未经治疗的边缘人格障碍的健康后果是什么？

Borderline personality disorder, sometimes called simply BPD, is a mental illness marked by mood swings and self-image issues that, if left untreated, can lead to impulsive behaviors and relationship troubles, among other serious health problems. (1）BPD最常见于青少年或成年早期的年轻女性，并且在有童年创伤或虐待历史的人中更为常见。（2)

根据国家精神卫生研究所，诊断BPD一般涉及一种采访患者的心理健康专业人员，通过他或她正在经历的症状，以及审查家庭医疗历史。（1）Marra Ackerman，MD，精神病学助理教授NYU Langone Health在纽约市表示，BPD的症状可以包括人际关系困难，激烈和不恰当的愤怒，自杀意念和害怕遗弃。

诊断临界人格障碍的困难

Despite this list of specific symptoms, BPD can be tough to diagnose, just like other personality disorders, saysRyan Hooper, PhD, a clinical psychologist in private practice and an assistant clinical professor of psychology at the University of Illinois in Chicago. He says that’s partly due to a lack of understanding. Personality disorders just aren’t talked about often, and they can be confusing to some people, which leaves many people suffering from BPD without ever realizing they have it.

Other times, a patient exhibiting the symptoms tied to BPD might be embarrassed to admit there’s something going on. “This is an illness that’s really been stigmatized because it’s a personality disorder,” Dr. Ackerman says. The problem is in the name. “When you call it a personality disorder, it makes people assume it’s not biologically driven,” Ackerman continues. On the contrary: Ackerman says there are biological underpinnings. Genetics, brain structure, and a history of traumatic events all play a role in putting someone atBPD的风险。（1）

Finally, BPD is often misdiagnosed, usually asbipolar disorder因为有一些overlap of symptoms — primarily unstable moods, according to a study published in the精神病学杂志。（3）Hooper博士表示，在BPD被确定为问题根本之前，它可以花费多达五个与心理健康系统相互作用。

然而，好消息，接受了BPD诊断，可以是愈合的一步。“BPD绝对可以治疗，”霍珀说。“人们反应治疗，心理治疗和药物。”

他估计，大约四分之三的BPD患者，他已经服用了服药。通常，药物用于治疗共同发生的疾病。例如，一个antidepressant可能是指治疗可以与BPD一起使用的抑郁症。（4) Psychotherapy, which is the first-linetreatment for BPD，可以帮助解决其他症状。在过去的10年里，辩证行为治疗（DBT），由此开发的认知行为治疗Marsha Linehan, PhD, has become the gold standard in treating BPD, Hooper says. (5)

但它并不一定很容易。DBT可以涉及高达一年的强烈治疗，通常包括每周两小时和半小时的群体治疗加上一对一的治疗课程，以及如果需要的一对一治疗课程以及案例管理。这种类型的治疗主要是基于技能。待遇的人将学习如何通过练习谨慎，容忍痛苦，调节情绪和有效地与他人与他人联系起来的不同情况。（5）

如果DBT对您没有成功，请知道您有其他心理治疗选项。其他人可能会与良好的精神病管理做得很好，而有些人可能会在转移的心理治疗或基于心理化的治疗中看到成功。（6)

Maybe someone exhibits the signs of BPD, but is in denial or actively decides not to seek treatment. Over the course of this person’s life, he or she might experience the following:

男女关系问题

People with BPD have a black-and-white view of the world: Things (and people) are either good or bad, and how someone with BPD is feeling can change almost instantly. (1) Relationships in particular can be problematic. Hooper says people with BPD commonly have a love-hate approach to others. One day, a person with BPD might view their partner, friend, or family member as the best person in the world. The next day, he or she might do a 180 and decide that that “best person in the world” is now the worst.

