Borderline personality disorder (BPD) is a psychiatric disorder with a prevalent pattern of imbalance in four areas: interpersonal relationships, self-image, affect regulation, and impulse control. In this assignment, I am going to explain what Borderline Personality Disorder is and its history. Also, I will explain the causes and the symptoms of the BPD. I will then focus on the sex bias of the diagnosis of BPD such as the causes and symptom differences between males and females. The final part will conclude in discussing the BPD therapeutic approaches in women.
In 1938, Adolf Stern was the first person who used the term 'borderline'. He explicated the patients with borderline were not 'psychotic'. At the same time he does not approved to call neurotic to the patients with borderline because these patients were show more disturbed symptoms than the 'neurotic'. (Wirth-Cauchon, 2000). After 1980, America was the first country which accepted BPD as a diagnosable personality disorder. However, nowadays, out of the ten PD which are categorized by the psychiatric categorization system (DSM-IV) BPD is the one of the common Personality Disorder (PD). This diagnosis also progressively common disorder in psychiatry (Johnstone et al., 2000). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) the BPD is "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts" (p. 706). This quotation shows individuals with BDP often experience repetitive patterns of disorganization and instability in their emotions and interpersonal relations. For example in their self-image, mood, behaviour and close personal relationships. In relation to this, BPD can be induce considerable impairment and afflict to individuals interpersonal relationships, friendships and work. Previous studies revealed the general symptoms of the BPD. Levine et al., (1997) indicated "individuals with BPD show less emotional awareness, less capacity to coordinate mixed-valence feelings, less accurate recognition of facial expressions of emotion, and more intense reactions to negative emotions". Similarly, Stein (1996) also compared individuals with BPD and without BPD. The results pointed out that individuals with BPD possess higher unpleasant and negative affect emotions such as depression, guilt, anxiety, anger, sadness etc. Stein also found that individuals with BPD represents short-term fluctuations. Additionally, researchers commonly recognize impulsivity is one of the fundamental element (trait) of the BPD (Hurt et al., 1992). The revised Diagnostic Interview for Borderline also emphasizes that impulsive behaviour plays a crucial role on the BDP. For example; verbal explosion, physical fights, suicide attempts, substance use, sexual abuse, and self-laceration (Zanarini et al., 1989). To support this idea, According to the DSM- IV-TR, "BPD involves impulsivity in at least two areas that are potentially self-damaging such as; spending, sex, substance abuse, reckless driving, binge eating (p. 710)".
Furthermore, several previous researchers have been proved that individuals with BPD have a number of imbalances especially in their emotions and personal relationships (i.e mood, self image, impulse etc.). There are several reasons why BPD patients have instabilities. Firstly, patients with BDP are unable to comprehend social cues correctly to develop personal relationships. Secondly, these patients also not able to distinguish and experience acute mood swings because they are incapable to manage their own emotions and impulses. Patients with BPD show signs of negative emotions, such as; obstructive, pessimistic, and immature. Negative emotions are pertinent to the behavioural problems which BPD patients experience. Finally, BPD patients thought that people around them always misunderstood them and generally they feel resentful, dissatisfied and betrayed (Bland et al., 2004).
Moreover, there are evidence which supports that both genetic and early environmental influences play role on the BPD (Gunderson & Berkowitz 2003; Lieb et al., 2004; Paris, 2005). However, genetic factors of BPD have not been studied comprehensively. A small number of studies about twins revealed that there is an acceptable genetic impact on the development of the BPD (Torgersen et al., 2000). Further research of Gunderson & Berkowitz (2003) is carried out to distinguish whether there are any specific genes which possibly illustrate genetic effect has impact on the development of BPD. According to this study, researchers examined genetic traits and the birth conditions of the BPD patients'. Researchers found that feelings of neglect during childhood, parental loss and prolonged parental separation related to the BPD. As a result, this study supports that there is a relationship between early environmental origins and BPD. Parental environment plays an important role on BPD patients because physical and emotional abandonment during the childhood provokes patients' to develop the feeling of the abandonment in their later life (Barone, 2003). For example when parents ignore their children's wants and needs, it will cause a damage to the children to continue their tenacity to get into the touch about their feelings and desires.
Moreover, gender bias in the diagnosis of BPD has been investigated in several studies (Adler, et al., 1990; Ford & Widiger, 1989; Henry & Cohen, 1983). Several researchers reported higher BPD prevalence rates in women than in men which is about 75% (Davison & Neale, 1998). To support this idea, seventy-five studies of Widiger and Trull (1993) evidence for BPD which have seen more commonly in women than men because they found 75% of the BPD patients in the hospitals are women (Skodol & Bender, 2003). Additionally, in an extensive review of British mental health services for women, the Department of Health (2002) estimated that, for women in high security mental health care at least 70% may have histories of child sexual abuse and over 90% self-harm. They also note that women are more likely than men are to be given the diagnosis of BPD, and that this is the most prevalent diagnostic category for high security female psychiatric patients.
Furthermore, it is evident BPD has seen more in women than men. This emphasizes that, BPD does seem to capture something of the generic female condition. Current descriptions of this disorder emphasise affective symptomatology including rage, depression, self-destructiveness (including suicidality), feelings of emptiness, and emotional liability. The BPD symptoms above supports that the main reasons for the gender bias in the diagnosis of BPD depends on the kinds of the descriptors, because emotional liability and self-destructiveness, represent the extreme characteristics of the female role and hence, are more likely to typify women than men (Tavris, 1993).
Moreover, several studies elicited that people who are suffered from sexual abuse during the childhood generally possess BPD symptoms in the adulthood (Gunderson & Berkowitz, 2003; Lieb et al., 2004). A great deal of psychological research found that people who are suffered from BPD more frequently experienced childhood neglect, emotional trauma, and abuse during their childhood (Silk et al., 1995). According to Johnson et al., (1999), a study of a total of 639 individuals who were experienced abuse in their past specifies four times more BPD symptoms in early adulthood then other people who were not experienced abuse. This research emphasizes that childhood abuse and sexual abuse has been also found to be related to the later emergence of psychiatric symptoms associated with the borderline syndrome.
Furthermore, if sexual abuse is an important factor in determining the later emergence of the borderline syndrome, it is unsurprising that women predominate in this category as they are more likely to experience this form of abuse than men are (Finkelhor, 1994).
This may be especially the case for involuntarily detained female patients. To support this idea, Wilkins and Warner (2001) examined one of the British high security mental hospitals and found that all women patients (16 women) diagnosed as BPD reported histories of child sexual abuse (the majority corroborated). However, over half the sample reported that their histories of physical abuse and removal into care; and all could be judged to have suffered from emotional abuse and neglect. As a result, a number of previous studies proved that BPD is commonly diagnosed in women.