Borderline Personality Disorder

Condition & Symptoms

Borderline personality disorder (BPD) can cause a wide range of symptoms. 

If you have BPD, you may experience a range of often intense negative emotions, such as: rage, sorrow, shame, panic, terror and long-term feelings of emptiness and loneliness.  You may have severe mood swings over a short space of time.   It’s common for people with BPD to feel suicidal with despair, and then feel reasonably positive a few hours later. Some people feel better in the morning and some in the evening. The pattern varies, but the key sign is that your moods swing in unpredictable ways.

There are two main types of impulses that BPD patients may find extremely difficult to control.

  • First, an impulse to self-harm – such as cutting your arms with razors or burning your skin with cigarettes; in severe cases, especially if you also feel intensely sad and depressed, this impulse can lead to feeling suicidal and you may attempt suicide.
  • Second, a strong impulse to engage in reckless and irresponsible activities – such as binge drinking, drug abuse, going on a spending or gambling spree, or having unprotected sex with strangers.

If you have BPD, you may feel that other people abandon you when you most need them, or that they get too close and smother you.   When people fear abandonment, it can lead to feelings of intense anxiety and anger. You may make frantic efforts to prevent being left alone, such as constantly texting or phoning a person, suddenly calling that person in the middle of the night, physically clinging on to that person and refusing to let go or making threats to harm or kill yourself if that person ever leaves you.  Alternatively, you may feel others are smothering, controlling or crowding you, which also provokes intense fear and anger. You may then respond by acting in ways to make people go away, such as emotionally withdrawing, rejecting them or using verbal abuse.  These two patterns may result in an unstable “love-hate” relationship with certain people.

Many people with BPD seem to be stuck with a very rigid “black-white” view of relationships. Either a relationship is perfect and that person is wonderful, or the relationship is doomed and that person is terrible. People with BPD seem unable or unwilling to accept any sort of “grey area” in their personal life and relationships.   For many people with BPD, emotional relationships (including relationships with professional carers) involve “go away/please don’t go” states of mind, which is confusing for them and their partners. Sadly, this can often lead to break-ups.

Conventional Treatments

  • Treatment for BPD usually involves some type of psychological therapy, also known as psychotherapy.
  • Dialectical behaviour therapy (DBT) is a type of therapy specifically designed to treat people with BPD.
  • Another type of long-term psychotherapy that can be used to treat BPD is mentalisation-based therapy (MBT).
  • NHS Crisis resolution teams support people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis, which would require hospitalisation without the team’s involvement.
  • People with BPD often find that simply talking to somebody who understands their condition can help bring them out of a crisis.
  • While medication is not recommended by National Institute for Health and Care Excellence (NICE) guidelines for BPD, there’s evidence that it may be helpful for certain problems in some people.
  • Mood stabilisers or antipsychotics are sometimes prescribed to help mood swings, alleviate psychotic symptoms or reduce impulsive behaviour

BPD and RTMS Treatment

Research and Studies

There are very few evidence-based treatments for BPD. 

One current area of research is rTMS.

Research Studies

rTMS studies have also shown that stimulation of the right frontal cortex while inhibiting the left frontal cortex cortex reduces risk taking in healthy people (Fecteau et al, 2007).

Possible neurodevelopmental deficits have been found in the right hemisphere in borderline patients (Barnow et al, 2008).

Abnormalities in the EEGs have been found in the right hemisphere of borderline patients indicating possible deficits in the maturity of fronto-medial processing systems (Meares et al, 2011).

A small randomized controlled study of BPD patients treated with 10 sessions of high frequency rTMS to the Right DLPFC gave significant improvements in mood instability at 3 months (p < 0.05) and decision making at 3 months (p < 0.05) (Cailhol et al, 2014).  The treatment was safe and there were no significant side effects.  More research is required to establish rTMS as a treatment of choice for BPD. [/av_toggle] [/av_toggle_container] [av_hr class='invisible' height='15' shadow='no-shadow' position='center' custom_border='av-border-thin' custom_width='50px' custom_border_color='' custom_margin_top='30px' custom_margin_bottom='30px' icon_select='yes' custom_icon_color='' icon='ue808' font='entypo-fontello'] [/av_one_full][av_one_full first min_height='' vertical_alignment='' space='' custom_margin='' margin='0px' padding='0px' border='' border_color='' radius='0px' background_color='' src='' background_position='top left' background_repeat='no-repeat' animation=''] [av_button_big label='Repetitive Transcranial Magnetic Stimulation (TMS) ' description_pos='below' link='page,41' link_target='' icon_select='yes-left-icon' icon='ue889' font='entypo-fontello' custom_font='#ffffff' color='theme-color' custom_bg='#444444' color_hover='theme-color-subtle' custom_bg_hover='#444444'] A new non-invasive, non-medication based treatment [/av_button_big] [av_hr class='invisible' height='15' shadow='no-shadow' position='center' custom_border='av-border-thin' custom_width='50px' custom_border_color='' custom_margin_top='30px' custom_margin_bottom='30px' icon_select='yes' custom_icon_color='' icon='ue808' font='entypo-fontello'] [/av_one_full] [av_one_full first min_height='' vertical_alignment='av-align-top' space='no_margin' margin='0px' margin_sync='true' padding='15px' padding_sync='true' border='1' border_color='#bcbcbc' radius='0px' radius_sync='true' background_color='rgba(225,106,13,0.05)' src='' attachment='' attachment_size='' background_position='top left' background_repeat='no-repeat' animation=''] [av_textblock size='' font_color='' color='']

rTMS at The Smart Clinics in London

Transcranial Magnetic Stimulation therapy treatment is available at Smart TMS, based at The Smart Clinics, Brompton Cross, London.

Smart TMS offer treatments for a number of conditions including depression, anxiety and depersonalisation disorder.

To discuss this further, please contact us.
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