Borderline: A life full of extremes
Everyday life with Leonie had suddenly become incredibly stressful. The 14-year-old had moods that seemed to go far beyond puberty. Dad was a superhero or a complete loser. Dinner tasted unearthly good or unbelievably disgusting. Maths was absolute hell or the coolest subject ever. Girlfriends were the worst bitches in the morning and suddenly the greatest girls on the planet in the afternoon. «It was as if I suddenly had two completely different daughters,» remembers Cathrin, Leonie's mum.
The situation escalated completely when Leonie's beloved older sister moved away from home to study. Leonie, who had already scratched herself from time to time before, took half a pack of paracetamol and sent her sister a farewell message via WhatsApp. The dose was not life-threatening, but the parents took this signal seriously. They were lucky. Leonie was quickly diagnosed with borderline personality disorder and received help accordingly.
For people who suffer from borderline personality disorder, life is only black or white and full of extremes. They know no «it's okay», no shades of grey, no consistency. While mentally healthy people can easily accept that good and negative sides coexist in a person or in situations that everyday life brings with it, borderline patients lack this insight. They constantly vacillate between extremes, even when looking at themselves - one moment they feel like total losers, the next they are the absolute checkers who can't be fooled.
This is borderline personality disorder
The probability of developing borderline personality disorder in one's lifetime is between 1.5 and 6 per cent, depending on the study.
The first symptoms usually appear in childhood and adolescence, and the disorder is most pronounced in young adulthood between the ages of 20 and 30. Experts believe that there are two main causes: a genetic predisposition and environmental influences.
Many borderline sufferers have experienced sexual abuse, emotional neglect or other traumatic events in their childhood. A lack of emotional attachment, experienced insecurity and loss of trust can contribute to the development of borderline.
Relieve extreme inner tension
Those affected suffer from extreme inner tension due to the violent emotional fluctuations. To alleviate this, they often resort to self-harming behaviour. High-risk activities, drug use and self-harm immediately reduce the tension, but quickly become a form of addiction. Those affected have no clear picture of who they are, what defines them. They feel torn apart and suffer from massive fears of abandonment. The expression «I hate you - don't leave me» is often used to describe the emotional instability of borderline sufferers.
Our daughter screamed her hatred in our faces, only to burst into tears of despair shortly afterwards.
Cathrin, mother of Leonie
An extremely apt description, says Cathrin, who remembers a shattered family life: «Leonie torpedoed everything we had planned, shouted her hatred in our faces, only to burst into tears of despair a short time later. We were at a loss and completely overwhelmed.»
Leonie is now an adult, she is studying and is «a kind, reflective person». Her mother puts this down to the psychotherapy. Both women have different names in real life. The borderline period is just a memory for them, not a good one. Leonie says: «There was so much pressure inside me, it never stopped. I only know the feeling of inner peace from the time after therapy.»
A very sensitive phase of life
Borderline personality disorder is stressful - both for those affected and for those around them. The disorder makes it difficult to socialise with family, friends and acquaintances. Those affected are sometimes euphoric, sometimes highly sensitive and weigh every word on the gold scale. They feel attacked, get angry out of the blue and then apologise profusely.
«Borderline personality disorder can have a particularly unfavourable impact on the development of children and adolescents,» says Michael Kaess, Director and Chief Physician of Child and Adolescent Psychiatry at the University Psychiatric Services Bern.
«The social network and identity develop, as do autonomy and the experience of authority - and all of these factors, which can lead to adulthood and even determine a career, come under the influence of the personality disorder.» The so-called psychosocial level of functioning is jeopardised.
Experts use this term to describe how well - or not - someone functions in a professional and social context, whether they can live independently and take care of their relationships as well as their health. «If we start treating a borderline disorder early on and thus reduce the symptoms, the young person can develop normally,» says Kaess.
Adults can also be cured of borderline personality disorder, but for them the damage to their psychosocial functioning is usually much greater at the start of therapy and therefore more difficult to repair: they often have no partner or social network and change jobs frequently. «This is usually not so easy to repair,» says Michael Kaess.
