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You never know how she's going to react to any given situation. Sometimes she's okay, and other times it seems like the most innocent of comments will set her off into a rage, a crying jag, or trigger off an intense burst of emotion that can last hours or up to a day. She threatens to hurt herself, and sometimes does. She has an unstable pattern of relationships, spends too much money, can't stand being alone and takes too many risks.

You love her and you can't understand why she's acting the way she does.

The National Institute of Mental Health estimates that two percent of adults, primarily female, and twenty percent of psychiatric hospitalizations, are due to Borderline Personality Disorder. The causes are unknown for sure, but are thought to be a combination of environmental and genetic reasons. It could be a form of Post Traumatic Stress Disorder, or a matter of brain biology, but the common theme for forty to seventy-one percent of people who suffer from BPD is sexual abuse, physical abuse, neglect and separation as a young child.

In addition to all this, BPD can also occur in conjunction with other psychiatric or personality disorders such as depression, anxiety disorders, bipolar, and substance abuse. The disorder is characterized by heightened sensitivity to emotion, increased emotional intensity and a slow return to emotional baseline.

She tells you she feels worthless and evil. She tries to cut herself, maybe threatens suicide. You hear her say she feels empty, and she'll fly off the handle into a temper-tantrum at the least provocation. She uses sex, food, drugs, as a way to self-medicate and is frantic when faced with what she perceives as abandonment. There are periods where she is fine and happy, and others where she's in a bad mood for hours and you don't know the reason why. She doesn't see the shades everything is black and white.

People who suffer from BPD have difficulty feeling emotionally attached to people who are not physically present. They sometimes view themselves as unworthy, misunderstood and mistreated. They have inappropriate fears of abandonment, and succumb to impulsive behavior such as excessive spending, binge eating, and risky sexual behavior.

Treatment for this disorder can range from medication to group and individual therapy, including Dialectical Behavior Therapy (DBT.) The four modules of DBT are mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation. It's a relatively new treatment program developed in 1993, and has been effective in reducing the symptoms of BPD.

For more information, see: http://www.nimh.nih.gov/health /publications/borderline-perso nality-disorder.shtml

Learn more about this author, Annetta Ribken.
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