Chief physician explains the background: Women are affected twice as often by borderline

Impulsive and extremely emotional behavior can have many causes.

Chief physician explains the background: Women are affected twice as often by borderline

Impulsive and extremely emotional behavior can have many causes. A borderline disorder is one of them. "Women are affected at least twice as often as men," says Tobias Freyer, chief physician and medical director of the Oberberg Parkklinik Wiesbaden Schlangenbad and specialist in psychiatry and psychotherapy. The expert also reveals how borderline is expressed in couple relationships and how those affected should deal with it.

What is borderline?

Tobias Freyer: The borderline disorder is a form of personality disorder in contrast to the healthy/undisturbed personality and other personality disorders such as the anxious-avoidant, narcissistic or schizoid personality disorder. The technically correct term is: emotionally unstable personality disorder of the borderline type. Those affected have problems with the regulation of feelings. They experience positive and negative emotions more intensely and it takes much longer for these people's emotions to subside. This can cause borderliners to become overwhelmed with their emotions and become highly tense.

What are typical symptoms of a borderline disorder?

The emotionally unstable personality disorder of the borderline type (BPD) is characterized by the difficulties in emotion regulation described above. In addition, people with a borderline disorder often suffer from a pronounced instability in their self-image. Their interpersonal relationships are also characterized by extremely positive and negative feelings. They tend to either strongly idealize or devalue other people and their partners, experience pronounced fears of abandonment. They tend to be more impulsive than healthy people, experiencing tantrums with smashing objects, or showing impulsiveness in other areas, such as spending money, substance abuse, binge eating, or reckless driving. The high levels of tension are very uncomfortable for those affected. Many people with BPD learn to stop these conditions through self-harm, which helps in the short term but can be very damaging in the long term. Typical are scratches or cuts. It is important here that the self-harm is typical, but does not have to be a mandatory prerequisite for the diagnosis of borderline disorder.

How many and which people suffer from it most often?

The lifetime prevalence, i.e. the probability of meeting the diagnostic criteria for emotionally unstable personality disorder of the borderline type over the course of a lifetime, is around three to five percent for the entire population. Women are affected at least twice as often as men. Symptoms usually peak in young adulthood (between the ages of 20 and 30), but often appear in adolescence or even childhood. Fortunately, the disorder resolves in about 80 percent of those affected over the course of their lives. Victims of sexual abuse in childhood are particularly affected by the disorder. Many of those affected state that they injured themselves when they were still in elementary school. People with BPD are naturally quick to respond to strong emotions and do not learn or have not learned how to manage their strong emotions appropriately. The environment is also important here. In particular, dealing with children and adolescents that does not take into account or suppresses the feelings of the children is considered an important factor in the development.

How does borderline manifest itself in a couple relationship?

Typically, those affected live very intensive couple relationships, which are often characterized by arguments. Due to the feeling of inner emptiness and the lack of their own identity as well as the fear of rejection and rejection, the patients often seek very close contact with their partners, behave clingily, and in order to bond the partner even more closely, they utter suicide threats in conflicts between partners. The partner is idealized for a long time, but then the relationship can suddenly break off.

What effects can this have in a couple relationship?

Due to the symptoms and problems described above, couple relationships are often heavily burdened. Depending on the personality of the partner, very unhealthy and dependent couple relationships or violent, unpleasant separations and on-off relationships can result.

How should the partner deal with it?

It is certainly helpful if the partner reacts very calmly, considerately and sensitively. However, this cannot replace treatment.

How is the disorder treated?

Mainly psychotherapeutic. Psychotropic drugs such as antidepressants, atypical neuroleptics or sedatives are only used in serious cases or in cases associated with so-called comorbidity (i.e. the simultaneous presence of a depressive illness or ADHD). Psychotherapy aims to give those affected a better understanding of their problems, to learn a more functional way of dealing with strong feelings and mood swings, and to reduce or completely eliminate self-harm and impulsive behavior.

Can you prevent borderline?

Anything that influences the development of an emotionally unstable personality disorder should be avoided. However, it largely takes place in childhood and is naturally not within the sphere of influence of those affected. These include hostile parental behavior, unstable parental relationships, sexual abuse, early drug use, eating disorders. Obtaining therapeutic help at an early stage is certainly the most important clue.

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