Diagnosis 18 years ago
Experts have therefore long been in favour of breaking an iron rule in psychiatry for borderline personality disorder, which is that personality disorders are only diagnosed from the age of 18. One of the reasons for this is to take account of the fact that a lot is still going on in a young person's head during the teenage years in particular; there is also a great danger that something that simply bears the label «puberty» will be falsely pathologised during this turbulent and emotionally unstable phase. This is also intended to protect children and young people from stigmatisation. After all, adults and those around them often find it difficult to deal with the diagnosis of a personality disorder, and in many cases this is even harder for adolescents.
I thought that nobody could have it as bad as me. But there were many others who felt the same way.
Leonie, borderline sufferer
In the case of borderline personality disorder, however, it has become increasingly clear in recent years how useful early therapy is. «The advantages of such treatment clearly outweigh the disadvantages,» says Kaess. «We see, for example, that the duration of the illness is shortened. It has a decisive impact on a person's life whether they are mentally ill for one year or ten years.»
For a good two years now, the so-called S3 guideline on borderline personality disorder, which has been drawn up by various professional associations, has therefore recommended a diagnosis from the age of 12. This is also because the effectiveness of specific therapies is well documented.
Specific therapies work better
For a long time, attempts were made to help patients primarily with non-specific and very long therapies, but in recent decades it has become clear that disorder-specific and also time-limited procedures, such as dialectical behavioural therapy, or DBT for short , work far better than non-specific standard procedures.
«In principle, it is possible to free 50 to 70 per cent of young people from their symptoms within a year with the help of DBT so that they can continue their schooling or training and participate normally in society again,» says Michael Kaess.
Leonie also underwent DBT. It took a few discussions, says Cathrin, before she agreed to it. In the end, it was Leonie's sister who convinced her. «The hardest thing was finding out that there were lots of other people who felt the same way as me. At first, I always thought that nobody else could have it as bad as me,» says Leonie.
If five of the following symptoms remain stable over a period of one year, it may be a borderline disorder:
- Desperate attempts to avoid actual or suspected abandonment. For example, suicidal gestures to prevent a relationship breakdown and to get others to «save» you.
- Unstable and intense interpersonal relationships; the other person is idealised or devalued.
- Self-image and opinions change frequently.
- Impulsivity in at least two potentially self-harming areas (e.g. spending money, sexuality, substance abuse, reckless driving, «binge eating»).
- Suicidal acts, suicidal thoughts or threats or self-harm behaviour.
- Chronic feeling of emptiness.
- Inappropriate violent anger or difficulty controlling anger (for example, frequent outbursts of anger, persistent anger, repeated physical altercations).
- Paranoid thoughts or the feeling of unreality.
(Source: MSD Manual)
There are currently no drugs that can be used to treat borderline personality disorder. This is not a problem, says Christian Fleischhaker, Medical Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics in Childhood and Adolescence at the University Medical Centre Freiburg im Breisgau: «We achieve very good results with psychotherapy, there is no need for medication.»
When the number of young sufferers increased rapidly around the year 2000, the University of Freiburg decided to try out DBT with adolescents aged 16 and over - although the guidelines did not provide for this at the time. «We were surprised to find that DBT works even more effectively with them than with adults,» says Fleischhaker. «It is a highly complex therapy programme that we mainly carry out on an outpatient basis.» DBT includes individual therapy and group training, and the therapist is also available to the patient by telephone in an emergency.
Behavioural change as a goal
In individual therapy, the various problems of the affected person are worked on in a hierarchical sequence. Suicidal and therapy-endangering behaviour is at the top of the list. The therapist tries to show the patient understanding and thus a form of appreciation for their problems, but also to encourage them to make the necessary changes. Group therapy is used to train the skills needed to change behaviour.
Borderline personality disorder in adolescence jeopardises the development of identity and the social network.
