Borderline - An insight into the topic with Dr Ruedi Schweizer, MD

How common is borderline personality disorder and who is typically affected?

The data varies because the diagnosis is complex and cannot be made in a short space of time like a laboratory test. It is generally assumed that 1 to 2 % of the population is affected. Typically, more women are affected and the incidence decreases with age.

How do the symptoms of borderline personality disorder manifest themselves in the everyday lives of those affected?

Those affected often have difficulty recognising, classifying and naming their own emotions and developing a certain inner distance. To a certain extent, they are flooded with their own feelings and are often threatened or overwhelmed by them. This then leads to actions that patients can no longer control well, such as sudden relationship breakdowns, outbursts of anger or self-harming, tension-regulating behaviour. Personal and working relationships are often difficult to maintain. Those affected need reliable, stable, benevolent but clear and dependable relationships. Then participation in society can be successful. It is also important to emphasise that there are different degrees of the disorder and that affected people have often got to know each other well through their life or therapy experience and can have a fulfilling life.

What are the causes of borderline personality disorder?

Personality disorders were long regarded as purely acquired disorders. Today, a more differentiated view is taken and genetic or at least familial (transgenerational) causes are also discussed. However, the acquired component remains the most frequently cited. In recent years, it has become increasingly clear that many "borderline" patients report traumatic biographical experiences. These are not exclusively experiences of abuse, but also other so-called Adverse Childhood Experiences (ACE), such as emotional deprivation or a lack of a sense of security as a child. The so-called "complex trauma sequelae disorder", as described in the new classification of mental illnesses, has a large overlap with borderline personality disorder. Some researchers say they are actually one and the same.

What treatment options are there for people with borderline?

Treatment is the domain of psychotherapy. There is no medication for borderline personality disorder. Nevertheless, they are occasionally prescribed, for example for sleep disorders or depression, which can also occur due to the personality problems. Psychotherapy is first and foremost about creating a sustainable, reliable, trusting relationship. This can be difficult and time-consuming work for both the person affected and the therapist. There are also some very well researched and widely used specific therapy methods such as Dialectical Behavioural Therapy (DBT) or Transference-Focused Therapy (TFP), which are also offered in specialised psychotherapy centres. Skills training, which originates from DBT and is widely used, is also well-known. Patients learn tools to better perceive and control their experience. Many have put together an actual "skills kit" from which they can then seek help depending on the situation. Trauma-focussed therapies are also an option if there are clear traumas in the biography. All therapy methods must be carefully evaluated and selected with those affected. This is already part of the actual therapy.

How can relatives and friends of people with borderline personality disorder help?

As for those affected themselves, it is important to know a few things about the particularities of the illness and to be "in the know". This helps to prevent misbehaviour and to be able to respond more empathetically to those affected. As this is (by definition) a long-term issue, the people affected become experts on their illness. Relatives can take advantage of this and ask those affected what could help, what support they should and should not offer. This can reduce the helplessness that can occasionally arise when dealing with borderline patients in a crisis. If possible, it is important to have lasting, reliable relationships that are not immediately abandoned after a conflict. This often requires a great deal of personal resilience from relatives. It may also help to seek psychotherapeutic counselling as a friend. There are also family groups within the self-help movement.

What progress has been made in research into borderline personality disorder?

As mentioned above, the overlaps between borderline personality disorder and trauma-related disorders are becoming increasingly clear. Therapy concepts are likely to converge accordingly. It may also serve to destigmatise them to a certain extent. "Borderliners" often suffer from the label ("stigma") that they have been given. The heated debate as to whether the term borderline personality disorder should be abolished in the new classification (ICD 11) (in favour of the above-mentioned dimensional classification of personality disorders) also has to do with the stigmatisation of the term, similar to "hysterical disorder" decades ago. For the time being, the term will probably remain as the only "pigeonhole" within personality disorders.

What is your most important message to people who struggle with borderline?

Personally, I take a critical view of the construct of individual personality disorders as self-contained disease entities and am grateful for the new model of dimensionality, which is now to replace categorisation. It also helps those affected to identify themselves as "people with special characteristics" rather than "personality disorder sufferers". Rainer Sachse (a German psychotherapist) describes the problematic behaviour of people with stressful biographies as a "creative attempt to find a solution" to satisfy previously unfulfilled basic needs. Unfortunately, this does not work, or only with many side effects. But it seems to me to be a helpful concept and an important message for patients and therapists alike.

Borderline personality disorder is often a distressing but treatable illness. Dr Ruedi Schweizer shows us that there is hope for those affected - be it through suitable therapy, support from their environment or through ongoing research, which is offering more and more new approaches. It is important that people with borderline get the support they need and that the topic continues to be destigmatised.