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  1. Oppositional Defiant Disorder
  2. Separation Anxiety Disorder
  3. Low self-esteem in children
  4. Borderline Personality Disorder (BPD)


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Borderline Personality Disorder (BPD) | Dr. William Winter is a child and adolescent psychiatrist.
Will Winter, MD, FAAP
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A healthy defense to a sense of helplessness is to try to master one's environment. For example, it may mean learning information or establishing connections.

A maladaptive defense to feeling a need for control is to try to control others. Controlling others/ forcing others to do what you want is also called "manipulation" and is not pleasant. Sometimes when people threaten themselves this is what is happening. Self-cutting and/ or suicidal threats can be a part of the picture. A call for help in this manner must be taken very seriously.

Intense and tumultuous relationships with others are external evidence of dysfunction for someone with Borderline Personality Disorder (BPD). However, these aspects of dysfunction- intensity and tumultuousness of emotion are present internally as well.

Borderline Personality Disorder is an emotional disorder. Although not defined as a mood disorder per se in the DSM IV, (like major depressive disorder or bipolar disorder) the internal emotional experience is powerful.

On a scale from 1 to 10, how happy are you?
Using the same scale, how happy are you with yourself?

The first question addresses overall happiness. If the answer to this is low, we start considering the possibility of depression. If the answer to the second question is low, we start considering low self-esteem.

When people are asked to rate their overall level of happiness and to rate how happy they are with themselves (self esteem), the number is similar- or identical- most of the time. BPD is associated with low self-esteem. So, although those with BPD may not meet criteria for a diagnosis of depression, they may often have symptoms of it.

Emotional instability/reactivity a.k.a. "riding the emotional rollercoaster"
Moment-to-moment, things happen in our lives. Some are positive and some are negative. Regardless of the situation, most of us have a buffer so that our internal experience is not radically altered. We are still able to function, and rather well.

For example, if something negative happens, i.e. someone didn't call back, some of us might say to ourselves, "Whatever." and dismiss it. Others might become sad because an expectation was built up with or without realizing it. Even if they became sad, it would be tolerable and automatic self-soothing mechanisms would kick in for protection.

This is often not the case when someone has BPD. People with BPD will often be extremely emotionally reactive- with both highs and lows. The more severe the case of BPD, the smaller the buffer will be with which to insulate themselves from the world around them. In effect, they are emotional slaves to the vicissitudes of the environment.
(It is for this reason- the emotional highs and lows- that some clinicians may confuse BPD with Bipolar disorder.)

Origin of the term
The term "Borderline" Personality Disorder originates from the psychoanalytic idea of being on the borderline between "neurotic" and "psychotic". In some severe cases, psychotic symptoms may be present.

Possible positive aspects of BPD
Although people with BPD have dysfunction as discussed, this isn't the whole picture. The fact is that many people with BPD are very interesting, articulate, bright and capable (even if they, themselves, don't recognize it). By their nature, they can be creative, "out of the box", "trailblazers", and these qualities can be a very good thing in life.

Firstly, like all personality disorders, this is not diagnosed until 18 years of age. This is because personality is considered to be evolving during adolescence. However, if some symptoms of BPD are recognized and are causing dysfunction, they can be treated.

Treatment for BPD is behavioral therapy, specifically, DBT (Dialectical Behavioral Therapy). Sometimes medication may be useful, especially to treat depressed or unstable mood.

Some people with BPD/ symptoms of BPD are able to live with it and do not get treatment. Understandably, they may get nominally better throughout their lives. On the other hand, the prognosis may be significantly brighter for young people, i.e. teenagers who may present with cutting or other urgent/emergent situations. This may be because they receive therapy and stressors, family problems or personal problems are addressed.

Final Point.

*It is important to realize that if someone with or without a diagnosis of BPD threatens him/herself with harm or suicide, this is an emergency and EMS must be called. (Dial 911 for Emergency Medical Services in the U.S. and Canada)