Borderline personality disorder (BPD) is a serious mental illness. It is diagnosed in women much more frequently than men (the ratio is about 3:1). The gender discrepancy in the disorder has been the subject of many scholarly papers and in-depth articles. Some attribute this difference between women and men in regard to the diagnosis to be related to neurological possible causes of the disorder, like hormone levels. Others accredit it to institutionalized sexism or additional factors related to gender identity and behavior. Regardless of the conversation surrounding gender and BPD diagnosis, the illness affects roughly 1.6 percent of Americans in any given year and should be taken seriously as one of the risks of untreated BPD is suicide.
Borderline Personality Disorder Defined
"People who suffer from BPD often have experienced childhood trauma, and as adults, they regularly experience a severe fear of abandonments as well as an exceptionally high sensitivity to any type of perceived criticism or rejection."
Borderline personality disorder is primarily marked by insecurity and instability in the sufferer. People who suffer from BPD often have experienced childhood trauma, and as adults, they regularly experience a severe fear of abandonments as well as an exceptionally high sensitivity to any type of perceived criticism or rejection. Black-and-white thinking defines much of how a person with BPD views the world and the people within their world. Individuals are regularly put on a pedestal or intentionally devalued in the mind of a person with BPD.
There are four general subtypes of BPD. Although these subtypes might share many of the characteristics that are common among BPD sufferers, each subtype has its own specific type of BPD manifestation. The subtypes of BPD can be difficult to discover or diagnose, but they can become apparent to a trained eye, and the individual can receive better treatment if their subtype has been identified.
Impulsive borderline personality disorder is among the four subtypes of BPD. This particular subtype of BPD is the most charismatic of all four. The impulsive subtype is said to have much in common with histrionic personality disorder, according to psychologist Theodore Millon.
Signs and Symptoms for Impulsive BPD
A person with impulsive borderline personality disorder often displays the following signs and symptoms of the subtype:
- Flirtatious with others, sometimes without even realizing it
- Captivating, able to act with a natural magnetism
- Elusive and mercurial
- Superficial, easily entertaining others on a surface level but avoiding more meaningful interactions or relationships
- High levels of energy and easily bored
- Thrill-seeking and risk-taking behaviors without regard for consequences
- Attention-seeking behaviors
- Charismatic and charming
- Highly manipulative of others, particularly in order to position oneself as the center of attention
- Complaints of chronic or recurring illness
These signs and symptoms of the impulsive subtype overlap with or complement some of the more general BPD symptoms.
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General BPD Signs and Symptoms
Some of these signs and symptoms might include:
- A low or unstable self-esteem and self-image
- Excessive self-criticism
- Ongoing feelings of emptiness
- Dissociative states, particularly when under distress
- Instability in regard to goals, aspirations, career path, or core values
- Hypersensitivity, especially in regard to perceived criticism or rejection
- Black and white thinking
- Tendency to idealize or devalue people
- Emotions that are easily aroused
- Emotions that are disproportionately intense when compared to the cause for the emotion
- Increased anxiety, nervousness, tension, worry, and panic
- Discomfort and fear of the uncertain
- A fear of losing control
- Deep and pervasive feelings of shame
- Separation anxiety
- Feelings of hopelessness and powerlessness
- Suicidal thoughts
- Difficulty with creating or sticking with plans
- Risk-taking behaviors, like sexual promiscuity and gambling
Causes of BPD and the Impulsive Subtype
In the world of mental illness, it is difficult to find the cause of a disorder with exacting precision. That is because mental illnesses are complex and still undergoing much of the research needed in order for us to one day better understand their cause.
At this point in time, mental illnesses are seen as the result of multiple factors, none of which we know to necessarily be more impactful than others. Some of these causes include childhood trauma, neurobiological factors, brain abnormalities, genetics, environmental factors, social factors, and psychological factors.
A lot of research is still underway in regard to BPD and the impulsive subtype and the causes and correlations for both. We do know that these issues factor in:
There is a high incidence of childhood trauma among BPD sufferers. Abuse and neglect are some of the primary childhood traumas documented among sufferers, and sexual abuse is one of the common forms of abuse. Researchers have also noted a high incidence of the loss of a caregiver as well as incest in the childhoods of those with BPD. Adults with BPD often report that their caregivers during their childhood frequently denied the validity of their feelings and failed to provide the protection they needed as a child. Emotionally withdrawn and inconsistent behavior among caregivers has also been seen as a common denominator for those suffering from BPD or impulsive subtype.
Disturbed estrogen levels have been associated with BPD. These types of estrogen levels are sometimes seen in women as a part of their menstrual cycle. However, it is important that severe PMS is viewed differently than BPD and that hormone-related treatment is not initiated on patients who also suffer from endometriosis.