Michael Kaess, child and adolescent psychiatrist
A cured mental illness nevertheless increases the risk of mental illness returning later in life. This is also the case with borderline personality disorder. Experts cannot yet say exactly why someone develops this personality disorder.
«There is certainly a genetic component, but so-called psychosocial factors probably also play a role,» says Michael Kaess. «We know that early childhood can play a significant role - for example, if children are neglected, abused or traumatised.»
On the other hand, there are also borderline sufferers who become ill without such factors. In vulnerable adolescence, says Kaess, bullying or severe parent-child conflicts, for example, increase the risk of developing a borderline disorder.
Complex symptoms
Even doctors sometimes find it difficult to recognise whether this is the case in a child. «It takes practice to distinguish certain aspects from normal adolescence,» says Kaess. The fact that a girl aged 12 or 13 may have a wild taste in music, make completely new friends or idolise pop stars excessively is not immediately pathological. Even if the career aspirations are constantly changing, no parent needs to be alarmed.
However, a warning sign can be when clothing style, musical taste and peer group change completely every few months as a strong expression of one's identity. «We were prepared for puberty,» says Leonie's mum. «We had already accompanied a daughter through it and I had enough friends with children of the same age. But Leonie's behaviour just seemed far too extreme all the time, too much of a swing in both directions of the emotional scale, there was no in-between.» A life of constant emotional chaos.
Instead of waiting to diagnose young patients, they should be closely monitored.
Michael Kaess, child and adolescent psychiatrist
One of the most important characteristics that parents should look out for is self-harm. However, not every adolescent who scratches their arms, for example, suffers from a borderline personality disorder. Conversely, almost all borderline sufferers self-harm. In male sufferers, the aggression is often directed more towards others. «They then stand out due to their delinquency and high-risk behaviour,» says Kaess, «and are more likely to end up in youth services and the penal system rather than in a psychiatric ward.»
Inform, network, educate
Mental illness in general and borderline personality disorder in particular still carry a strong stigma. So much so that even professionals sometimes shy away from making the diagnosis so as not to expose young sufferers to too many prejudices.
«As a result, they can only be helped later and treatment takes longer,» says Michael Kaess. «Our advice is therefore not to withhold the diagnosis out of such concern, but on the contrary to provide the patient with very good and close support with lots of information and education.»
Here those affected can find help
Close carers of borderline patients can help if they are well informed about the personality disorder. This enables them to better classify certain behaviour patterns, for example. It is very important not to take the difficult behaviour of the sufferer personally. In addition to providing understanding support for the sufferer, it is important that relatives also look at their own resources and seek help if necessary.
- Die Selbsthilfe Schweiz listet einige Selbsthilfegruppen zur Borderline-Persönlichkeitsstörung auf:
www.selbsthilfeschweiz.ch - Auf der Website des Vereins Borderline ps finden Sie umfangreiche Informationen: www.borderlineplattform.de
- Ein Portal von Betroffenen für Betroffene: www.borderline-netzwerk.info
- Der Dachverband der Vereinigungen von Angehörigen psychisch Erkrankter stellt umfangreiche Informationen zur Verfügung und bietet eine telefonische Beratung für Angehörige: www.stand-by-you.ch
Leonie's parents joined a self-help group immediately after Leonie's diagnosis. They wanted to be there for their daughter as much as possible. «The dialogue with others helped us enormously,» says Cathrin. «We understood much more clearly what was going on inside her and were able to deal with it better. It also led us to scrutinise how we dealt with our daughters.»
The parents had a relationship crisis when Leonie and her sister were young and lived apart for a time. «I always thought that we got our children through this time well, but Leonie's illness made us look at things with new eyes,» says Cathrin.
Looking back now, Leonie really appreciates the fact that her parents helped her through the dark phase. The family has a good relationship and looks out for each other. But above all, Leonie also looks after herself and listens when she realises that something is not okay. Breathing training was an essential part of her therapy. «I still do it regularly today,» says Leonie. «And whenever it gets a bit much, my golden rule is to breathe out through my mouth for a long time. That calms and grounds me.»
