Petulant borderline disorder: definition, causes, symptoms, and treatment

Petulant borderline personality disorder, or petulant BPD, is one of the four subtypes of borderline personality disorder (BPD) that features severe mood swings, inability to regulate emotions, passive-aggressive behavior, and defiance.

The causes of petulant BPD are multifactorial and include a combination of genetics as well as neurobiological and environmental factors.

The symptoms of petulant borderline personality disorder are emotional outbursts, passive-aggressive behavior, jealousy, being demanding, and feelings of paranoia.

Petulant borderline disorder treatments include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and medications.

What is petulant borderline disorder?

Petulant borderline disorder is a chronic mental illness that involves feelings of unworthiness, mood instability, distorted self-image, and relationship problems, according to an article entitled, “What Is a Petulant Borderline?” from Choosing Therapy.

Borderline personality disorder is a relatively new condition and was recognized as a personality disorder diagnosis in 1980, following the publication of The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III).

However, even before it was added as a diagnosable condition in the psychiatry text, the petulant type of borderline personality disorder (BPD) has long been around and affecting people. Its features and manifestations were often described in literature even before the condition had its own name.

When the DSM-IV was published in 1994, the symptoms of and diagnostic criteria for BPD were further defined. At the present time, research from the field continues to advance.

How common is petulant borderline disorder?

Petulant borderline disorder is rare. In general, borderline personality disorder affects 1.6% of the population, according to a continuing education activity on BPD published in StatPearls. BPD in children and teens is uncommon, mainly because the condition is typically diagnosed after the age of 18; however, an article on the diagnosis of personality disorders published by The Centre for Addiction and Mental Health (CAMH) states that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) now allows this diagnosis if the symptoms are significant and have been present for at least a year.

It was previously assumed that BPD affects more women than men. However, a 2008 report on borderline personality disorder, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA)—part of the US Department of Health and Human Services—found 5.6% of men and 6.2% of women live with BPD. This suggests that there is no significant difference in the rate of prevalence among men and women, as opposed to what was previously recognized.

According to a brief review on borderline personality disorder published in the journal Gerontology & Geriatrics in 2018, rates of BPD in the elderly are also higher than previously recognized, based on clinical experience. An article on how BPD symptoms may change with age from Verywell Mind adds that BPD symptoms tend to decline with age, although researchers are not exactly sure why. Experts, however, have suggested potential reasons, including burn out, better management of symptoms, and avoidance of intimate relationships.

What are the causes of petulant borderline disorder?

The causes of petulant borderline disorder include a complex combination of different factors. The causes of petulant borderline disorder are listed below.

1. Neurobiological factors

Neurobiological factors are those that involve brain or other biological factors that influence the development of petulant BPD. These include brain chemical imbalance and problems with brain development. An imbalance of a brain chemical called serotonin is believed to play a role in the disorder. Individuals with petulant BPD have altered levels of serotonin, and this is associated with impulsive aggression, depression, and suicide attempts. Furthermore, in people with BPD, three areas of the brain, namely the amygdala, hippocampus, and the orbitofrontal cortex, were either smaller in volume or had low levels of activity, according to an article on the causes of BPD published by the National Health Service.

2. Environmental Factors

Environmental factors refer to socioeconomic and relational conditions that can increase an individual’s risk of illnesses or stressful situations. The environmental factors involved in the development of petulant BPD include childhood abuse and trauma, being abandoned as a child or teen, and family life stress. These experiences cause distress to a child and increase their risk of developing BPD in adulthood.

3. Genetics

Genetics refers to genes inherited from one’s parents that can increase a person’s likelihood of developing a disease or illness. A 2020 study by Maurex et al., published in European Psychiatry suggests that a gene variation that influences how the brain uses serotonin may be associated with the development of petulant personality disorder. Individuals who possess this serotonin gene variation may have higher chances of developing BPD if they also experienced traumatic events during childhood.

What are the symptoms of petulant borderline disorder?

The symptoms of petulant borderline disorder are thought to stem from a lack of self-worth, fear of abandonment, and inability to self-soothe. The symptoms of petulant borderline disorder are listed below.

1. Emotional outbursts

Emotional outbursts are sudden and intense emotions that occur without warning and are often disproportionate given the situation at hand. The physical effects of emotional outbursts include increased blood pressure, headaches, tingling, heart palpitations, and fatigue. Explosive outbursts of anger can also have behavioral effects, including aggression, violence, anxiety, depression, stress, and difficulty concentrating.

2. Passive-aggressive behavior

Passive-aggressive behavior is a pattern of indirectly expressing negative thoughts and feelings instead of actively handling them. The physical effects of passive-aggression include burnout, trouble sleeping, muscle tension, headaches, and shaking. On the other hand, the behavioral effects of passive-aggressive behavior include frustration, confusion, attachment problems, frequent miscommunication, and internalized guilt.

3. Jealousy

Jealousy refers to a feeling or state of bitterness, insecurity, or anger that someone experiences due to a real or perceived threat of loss over someone or something that they think is theirs. This complex emotion often applies to relationships, and in this case, borderline personality disorder dating. Someone with BPD tends to be very possessive due to their fear of abandonment. The physical effects of jealousy include increased heart rate, elevated blood pressure, difficulty sleeping, digestive issues, anxiety, and weakened immunity. Jealousy can also have behavioral effects, including paranoia, obsession, controlling behavior, isolation, and severe distrust or suspicion.

