Borderline syndrome

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Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

Borderline syndrome is a serious personality disorder. The life of those affected is characterized by impulsiveness and instability. Feelings, thoughts and attitudes can change in a very short time.The borderline disorder often conceals traumatic experiences in early childhood. In the meantime, special therapeutic offers offer hope for an improvement. Read here how to recognize borderline syndrome and how you can help borderliners.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F60

Borderline syndrome: description

What is borderline? Borderline personality disorder (BPD) is one of the so-called "emotionally unstable personality disorders". People with this severe mental disorder suffer from their intense and uncontrollable emotions. According to the borderline definition, the main characteristics of this disorder include strong mood swings and violent outbursts of anger. A pronounced black and white thinking is also typical for borderliners.

Most borderliners also have difficulty completing vocational training. Some spend years of their lives in psychiatric hospitals. Only around the age of thirty does the intensity of the borderline syndrome slowly decrease and the violent storms of emotions subside.

Who does borderline syndrome affect?

Borderline disease often develops in adolescence or young adulthood. The first signs of the mental disorder can appear in childhood, but it is difficult to diagnose borderline in children. The noticeable signs in children and adolescents can often not be clearly assigned to the borderline syndrome. If a borderline disease is suspected at a young age, experts speak of a borderline developmental disorder.

In the past, young women were thought to be particularly susceptible to borderline disorder. However, recent studies indicate that the gender distribution is balanced. Up to 80 percent of patients in therapy are female. Scientists assume, however, that borderline expresses itself differently in men than in women. Male borderliners are more prone to violence against others and are therefore more likely to end up in juvenile detention centers than in a therapeutic institution.

Borderline mothers and fathers

Borderline people expecting a child often have great self-doubts and worry about not doing the child justice. However, if a mother or father suffers from borderline syndrome, it does not automatically mean that the children will also have psychological problems. Affected parents who are ready to seek therapeutic treatment and work on their typical borderline behavior can offer their child the necessary protection against the disease.

Borderline: Children suffer too

Borderline parents, like other parents, have the best of intentions for their children. But you can overwhelm them. Often, for example, mothers with borderline syndrome have very high demands on themselves and want the child to have a better life than theirs. There is a risk that they overprotect the offspring and hardly give them room to develop.

In the case of parents with severe borderline symptoms, the children suffer greatly from the effects of the mental disorder. You are helplessly exposed to the mood swings of your parents. The change between loving closeness and rejection unsettles the children and they lose trust in their parents.

When the children notice that their parents are unable to cope with everyday life, they take on the role of adults. Experts call this parentification. The children strive to meet the needs of the parents and put their own aside. This reversal of roles usually creates psychological problems in the children that can last for a lifetime.

Many borderline syndrome patients were neglected or abused in their own childhood. A child of his own can bring back memories of such traumatic events. As a result, those affected feel that they have returned to the role of children and are often unable to adequately care for their own child. The parenting role overwhelms them, creates aggression - and in some cases also violence against the children.

So there are many reasons why parents with borderline syndrome should seek help. A therapist can accompany the family on their way. With support, parents can learn to recognize their child's needs. If the children are educated about the illness of the mother or the father, they have a better understanding of difficult situations.

Borderline: relationships

Typical borderline behavior is to idealize other people at first, but devalue them greatly at the slightest disappointment. That makes relationships with relatives, friends and life partners very difficult. For more information on borderline patient relationships, see the "Borderline Syndrome: Relationship" post.

Often comorbidities

Borderline syndrome often goes hand in hand with other conditions. The majority of patients experience depression, at least temporarily. Panic disorders, post-traumatic stress disorder and alcoholism or drug addiction are also common.

Borderline syndrome: symptoms

You can read everything you need to know about the signs of borderline syndrome under Borderline Symptoms.

Borderline syndrome: causes and risk factors

Can borderline be hereditary? Many of those affected are interested in this question. However, the borderline causes have not yet been conclusively clarified. What is certain is that a genetic predisposition and early traumatic experiences can work together and trigger the disorder. The only twin study to date has shown that genetic factors have a major influence on the development of borderline syndrome. Thus, although borderline itself cannot be inherited, the predisposition for it is.

Traumatic experiences

Traumatization significantly increases the risk of borderline syndrome. A large proportion of those affected were sexually abused in early childhood - especially within the family. Borderline patients have also experienced physical violence in many cases.