Some of this can be traced back to the fact that people with BPD tend to fear abandonment. For instance, they might cut off communication with a loved one if they feel they’re at risk of being left behind. (1)

This, of course, can lead to lots of interpersonal conflict and chronic difficulties with relationships, Ackerman says. Hence relationship turmoil, divorce, and trouble maintaining positive relationships with family and friends can be common among people suffering from BPD. (2)

失业

These interpersonal conflicts can also affect someone’s ability to maintain a steady job, say if they take that love-hate approach with their boss or coworkers. (2) “Their life is in disarray,” Hooper says. The symptoms of BPD can be severe and debilitating, to the point where being unable to regulate emotions can “almost certainly wreck their life,” Hooper says. “What you begin to see is a life described as instability.”

但这并不意味着BPD的每个人都将陷入这个营地。“有些人有一些人的努力工作，”阿克曼说。“我不会说诊断单独意味着有人可能无法持有工作或者如果他们想要结婚。”但如果关系问题严重，失业可能是最终结果。

Hospitalizations Due to Self-Harm

许多人患有BPD伤害自己，如通过切割，试图处理他们的感受。（1）有些人甚至可能试图采取自己的生命。

Suicide attempts are so common among people with BPD that Hooper calls them a symptom of the disorder. Up to 10 percent of the people who qualify for having BPD die by suicide, which according to a study from University of Washington researchers is 50 times the rate of the population as a whole. (7)

Generally, this self-destructive behavior starts up when a person’s mood is down. “That’s where the self-mutilation comes in, the really impulsive behavior comes in,” Hooper says. Suicidal thoughts that become overwhelming may lead a person with BPD to seek help through hospitalization or by entering an inpatient treatment center, according to a study published inThe American Journal of Psychiatry。（8)

Oftentimes, this kind of behavior serves as a wake-up call for the person suffering. “For a lot of clients, the suicide attempt scares them, and it wakes them up to how threatening this is to their life,” Hooper says.

A Desire to Engage in Reckless Behavior

Engaging in dangerous and reckless behavior is another complication of BPD. If left untreated, the person suffering from BPD may find themselves involved with extravagant spending, substance abuse, binge eating, reckless driving, and indiscriminate sex, Hooper says. The reckless behavior is usually linked to the poor self-image many BPD patients struggle with.

As a result of engaging in these dangerous activities, the person with BPD will have to face the health and physical repercussions, Ackerman says. For instance, binge eating can lead to serious health issues, such as heart disease and blood sugar spikes, whilesexually transmitted diseases或者无计划的怀孕可能是因为从事不安全的性行为。（1）

A General Feeling of Unsteadiness

Hooper saysliving with BPDwithout treatment is like trying to walk on ice. “That’s how a person with BPD feels almost at all times, like they can just never get their footing,” he says. For instance, people with BPD can be preoccupied with the fear of abandonment (whether real or imagined) mentioned earlier. They may also have a skewed view of reality and feel like they’re cut off from themselves and viewing their body from the outside. (1)

其他疾病

根据国家精神卫生研究所，患有BPD的人拒绝治疗的风险是其他医疗问题和精神疾病的风险。（1）例如，约有10％的患有BPD的人，也有双极1紊乱，另外10％具有双相2疾病，根据一项公开的研究Dialogues in Clinical Neuroscience.（9)

It may seem strange that having one condition means you’ll likely have another, but this is common across personality disorders. People with personality disorders are at an increased risk of having other anxiety, mood, and impulse control disorders, as well as issues with substance abuse. (10) Still, Ackerman says it’s entirely possible for a person to have BPD as their primary diagnosis.

Not all people with BPD will identify with these situations. And if they do, experiencing these chaotic, unstable life events may push them to seek treatment. “Because it’s so scary, it can really drive the people to change,” Hooper says.

还有一个机会，BPD症状会随着时间而改善。“研究表明，几乎所有的心理健康都变得更好，”霍珀说。事实上，根据一项发表的一项研究一般精神病学的档案, 85 percent of the study’s 175 BPD patients were able to enter remission by the 10-year mark. Only about 11 percent of the study participants relapsed, though some of the social functioning issues remained. (11)

为什么会发生这种情况？“情绪化的失灵扫描只是随着时间的变化而变化，”盖珀说。“当你变老 - 进入你的三十多岁，四十年代，五十年代 - 激素改变，以及一些失恋量的消退。”