Mental Status Examination of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a serious personality disorder. People with BPD show a pattern of behavior characteristics marked by impulsivity and instability in interpersonal relationships, self-image, and moods. BPD is a debilitating disorder that occurs in approximately 1-4 % of the general population and about 75% are females [1-3]. Recent studies have found that BPD is actually more prevalent affecting almost 5.9% of the population; and there was no difference found among the rates of BPD among women vs. men [4]. Within a sample of personality-disordered patients, Zanarini et al. [5] found gender differences in the “type of disorder of impulse in which they specialized”, with male borderline patients significantly more likely to meet criteria for lifetime substance use and females significantly more likely to meet criteria for life-time eating disorders. Common clinical features of BPD are frequent intense mood swings, the inability to be alone nor to tolerate intimacy, fears of abandonment, extreme dependency on others alternating with sudden hostility, perceiving others as all good or all bad (“splitting”), chronic self-mutilation (often described as relieving emotional pain), and chronic suicidality. Suicide attempts serve to punish others, escape suffering, and to communicate distress [6,7]. These patients are argumentative, irritable, sarcastic, quick to take offence and very hard to live with. Self-mutilation is one of the most discriminating signs of BPD [8]. Self-injurious behavior is associated with relief from anxiety or dysphoria and with analgesia (absence of the experience of pain in the presence of a theoretically painful stimulus) [8]. Other researchers have emphasized interpersonal problems and conflict as important precipitating events to the parasuicide [9-12]. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [13,14], these conditions are defined by maladaptive personality characteristics beginning early in life (early adulthood) that have consistent and serious effects on functioning. BPD is frequently seen in clinical practice, characterized by emotional turmoil and chronic suicidality (suicide ideation and attempts). Several studies stress the role of impulsiveness as a core construct of BPD [15-17]. Emotion dysregulation is supposed to be a central mechanism of the disorder [6]. Patients with BPD are supposed to show high sensitivity and intense reactions to emotional stimuli as well as longer latencies to return to their baseline emotional state [18]. BPD commonly co-occurs with a variety of Axis I disorder ranging from mood & anxiety disorders (esp. panic & Post Traumatic Stress Disorder), to substance use & eating disorders [19]. Several studies have shown high comorbidity between BPD and substance use disorders (SUD) [20-22]. It has been suggested that the comorbidity occurs because both conditions share the Volume 8 Issue 2 2017