There are a number of brain abnormalities that have been documented in those with BPD. Among these are a decrease in the size of the amygdala and hippocampus.In people with BPD, the prefrontal cortex is often less active than what is seen people who do not have the disorder. Cortisol production, a function of the hypothalamic-pituitary-adrenal axis, is usually elevated in people who suffer from BPD as well. This overproduction of cortisol might be the result of traumatic childhood events, which can trigger cortisol production, or perhaps a preexisting elevated level of cortisol production could cause sufferers to experience events as traumatic.
Heritability is a focus of BPD causal research. The heritability factor of BPD is estimated to be around 65 percent. A study in the Netherlands found that genetic influence accounted for 42 percent of variation in BPD features in sufferers and that BPD features are linked with chromosome nine. Other genes under current investigation for the role they might play in the development of BPD are DRD4, which has also been associated with disorganized attachment, as well as DAT, which has been associated with inhibitory control abnormalities.
Researchers are also looking into other factors that might contribute to the development of BPD. A stable family unit can buffer the development of this disorder, so some factors like family stability as well as social stability are being examined and might prove to play a role in BPD development.
Diagnosing Impulsive Type BPD
Properly identifying and diagnosing BPD has long been an issue. Since the term was first coined in 1938 by Adolf Stern, mental health professionals have struggled to define the terms of diagnosis and treatment for those with BPD. There are many issues that cloud the examination of BPD in a clinical setting that have contributed to this type of difficulty.
There is a high rate of comorbidity among BPD sufferers. Many people who suffer from BPD also suffer from major depression, anxiety disorders, substance abuse, antisocial personality disorder, and eating disorders, among other conditions. These conditions can make it difficult for someone to see BPD from an outside perspective, and some of these conditions, like substance abuse, can greatly hinder a person’s cognitive function as well as their treatment.
"Although the ups and downs of everyday living might seem like too much to take at times, there is treatment available that can truly change the way a person processes and manages their disorder."
It is incredibly important that a person with BPD is treated sooner rather than later. Delaying treatment will lead to a worsening of the illness, which can become severely debilitating over time. Moreover, BPD accounts for a large chunk of suicides every year. For this reason, any self-harm, self-mutilation, or suicidal thoughts or behaviors on behalf of a person suffering from BPD need to be immediately addressed and taken seriously. If you or someone you know is at risk for suicide, it is vital that you reach out for professional help immediately. You can call the National Suicide Prevention Lifeline at 1-800-273-8255, or call 911.
Although the management, treatment, and recovery from BPD might seem harrowing, it is not impossible. In fact, studies have shown that recovery from BPD is indeed possible and that those who suffer from BPD can work toward leading a fully functional and rewarding life.
Treat BPD in the way that works for you.
One study found that:
- 34.5 percent of individuals suffering from BPD could achieve remission within two years of treatment,
- 49.4 percent within four years of treatment,
- 68.6 percent within six years of treatment, and
- 73.5 percent by the end of the study.
These numbers are incredible proof of a positive prognosis for BPD, which flies in the face of the common assumption that those who suffer from BPD are condemned to a lifetime of suffering with little, if any, improvement over time.
Much of the work on BPD is done through psychotherapy. Psychotherapy options like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy, schema-focused therapy, and general psychiatric management have all proven to be successful in treating BPD. Among the most successful are MBT and DBT, but the key to a successful recovery is finding exactly what works for each person individually.
There is no prescription medication that can treat BPD, but sometimes prescriptions are used to help manage conditions that occur alongside BPD for better overall treatment. For instance, anxiety, depression, anger, and impulsivity can all be treated with medicine while the core issues of BPD are addressed without the debilitating distraction of the other issues. The medicinal management of these concurring issues is not only helpful; it is typically seen as necessary in order to treat BPD. It is important to fully understand that there is no set cure for BPD, and there is medication available to help treat the symptoms of the disorder. Treating the concurring issues is simply a matter of clearing the path for more accurate and successful treatment.
Living with impulsive type BPD does not have to be a continual struggle. Although the ups and downs of everyday living might seem like too much to take at times, there is treatment available that can truly change the way a person processes and manages their disorder.
Optimum Performance Institute leads the way in the treatment of BPD in adolescents and young adults. Our OPI Intensive was named “Best In Treatment” by Psychology Today for the treatment of BPD. OPI Intensive addresses the individual needs of each person in the treatment program while also providing a supportive social structure for those undergoing treatment for BPD. The program uses a 30-day immersion phase as well as a 30-day transformational phase, and in the end yields young adults who are much better equipped to manage their BPD and live self-sufficiently and successfully in adult life without assistance.