Show Medically Reviewed by Sabrina Felson, MD on October 30, 2021 Avoidant personality disorder is characterized by feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection. Yet the symptoms involve more than simply being shy or socially awkward. Avoidant personality disorder causes significant problems that affect the ability to interact with others and maintain relationships in day-to-day life. About 1% of the general population has avoidant personality disorder. Avoidant personality disorder symptoms include a variety of behaviors, such as: When in social situations, a person with avoidant personality disorder may be afraid to speak up for fear of saying the wrong thing, blushing, stammering, or otherwise getting embarrassed. You may also spend a great deal of time anxiously studying those around you for signs of approval or rejection. A person who has an avoidant personality disorder is aware of being uncomfortable in social situations and often feels socially inept. Despite this self-awareness, comments by others about your shyness or nervousness in social settings may feel like criticism or rejection. This is especially true if you are teased, even in a good-natured way, about your avoidance of social situations. Avoidant personality disorder causes a fear of rejection that often makes it difficult to connect with other people. You may be hesitant to seek out friendships, unless you are certain that the other person will like you. When you are involved in a relationship, you may be afraid to share personal information or talk about your feelings. This can make it difficult to maintain intimate relationships or close friendships. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person diagnosed with avoidant personality disorder needs to show at least four of the following criteria: Avoidant behavior may commonly be seen in children or adolescents, but a diagnosis of a personality disorder cannot be made in childhood because shyness, fear of strangers, social awkwardness, or being sensitive to criticism are often a normal part of child and adolescent development. A mental health professional can assess your symptoms, make an accurate diagnosis, and suggest the appropriate treatment options. As with other personality disorders, a mental health professional will design a treatment plan that is appropriate for you. Avoidant personality disorder treatments vary, but they will likely include talk therapy. If a co-existing condition, such as depression or anxiety disorder, is also diagnosed, appropriate medications may also be used. Other mental health disorders can occur along with avoidant personality disorder. Treatments in these cases will be designed to help with the symptoms of each disorder. A few of the conditions that most frequently occur with avoidant personality disorder include: Many avoidant personality disorder symptoms are commonly shared among these other conditions, particularly in the case of generalized social phobia. Because of this, the disorders can be easily confused. It may take some time for a mental health professional to make a clear diagnosis and choose the appropriate treatments for you.
Borderline personality disorder (BPD) is a mental health condition that affects mood, behavior, and self-image. BPD is a type of personality disorder. A person with BPD experiences intense emotions, poor self-image, and impulsive behaviors. Another characteristic symptom of the condition is a lack of stability in personal relationships. The term borderline originally came into use when clinicians thought of the person as being on the border between having neuroses and psychosis, as people with a diagnosis of BPD experience elements of both. The National Institute of Mental Health (NIMH) suggest that around 1.4% of adults in the United States have BPD. Historically, BPD has been difficult to treat. However, the NIMH say that new evidence-based treatments can reduce the symptoms and improve the person’s quality of life. This article provides an overview of BPD, including its causes, symptoms, diagnosis, and treatment options. Share on PinterestPeter Dazeley/Getty Images BPD is a complex mental health condition characterized by difficulties with emotion and self-image, unstable personal relationships, and impulsive behaviors. BPD is a cluster B personality disorder. This is a group of disorders that affect a person’s emotional functioning and lead to behaviors that others see as extreme or irrational. Common challenges in BPD include:
The way a person with BPD interacts with others is closely associated with their self-image and early social interactions. Almost 75% of people with BPD are women. It may affect men equally, but men are more likely to receive a misdiagnosis of post-traumatic stress disorder or depression. In most cases, BPD begins in early adulthood. Clinicians will not usually diagnose it in children or adolescents, as their personality is still developing during these years. Symptoms that may look like those of BPD may resolve as children get older. Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose mental health conditions, including BPD. Insurance companies also use the DSM-5 to reimburse for the treatment of this condition. According to the DSM-5, the following signs and symptoms are characteristic of BPD:
The symptoms of BPD are present in a variety of different situations. They are not consistent with the individual’s developmental stage or place in society, and they are not solely due to the use of drugs or the presence of a medical condition. The following sections will look at some of the significant symptoms of BPD in more detail. Emotional symptomsA main symptom of BPD is difficulty regulating emotions. The person may feel emotions intensely and for long periods, and they may find it more difficult to return to a baseline emotion after experiencing emotional stress. The person may also have feelings of intense anger or difficulty controlling their anger. This is often followed by shame or guilt, which can impair the person’s self-image. This anger is often in response to a fear of neglect, uncaring, or abandonment. Self-harm is another common symptom. People with BPD may use this as a means of regulating their emotions, punishing themselves, or expressing their inner pain. Another symptom of BPD is recurring thoughts of suicide. Some people also engage in suicidal actions. The rates of self-harm and suicide are higher in people with BPD than in people without. Receiving effective treatment can help people manage their emotions and reduce the frequency or severity of self-harm behaviors and suicidal thoughts. Impulsive behaviorsAnother characteristic symptom of BPD is engaging in impulsive behaviors, which may involve:
People may also feel bored often and have a persistent need to have something to do. Relationship difficultiesPeople with BPD often have patterns of intense or unstable relationships. This may involve a shift from extreme adoration to extreme dislike, known as a shift from idealization to devaluation. Relationships may be marked by attempts to avoid real or imagined abandonment. The perceived threat of being abandoned can have a significant impact on the person’s self-image, moods, thoughts, and behaviors. For example, the person may feel panicked or angry over minor separations from people they feel close to. Some people may be genetically predisposed to developing BPD, with certain environmental factors increasing the risk. Experts have identified three factors as likely to play a part in the development of BPD: genetics, environmental factors, and neurological factors. The following sections will look at each of these in more detail. GeneticsThere is a genetic predisposition to developing BPD, with twin studies suggesting over 50% heritability for the condition. Many people with BPD have an immediate relative who has a mental health condition, which might be bipolar disorder, depression, substance use disorder, or antisocial personality disorder. Environmental factorsMany people with BPD have had experiences of trauma, such as abuse or abandonment in childhood, hostile conflicts, or unstable relationships. Some sources say that 70% of people with BPD experienced mistreatment during childhood, such as physical abuse, sexual abuse, or neglect. Neurological factorsSome studies have found structural and functional differences in the brains of people with BPD — specifically in brain areas linked with emotion regulation. However, experts do not know whether these differences were risk factors or developed due to the condition itself. BPD is difficult to diagnose because its symptoms overlap with those of other mental health conditions. Individual cases can also vary greatly. Mental health professionals can diagnose BPD following a thorough psychological evaluation during which they ask about the person’s clinical history and their symptoms. As BPD shares some symptoms with several other conditions, mental health professionals will need to rule these out before being able to make a firm BPD diagnosis. In addition, BPD often occurs alongside other mental health conditions, such as: Due to the difficulties in diagnosing BPD, it often goes underdiagnosed or misdiagnosed. People with BPD who receive effective treatment experience fewer and less severe symptoms, a better ability to function, and an improved quality of life. Some treatment options for BPD include: PsychotherapyPsychotherapy, or talking therapy, is the first line treatment for BPD. Several different types of psychotherapy can reduce the impact of BPD, including:
MedicationThere is no medication currently available that can cure the condition itself, but clinicians can prescribe certain medications to treat issues that occur alongside BPD. These medications include:
Preliminary research also suggests that there may be a role to play in BPD treatment for medications that modify glutamatergic, opioid, and oxytocinergic neurotransmitter systems. HospitalizationIn some cases, such as those in which a person has attempted suicide, treatment in specialist environments such as hospitals and psychiatric clinics may be necessary. Often, inpatient treatment will be a combination of medication and psychotherapy sessions. It is rare for a person to be hospitalized with BPD for a long time. Most people only need partial hospitalization or a day treatment program. According to the DSM-5, the impacts of BPD and the risk of suicide are highest in early adulthood. However, they gradually reduce with age. Most people achieve greater stability in their relationships and jobs by their 30s and 40s. Although BPD can be difficult to treat, new evidence-based treatments can reduce the symptoms and improve the person’s quality of life. People who receive therapeutic treatments often experience improvements during the first year. Studies have reported that after about 10 years, as many as 91% of people achieve remission from BPD. BPD is a complex mental health condition characterized by instability in a person’s moods, behaviors, and personal relationships. Receiving effective treatment, such as psychotherapy and social support, can reduce the frequency and severity of the person’s symptoms. The National Alliance on Mental illness offer advice for family members and caregivers on how to support others with a mental health condition while looking after themselves. Last medically reviewed on August 21, 2020
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