Mental abuse can also result in borderline syndrome. Many of the patients were severely neglected in their youth. A lack of warmth in family relationships or unpredictable caregivers increase the risk.

Early experiences of separation through divorce or the death of a parent also favor mental illness.

Mental health problems in the family, such as alcohol abuse, depression or schizophrenia, also increase the risk of children developing borderline syndrome.

As conspicuous as the accumulation of trauma in patients with the borderline syndrome is - in some of the patients the personality disorder evidently develops even without harrowing experiences. So it is not always and automatically the family "to blame" for the mental illness.

Disorders in the brain

Researchers assume that in people with borderline syndrome the communication of certain brain centers that control emotional processing is disturbed. Therefore, borderliners experience all feelings much more intensely than healthy people. It is not yet clear whether this tendency is innate or whether it arises through traumatic experiences.

Some studies have reported impairment of the frontal lobe in borderliners. This brain region is important for impulse control, among other things. Actions are planned and also inhibited there. The impaired function of the frontal lobe could be related to the impulsive actions of borderline patients.

Borderline Syndrome: Investigations and Diagnosis

The first step in diagnosing borderline personality disorder is taking a thorough medical history. To this end, the doctor / therapist speaks not only with the person affected, but also, if possible, with other caregivers, especially the parents. The following questions can help the doctor determine borderline syndrome:

Did the symptoms appear in childhood or adolescence?
Are the symptoms typical for the person affected? (e.g. aggressive behavior not only towards the mother, but also towards classmates)
Do the symptoms occur in different life situations?
How high is the personal suffering of the person concerned?

In the case of the borderline personality, the experience and behavior of those affected deviate significantly from culturally expected and accepted guidelines ("norms") in at least two of the following areas:

Cognition: Borderliners see and interpret their environment differently than other people.
Affectivity: Your emotions are more intense than usual and they respond inappropriately.
Impulse control: Affected people have difficulty controlling their impulses and have the urge to satisfy needs immediately.
Relationships: Relationships with other people are disturbed.

In addition, the doctor or therapist asks about typical symptoms of borderline syndrome, for example problematic relationships, frequent life crises, aggression and self-harm.

When making a diagnosis, the doctor / therapist must rule out other mental disorders that are sometimes associated with similar symptoms. These include, for example, schizophrenic disorders and behavioral disorders.

Overview: diagnostic criteria in borderline syndrome

In order to be able to make the diagnosis of a borderline personality disorder (according to ICD 10), at least three of the following characteristics must apply:

clear tendency to act unexpectedly and without considering the consequences (lack of impulse control)
clear tendency to quarrels and conflicts with others, especially when impulsive actions are prevented or reprimanded
Tendency towards outbursts of anger or violence with inability to control the explosive behavior
Difficulty maintaining actions that are not immediately rewarded
inconsistent and moody mood, mood swings (affect instability)

In addition, at least two of the following criteria, which are specific to borderline syndrome, must be met:

Disturbances and insecurities of self-image, personal goals and preferences (including sexual ones)
Tendency to get involved in intense but unstable relationships, often resulting in emotional crises
excessive efforts to avoid abandonment
self-harming behavior, suicide threats and attempts
persistent feelings of emptiness

Borderline Syndrome: Treatment

All important information about the treatment of the borderline symptom can be found under Borderline Therapy.

Borderline syndrome: disease course and prognosis

For a long time, borderline patients were considered hopeless cases. This picture has changed considerably with the development of therapies specially tailored to borderlines. However, many experts see the problem that, despite the development of treatment guidelines for borderline syndrome in various countries (such as Germany, Great Britain), only a small proportion of patients actually receive guideline-compliant therapy.

About half of the patients respond to a given therapy at the first attempt at treatment. However, it is still unclear to which form of therapy the success of the treatment can be attributed and with which treatment one meets a repeated need for therapy.

However, if a patient no longer fully meets the borderline criteria at the end of therapy, this does not mean that they are cured. Many borderliners also have long-term problems controlling their emotions or integrating socially.

Drug or alcohol abuse patients, in particular, have a worse chance of getting their problems under control. This is followed by patients who suffer from post-traumatic stress disorder and / or were sexually abused as a child. A small proportion of borderline patients die as a result of suicide or risky behavior such as risky driving or drug use. The impulsive behavior typical of borderline syndrome decreases with age. In its place, however, depressive moods often appear.

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