O transtorno de personalidade borderline, também chamado de transtorno de personalidade limítrofe, é um grave problema de personalidade caracterizado por desregulação emocional, raciocínio extremista e relações caóticas. Pessoas com esse sofrimento mental possuem sintomas psiquiátricos diversos, como humor instável e reativo, problemas com a identidade, sensações de irrealidade e despersonalização, tem a tendência a comportamentos impulsivos, sobretudo autodestrutivo, manipulação, chantagem, conduta suicida, e sentimentos crônicos de vazio e tédio.
Essas pessoas agem de modo imprevisível, sem se preocupar com as consequências de seus atos, possuindo uma tendência a ter crises de cólera. São frequentemente tidas como rebeldes, problemáticas, geniosas e temperamentais, mas na realidade, possuem um distúrbio mental mais profundo do que aquelas pessoas que têm apenas um temperamento difícil. Existe um indivíduo com personalidade impulsiva, no qual há uma instabilidade emocional e ausência de controle emocional, e o tipo borderline propriamente dito, cujas características vão além dos impulsos descontrolados. A pessoa tem alterações da autoimagem, relacionamentos intensos e instáveis, comportamento autodestrutivo e dificuldade na criação de projetos para a vida.
A palavra boderline vem do inglês, que significa limítrofe, linha de demarcação de uma fronteira. A linha que separa uma área de outra. Esse termo foi usado por Adolph Stern, que descreveu na década de 1930 uma condição como a que permanece no limite entre a neurose e a psicose.
O transtorno de personalidade borderline afeta seriamente toda a vida da pessoa acometida por esse sofrimento, causando prejuízos significativos tanto para si mesma como para outras pessoas. Frequentemente essas pessoas necessitam de medicamentos psicotrópicos, como antidepressivos ou moduladores do humor, para evitar um descontrole emocional intenso. Os sintomas aparecem mais no fim da adolescência e se concretizam nos primeiros anos da fase adulta, persistindo geralmente por toda a vida, a menos que haja intervenções adequadas.
Muitas vezes a severidade do transtorno diminui com tempo. Envolvimento com drogas, tentativa de suicídio, suicídio consumado, são possíveis resultados se a pessoa não se submete aos devidos cuidados e uma terapia psiquiátrica e psicológica.
A causa do transtorno de personalidade borderline se relaciona com uma soma de fatores, que inclui uma infância traumática com diversas formas de abuso na família de origem, separação dos pais, abusos sexuais e emocionais, e tem também uma predisposição genética e alterações ou disfunções no metabolismo cerebral. Em média, 2% da população sofre desse transtorno, sendo 76% mulheres e 20% na população carcerária.
Cerca de 80% dos pacientes com transtorno de personalidade borderline relatam que o casamento de seus pais foi ou é bastante disfuncional, com muitos conflitos. Muitos pacientes com esse transtorno experimentam negligência, ou experimentaram no seu passado, ou continuam ainda experimentando no presente negligência e abusos físicos e sexuais dentro da família de origem, mas apesar disso, cerca de 20 a 25% das pessoas com o transtorno borderline vêm de famílias estruturadas, não tem grandes complicações na família desse grupo de pessoas.
Para fazer uma avaliação inicial na direção de um diagnóstico sobre se a pessoa tem ou não esse tipo de transtorno, é importante o médico solicitar exames de sangue para medir os níveis de TSH, para excluir a possibilidade de um problema de tireoide, e a dosagem do cálcio sérico para descartar uma possível doença metabólica. Um hemograma completo é importante para verificar se há alguma infecção sistêmica que possa colaborar com os sintomas. A sorologia para excluir a infecção por sífilis ou HIV também é importante, pois essas doenças podem afetar áreas cerebrais. Além disso, exames neurológicos como eletroencéfalograma, tomografia computadorizada e ressonância magnética são importantes para verificar lesões cerebrais.
Sintomas da Personalidade Borderline
Sintomas Afetivos
A pessoa com personalidade borderline tem uma instabilidade afetiva acentuada devido a reatividade intensa do humor. Então, tem episódios de disforia. Disforia é quando a pessoa está gritando uma hora, e outra hora quer total isolamento, está muito eufórico em um momento, depois tem irritabilidade. Tem uma ansiedade durante algumas horas e, raramente, no máximo, alguns dias. A pessoa com esse transtorno também tem uma carga de ira, ódio e raiva inapropriada, intenso e de difícil controle. Apresenta, por exemplo, frequentes demonstrações de irritação, raiva constante, sentimento de vingança e às vezes briga muito no sentido de luta corporal mesmo com os outros.
