Dr. Anna R. Miari, MD

Borderline personality disorder is diagnosed by a psychologist, psychiatrist, clinical social worker, or other mental health professional. The disorder is a type of "Cluster B" personality disorder, which are chronic conditions characterized by unstable and dysfunctional behaviors that affect one's relationships with others. People with BPD often have co-existing mental conditions, such as depression, anxiety, PTSD, or substance abuse.

Borderline personality disorder is known to develop and become present during adolescence, however, mental health providers rarely diagnose anyone under the age of 18 with BPD. Mental health providers analyze behaviors, family history, and discuss symptoms with their patients, which may lead to a diagnosis using the DSM-5 criteria for BPD.

Borderline personality disorder is treated with psychotherapy and oral medications. Forms of therapy like dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) can help people with BPD identify self-destructive attitudes and harmful behaviors, which they may then be able to manage or change. Group therapy is another treatment option which may improve people with BPD's ability to share their emotions and to promote positivity. Psychiatrists may prescribe patients antidepressants and/or anxiety medications such as Prozac (fluoxetine), Wellbutrin (bupropion), and Zoloft (sertraline). Some patients may receive antipsychotic drugs which can help stabilize mood and reduce impulsivity.

With consistent treatment, people with BPD are able to recognize and prevent destructive behaviors and mood swings, typically by changing their patterns of thought. Many people with borderline personality disorder are able to live successful and healthy lives.

OCD frequently revolves around themes such as the fear of contracting germs or the fear of death. Common obsessions include:

• Fear of getting contaminated by people or the environment
• Extreme concern with order or precision
• Fear of death or behaviors perceived as risky
• Fear of accidents, disasters, and traumatic incidents

These obsessions and compulsions often contribute to anxiety, depression, and recurring emotions of fear and disgust. People with OCD cannot "turn off" their patterns of thought or behavior, and thus must continually grapple with urges to behave or think in a certain way, as well as the emotions associated with these urges. Some OCD patients describe their entire life as revolving around their obsessions and compulsions and this can result in their missing out on important school and social activities, travel, and family time. The impact of OCD is extensive and can even make daily activities like drinking, reading, sleeping, and eating extremely difficult.

The obsessions manifest in compulsive behaviors that can have negative implications on one's life. Some examples of compulsive behaviors include, among others:

• Excessive hand washing or showering
• Constant reordering or arranging of items
• Refusal to fly, drive, or participate in other activities
• Refusal to leave one's residence

Obsessive-compulsive disorder affects adults, adolescents, and children. OCD has been observed in children as young as five or six years of age, usually through sensitivity issues, obsessions about dirt or germs, or repeated doubts. The cause of obsessive-compulsive disorder is unknown. However, a person's likelihood of developing the condition may be increased by a number of variables such as family history, stressful life events, and pre-existing mental health disorders.

OCD is diagnosed based on a patients' reported symptoms. For example, a pediatrician or child psychiatrist may ask children (or their parents) how often they wash their hands or experience behavioral urges. Psychiatrists will evaluate patients for other symptoms and may instruct patients to describe their mental processes, thought patterns, and previous traumatic experiences.

While there is no cure for OCD, treatment can greatly improve patients' functioning in daily routines and activities. A common treatment for OCD is cognitive behavioral therapy (CBT), which helps patients identify negative patterns of thought and behavior and learn how to adjust them. Aversion therapy may also help those who have a fear of germs or contamination by forcing them to confront their fear and slowly overcome it. Many patients also benefit from counseling to address the anxiety, stress, and trauma that may accompany OCD. Other treatments for OCD include oral medications such as selective serotonin reuptake inhibitors (SSRIs, which are antidepressants) to normalize levels of a brain chemical called serotonin, which may improve OCD symptoms. Medications such as fluoxetine (Prozac) and sertraline (Zoloft) can help alleviate OCD-related behavioral urges, anxiety, and depression. Many OCD patients also find OCD support groups helpful to learn new coping strategies, to socialize, and to verbalize their emotions and experiences.

It is important to note that while OCD is a common mental health disorder, it is not a personality trait. The term "OCD" is sometimes used to informally describe someone having a tendency towards organization or orderliness. This usage is pervasive but inappropriate - OCD is a severe, life-altering condition. Some people with OCD who successfully manage their symptoms find that they may benefit from other traits that may be associated with OCD, such as high attention to detail and precision.

• Accidents
• Sexual or physical assault
• Combat
• Childhood abuse
• Domestic abuse
• Natural disasters
• Torture and kidnapping

People who have experienced significant and repeated trauma are more likely to develop PTSD. Those who have disorders like depression or a family history of depression may also be more prone to PTSD. PTSD symptoms typically begin one month to one year following the traumatic event. There are four main categories of PTSD symptoms:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

The intensity and frequency of these symptoms can vary over time. PTSD symptoms may suddenly return after disappearing for years. Many PTSD patients find treatment helps to gradually reduce their symptoms over time.

The most common treatments for PTSD are psychotherapy and oral medications. Psychotherapy for PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with PTSD.

The path to overcoming PTSD can be long and challenging and people with PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.