cured. Many have long term problems controlling their emotions or integrating socially.
In particular, patients with drug or alcohol abuse have worse chances to get their problems under control. This is followed by patients who suffer from post-traumatic stress disorder and / or who were sexually abused as children. About five to ten percent of borderline people die as a result of suicide or high-risk behavior, such as risky driving or drug use. With age, the impulsive borderline behavior decreases, but depressive moods often take its place.
Experts criticize that the supply of borderline patients in Germany is still inadequate. Although there are stationary offers at many specialist clinics. The outpatient care is not sufficient - also because there are too few trained therapists. In addition, the health insurance fund therapies that last more than a year, not in all cases. Thus, only about one in a thousand sufferers receives an effective outpatient treatment against the Borderline Syndrome.