Há também o indivíduo com transtorno afetivo borderline, que apresenta sentimentos crônicos de vazio, de tédio na sua vida. Agora, pensando em termos de sintomas ligados à impulsividade, ele apresenta conduta recorrente de tentativas ou ameaça de suicídio e comportamento de auto-mutilação, que é uma coisa que está bastante frequente, quase epidemia, no meio da juventude; automutilação – se auto-machucar, cortar a pele – isso acontece nesse tipo de transtorno de personalidade também.
O indivíduo vai ter um padrão de relacionamentos interpessoais muito instáveis, muito intensos, caracterizado por extremos de idealização: num momento aquela pessoa é a rainha da minha vida, é o rei da minha vida, e no outro, momento de desvalorização, ela não serve para nada, não quero para nada, é melhor morrer; sentimentos de amor e ódio, bom ou mau. Existe impulsividade, pelo menos em algumas áreas da vida dessa pessoa que são prejudiciais a ela mesma. Por exemplo, se envolve em gastos financeiros exagerados, tem comportamentos de risco na área da sexualidade, com drogas, com álcool, dirige carro de forma imprudente e com vários tipos de compulsões.
Interpersonal Symptoms
Now, let’s think about symptoms that occur in the relationship between a person with a borderline disorder and other people they live with. Firstly, they desperately try to avoid abandonment, real or imagined rejection. They have an unstable identity and self-image. Sexual preference fluctuates a lot; tastes and values are very and persistently unstable. Moods fluctuate constantly.
As cognitive symptoms in this person with this disorder, they start to have transient paranoid ideas related to the stress they are experiencing. What is a paranoid idea? They are ideas or suspicions of persecution: “they’re talking about me”, “there’s someone who’s going to disturb me”, and they may have symptoms of dissociation.
Psychopaths, which is an old term for a personality disorder, usually manipulate in order to obtain material or financial goods or things that give them pleasure, while people with borderline disorder manipulate and commit extreme acts in order to obtain support and affection.
These people suffering from borderline personality disorder end up pushing away those they need most. Paradoxically, at the same time as they need affection and companionship, they are capable of pushing them away in cruel and often frightening ways. They are very needy of attention and excessively manipulative, although they never admit it.
Borderlines have deep traits of masochism, of sadism; in general, they are like children in an adult body, not tolerating any limits. They are very emotionally immature, impatient, don’t know how to wait, their rewards must always be pediatric, they can’t tolerate frustration and always tend to blame others for their own failings. This is probably because borderlines have usually been children deprived of a basic need, possibly emotionally neglected at some stage in their psychic life, which in turn has caused deep and indelible marks on their personality. These marks can come from numerous traumatic events, such as parental separation, childhood sexual abuse, physical violence and even the early loss of a loved one.
So, based on this assumption, we can say that the emotional development of the person with borderline disorder has stalled dramatically before reaching the stage of full psychological maturation. In short, they are people who grow and age physically, but emotionally remain selfish and, unfortunately, very problematic children. Borderline individuals can be people who have grown up with a great sense of not having received enough attention, and generally act like angry children, seeking ways to make up for this lack of attention in their relationships; complicated ways that are immature and abnormal.
How to Change?
There are people who are difficult to live with, such as the obsessives, the emotional, the detail-oriented, the perfectionists, the inflexible, the rigid, among others. It’s not uncommon for some people to say, “Wow, what a neurotic person!” when dealing with such complicated individuals. Well, they’re like that because of some mental illness, or they’re like that because they grew up with one or more of these characteristics, which we’ve presented, of being detail-oriented, perfectionists and tragics. We know that there is a space in our mind called the unconscious, a virtual space that leads us to do or say things that can scare us. But the question also arises: do I have an unconscious mind, or am I unconscious? People can be changed, but they can also settle into their way of being and remain the same until they die.
An important questions in this regard might be: Do I want to change? Do I realize that my behavior is something that makes me suffer and makes other people suffer? Do I want to improve my personality traits, which are immature and complicated and cause suffering in the people I live with? It’s very difficult to live with people who answer such questions with arguments like: “That’s the way I am, and that’s the way I have been; it’s worked out well for me so far, why should I change?” Or others say: “I don’t have any difficulties with the way I am, it’s the other people who criticize me.” But the truth is that there is no person who doesn’t need to improve their personality. Emotional maturity is a lifelong goal.
Difficult people can change, but they need to want to change themselves because they have stopped denying that they have personality problems. Stopping denying is the first big step towards starting to change. To stop denying is to admit the existence of the problem, and this in turn is basic, and fundamental to finding ways of resolving it.
