It is most commonly diagnosed first in older adolescents and in In terms of differential diagnoses, I ve talked about the other personality disorders that one would try to distinguish the borderline disorder from, but again, remember it is the unstable intense relationships and the chronic self-destructive and impulsive acts that taken together often point to borderline personality disorder in particular. Affective disorders are quite common. Also, when we treat the affective disorder someone will often look much less dysfunctional in terms of their personality functioning. This is easier now that the antidepressants that we have are not so easy to overdose on. Using the SSRI s is much more reassuring to the clinician than using the MAOI s or tricyclics with these people who are prone to impulsive overdoses.
Treatment is quite difficult.
Usually the treatment is some form of psychodynamic or behavior therapy, or a combination of the two. The hallmark of therapy is creating a structured environment where borderline individuals boundary violations can be addressed within the treatment and where the therapist can help the patient connect the feelings with actions. Because one of the profound disconnects for borderline individuals is between what they feel and how they act. Often borderline individuals will not know that their actions are motivated by intense feeling. Behavior therapy is being used, particularly on dialectical behavior therapy which was developed by Marshall Lunahan at the University of Washington, and DBT is a combination of individual and group treatment.