4. Being demanding

Being demanding means that someone is hard to satisfy or has unreasonably high expectations of people surrounding them. Their loved ones may feel as if they can’t do anything right. The physical effects of being demanding include increased heart rate, blood pressure, and respiration due to anger, as well as unexplained aches or pains and muscle tension because of high levels of stress. The behavioral effects of being demanding are frustrations, low self-esteem, fear of intimacy, fear of change, self-judgment, and depression.

5. Feelings of paranoia

Feelings of paranoia refer to irrational and repetitive feelings that other people are out to harm or deceive you, even without sufficient basis. These are commonly experienced by people with a petulant demeanor or BPD. The physical effects of paranoia are difficulty thinking clearly or concentrating, hypervigilance, being tense, and trouble sleeping. Having feelings of paranoia may also have behavioral effects, including aggression, isolation, low mood, being defensive, and not being able to accept criticism from others.

Who is affected by petulant borderline disorder?

Anyone can be affected by petulant borderline disorder, but it tends to occur more frequently in people with blood relatives who suffer from the very same condition. It is also worth noting that those who are diagnosed with the disorder typically develop petulant BPD symptoms during their teenage years and only receive a formal diagnosis after the age of 18.

What are the risk factors for petulant borderline disorder?

The risk factors for petulant borderline disorder play a significant role in the development of the condition. The risk factors for petulant borderline disorder are listed below.

• Genetics: A family study of borderline personality disorder and its sectors of psychopathology published in 2011 in the Archives of General Psychiatry posits that the heritability of borderline personality disorder is estimated to be between 37% and 69%. This means that BPD may run in families and that having a family history of BPD may affect your likelihood of developing the condition.
• Experiencing abuse or trauma in childhood: An article on borderline personality disorder from Mayo Clinic states that many patients with BPD report being verbally, emotionally, physically, or sexually abused or neglected by their caregivers during childhood. Many of them also report having been lost or separated with their parents or caregivers when they were young.
• Problems with both parents: According to the guideline on borderline personality disorder developed by the National Collaborating Centre for Mental Health, people with BPD often see their mother as distant or overprotective, while their father as less involved and more distant. This suggests that issues with both parents are more likely to contribute to the development of the condition, rather than issues with either parent alone.

How is petulant borderline disorder diagnosed?

Petulant borderline disorder is diagnosed by conducting medical examinations, completing personality assessments, and performing diagnostic interviews that will aim to know a patient’s thoughts, feelings, current symptoms, and family medical history.

Conducting medical examinations first is important to rule out other health conditions that may mimic the effects of petulant borderline disorder. When other medical concerns have been ruled out, your healthcare provider may refer you to a mental health professional.

A thorough interview may then be done by your mental health provider in order to know more about your thoughts, feelings, current symptoms, and find out if you have a family history of mental health conditions.

Personality assessments may also need to be completed and may involve answering questionnaires that would provide more insights into the signs and symptoms you are having.

A formal diagnosis of borderline personality disorder may then be given if an individual meets at least five of the nine diagnostic criteria for BPD indicated in the American Psychiatric Association’s DSM-5, as stated by BPDFamily.com in its article entitled, “DSM Definition: Borderline Personality Disorder.”.

How to prevent petulant borderline disorder?

Unfortunately, there is no specific, proven way to prevent petulant borderline disorder. Most of the things that can increase your likelihood of developing the condition are things that are out of your control, including your genes, an imbalance in your brain chemicals, and your environment.

What are the treatments for petulant borderline disorder?

The treatments for petulant borderline disorder may involve the use of therapy or medications. The treatments for petulant borderline disorder are listed below.

• Dialectical behavior therapy (DBT): is a type of cognitive behavioral therapy (CBT) specifically designed for people with borderline personality disorder. DBT helps with developing effective ways to manage strong emotions and improving coping skills by combining strategies like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. A full course of DBT takes around six months to a year and typically involves weekly sessions and includes individual therapy, group therapy, and phone coaching. According to a study on the effectiveness of dialectic behavioral therapy in routine outpatient care published in 2014 in BMC Psychiatry, DBT effectively leads to positive results regardless of an individual’s sex, age, gender identity, sexual orientation, and ethnicity.
• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy (CBT) helps individuals with petulant BPD by teaching them how to identify and change negative or unhelpful thought patterns that have a detrimental influence on their emotional difficulties. CBT is a short-term treatment option that can last anywhere between five and 20 sessions. It is also an effective treatment option for a wide array of psychological disorders, including BPD.
• Medications: There are no specific medications approved by the Food and Drug Administration for the treatment of petulant BPD. However, certain medications, such as antidepressants, mood stabilizers, and antipsychotics may help with symptoms of frequently co-occurring conditions, like depression, anxiety, impulsiveness, or aggression. Because of the weak evidence on its effectiveness, however, medications may only be considered for reducing symptoms of comorbid conditions but not in specifically addressing BPD alone.

Does petulant borderline disorder have a cure?

No, petulant borderline disorder does not have a cure, as is the case with other subtypes of borderline personality disorder. An article written by Lois W. Choi-kain, MD, for the Psychiatric Times states that BPD in general is considered difficult to treat because of the self-defeating coping skills and difficulty with relationships involved in personality disorders like BPD.

It is worth noting, however, that even though individuals with petulant BPD can be challenging to treat, they are treatable with the help of treatment options that offer clinically meaningful symptom relief. Seeking professional treatment and sticking with it allows individuals to live a normal life with BPD.