It’s not easy to change who we are, I admit that; it’s a struggle. We often get complacent and stagnate in the way we are; we want to stay in the comfort zone of our lives, to stay that way because it has worked so far. But if you realize your personal problems, your personality and cultivate the desire to improve who you are, if you work hard enough, some change will occur in your way of being. This is the opposite of remaining stuck in a rigid way of being, of existing as a person causing suffering in others, as well as self-suffering, because the person ends up running away from the truth about themselves, and lives in suffering that they do not need to experience.
In fact, many people have what we scientifically call a personality disorder. They have a very unhealthy ego, above the limitations that we all have in our personality. For some authors, these people are individuals with an abnormal personality, without, however, having a brain injury. It’s a way of being with a very strong tendency to remain that way all their lives, compromising their relationship skills in general. The personality disorder appears early in the person’s development and becomes strongly ingrained in them, making them the way they are.
Thought Patterns
Do you want to know some of the types of thoughts that people with borderline personality disorder have? Some say: “I have to be loved by all the important people in my life all the time, otherwise it means I’m worthless.” You can see how extreme it is, can’t you? Others say: “Some people are great and everything about them is perfect. Other people are completely awful and should be severely censored and punished for it.” It’s a radical way of thinking that these people have.
Another individual with borderline disorder might reason like this: “I hate it when people don’t pay attention to me.” Or they might say: “I have no control over my feelings or the things I do as a result of them.” You want to wash your hands of it, right? Others think: “When I’m alone, I become nobody and nothing.” How radical is that? Still others might think: “I can’t stop the frustration I feel when I need something from someone and I’m not able to receive it.” What do you mean you can’t stop walking around in frustration? But they live it. And others may have this thought: “What have I done to make this person look down on me?” The person may not be looking down on them, but the borderliner interprets it that way.
If someone with a personality disorder makes an effort to analyze their unhealthy tendency to think, feel and relate to others, it will be possible to relax the rigidity of their altered personality trait. This will reduce the suffering for themselves and the people they live with. Then they will learn, when they do this self-analysis, when they are honest with themselves, when they stop denying and admit that they have problems with the way they think and the way they live with people, that they can learn to control aggressive, explosive impulses and discipline their serious distorted thoughts. They will see that they hold unhealthy psychological beliefs about situations in life and relationships. They will be able to reduce unhealthy jealousy by learning that it generates a lot of quarrels. They will be able to be more merciful to themselves and other people regarding spending and other things.
So, when someone with a personality disorder decides to do what they can to improve their behavior, they can get out of this unhealthy state of being and, step by step, become more pleasant, reliable, flexible, affectionate, less dramatic, less hysterical, less aggressive and explosive, less cold and calculating, starting to have just a few traits, perhaps not dominant, of what was previously very rigid and deeply ingrained in their personality.
How do you treat a person with a borderline disorder?
There is medication. Various medications can be used for people with borderline personality disorder. Since this disorder is considered to be primarily a psychosocial condition, medication is indicated to treat what they experience, such as anxiety symptoms or depressive symptoms, rather than behavioral changes. Psychotherapy is another basic tool to help people with borderline personality disorder, so that they can learn, through psychoeducation, to better control their impulses, to better understand their behavior. In psychological therapy, they can learn skills they don’t have, such as becoming aware of their distorted thoughts, improving their relationships with people and dealing with frustrations. To learn this, psychotherapy will generally help the person with this disorder to:
- Admitting that he has a problem.
- Seek and receive help to change, and be actively involved.
- Understand and realize that there are distorted thinking patterns in his mind, based on erroneous beliefs that he has developed throughout his life.
- Cultivate the concept that you need to accept that perfection is a goal that we can never fully achieve. Accepting this can reduce anxiety, as well as aggression, emotional outbursts and hostility, which hinder pleasant contact with people.
- Look at the mistakes you’ve made unintentionally as moments to learn from, rather than belittling and distressing yourself.
- Allow yourself to have moments of relaxation, leisure, enjoying something pleasant, and appreciating friendships.
I wish that God would give us all a clear mind to better understand ourselves and those around us. If you live with someone with borderline disorder, it’s important that you are knowledgeable so that you can learn to set limits. If you are the one with borderline disorder, then you have learned here today some steps to get out of it or to minimize and improve it step by step.
Fique sempre atualizado
Cadastre-se para receber nosso boletim informativo e mantenha-se sempre informado sobre as novidades e dicas para sua saúde.
Dr. Cesar Vasconcellos de Souza está trabalhando como psiquiatra e palestrante internacional. É autor de 3 livros, colunista da revista de saúde “Vida e Saúde” há 25 anos, e tem programa regular na TV “Novo Tempo”. Acesse mais conteudos no canal de Youtube.
Deixe um comentário