UC HEALTH LINE: Help Available for Borderline Personality Disorder

CINCINNATI—Normally, pro football stars call news conferences to discuss touchdowns, tackles or Twitter accounts. But Miami Dolphins wide receiver Brandon Marshall had a completely different objective when he stepped to the lectern earlier this summer at the team’s training camp.

Marshall used the occasion to announce that he has borderline personality disorder, a mental illness characterized by instability in personal relationships, high sensitivity to stress and difficulty in controlling urges.

"I have a dream home, my house is beautiful. … We have two nice cars, and three beautiful dogs,” Marshall said. "But with all of that said, I haven’t enjoyed one part of it.”

James Curell, MD, a UC Health psychiatrist and associate professor in the University of Cincinnati (UC) Department of Psychiatry and Behavioral Neuroscience, says borderline personality disorder got its name because patients tend to occupy an area between psychosis—full-blown mental illness, such as schizophrenia or bipolar disorder—and milder conditions of neurosis, such as inhibitions or phobias.

"These people tend to be unstable, always in distress,” says Curell. "They tend to act out in terms of substance use or violence, either toward others or themselves, and usually in reaction to stress of some kind.

"These patients are exquisitely sensitive to rejection, criticism or abandonment, and have tremendous conflicts about whether people care about them or not. But they don’t like to be controlled, so they have a conflict over dependence vs. independence and can’t find a happy medium where they feel comfortable.”

Causes of borderline personality disorder can stem from childhood, Curell says, and include feelings of abandonment, sexual or physical abuse and neglect. "Never really having a caregiver can be devastating,” Curell says.

Genetic factors are also believed to play a role. "There are some people who are just genetically more vulnerable than others,” Curell says. "We don’t know all the genetics of it, but I think eventually we will confirm that there’s a genetic component to it as well.”

Borderline personality disorder can be diagnosed through a psychological evaluation, which includes the history and severity of the symptoms. Once diagnosed, Curell says, it can be treated with drugs or therapy.

"Pharmacologic (drugs) management tends to be symptomatic,” Curell says. "If the patient has a lot of depression, you would treat the depression. If they have impulse control problems, you treat that. But to keep it economical and not just keep throwing drugs at symptoms, you try to get to the core symptom or group of symptoms.”

The mainstay of a treatment regimen for borderline personality disorder, Curell says, is psychotherapy.

"These people need to feel that somebody really cares for them and is in their corner,” he says. "There’s no substitute for that—a good, caring relationship with a good therapist who does care.”

Patients also need to develop insight into their behavior so they can understand what triggers their emotions and how they can control their reaction to those triggers.

"If they can start to contain their emotions and not act out, then they can start to change,” Curell says. "They start to build what we call ego strength or personality strength that enables them to adjust to the world in a healthier way.”