Last week, Australian Open player Destanee Aiava revealed she had struggled with borderline personality disorder.

The tennis player said a formal diagnosis, after suicidal behaviour and severe panic attacks, “was a relief”. But “it also felt like a death sentence because it’s something that I have to live with my whole life”.

A diagnosis is often associated with therapeutic nihilism. This means it’s viewed as impossible to treat, and can leave clinicians and people with the condition in despair.

In fact, people with this disorder can and do recover with adequate support. Understanding it is caused by trauma is fundamental to effectively treat this complex and poorly understood mental illness.

A stigmatising diagnosis

The name “borderline personality disorder” is confusing and adds greatly to the stigma around it.

Doctors first used “borderline” to describe a condition they believed was in-between two others: neurosis and psychosis.

But this implies the condition is not real in itself, and can invalidate the suffering and distress the person and their loved ones experience.

“Personality disorder” is a judgemental term that describes the very essence of a person – their personality – as flawed.

What is borderline personality disorder?

People with the disorder can express a range of symptoms, but high levels of anxiety – including panic attacks – are usually constant.

Symptoms cluster around four main areas:

• high impulsivity (leading to suicidal thoughts and behaviour, self-harm and other risky behaviours)
• unstable or poor sense of self (including low self-esteem)
• mood disturbances (including intense, inappropriate anger, episodic depression or mania)
• problems in relationships.

People with the disorder greatly fear being abandoned and as a result, commonly have distressing difficulties in interpersonal relationships.

This creates a “push-pull” dynamic with loved ones, as people with borderline personality disorder seek closeness, but push away those they love to test the strength of the relationship.

For example, they may escalate a small issue into a major disagreement to see if the loved one will “stick with them” and reinforce their love.

Conversely, if a loved one appears distant or fed up – for example, is thinking about ending the relationship – the person with borderline personality disorder will make major efforts to “pull” them back. This might look like a flurry of messages, expressions of despair, or even suicidal behaviours.

Who does it affect?

The disorder affects one in 100 Australians, although this is likely a conservative estimate, as diagnosis is based on the most severe symptoms.

Women are much more likely to be diagnosed with it than men – but why this is so remains a major debate, with political and sociological factors playing a role in making psychiatric diagnoses. Symptoms usually begin in the mid to late teens.

While an initial response to receiving a diagnosis can be comforting for some, it is commonly seen as a chronic, relapsing condition, meaning symptoms can return after a period of improvement.

Borderline personality disorder can fluctuate in intensity and mimic other conditions such as major depression, bipolar disorder, anxiety disorders and psychosis.

Estimates suggest 26% of presentations at emergency departments for mental health issues are by people diagnosed with personality disorders, particularly borderline personality disorder.

What causes it?

The main cause for borderline personality disorder appears to be trauma in early life, compounded by repeated traumas later.

Early life trauma can lead to biological changes in the brain that cause behavioural, emotional or cognitive shifts, leading to social and relationship issues. This is known as complex post-traumatic stress disorder.

Aiava has acknowledged the disorder is “mainly from childhood trauma”, although she has not given details about her specific experiences.

People with borderline personality disorder usually have complex post-traumatic stress disorder. But complex post-traumatic stress disorder doesn’t always result in a borderline personality disorder diagnosis.

Although the two disorders are not identical, they share many similarities, in particular that they are both caused by complex and repeated trauma.

However those with borderline personality disorder tend to experience more rage, emotional disturbances and have a greater fear of abandonment.

They also face greater stigma, whereas the term “complex post-traumatic stress disorder” doesn’t carry the same negative connotations and focuses on the cause of the condition – trauma – rather than “personality”, leading to better treatment options.

The recognition of the major role of trauma in borderline personality disorder is an important step forward in treating the disorder. But because of the stigma associated with it, using the diagnosis of complex post-traumatic stress disorder maybe a better step forward in the future.

Can it be treated?

There are many effective psychological therapies and other treatments for people with borderline personality disorder or complex post-traumatic stress disorder.

For example, dialectical behavioural therapy is a type of cognitive therapy that helps people learn skills such as tolerating distress, managing relationships, regulating emotions and practising mindfulness.

The treatment of people with post-traumatic stress disorder, including victims of war and rape, has taught us a lot about how to treat complex, underlying trauma. For example, with trauma-focused psychological therapies.

Other new treatments, such as eye movement desensitisation and reprogramming, have also shown to be effective.

Many people with borderline personality disorder who receive treatment and have supportive relationships are able to “outgrow” the condition. Others may need to continue to manage symptoms while pursuing a good quality of life.

Treating trauma, not personality

Rethinking borderline personality disorder as a trauma disorder enables a more effective and understanding approach for those with it.

Understanding what trauma does to the brain means newer, targeted medications can also be used.

For example, our research has shown how the brain’s glutamate system – the chemicals responsible for learning and making sense of one’s environment – is overactive in people with complex post-traumtic stress disorder. Medications that work on the glutumate system may therefore help alleviate borderline personality disorder symptoms.

Educating partners and families about borderline personality disorder, providing them support and co-designing crisis strategies are also important parts of total care. Preventing early life trauma is also critical.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Jayashri Kulkarni, Professor of Psychiatry, Monash University and Eveline Mu, Research Fellow in Women’s Mental Health, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?

Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them less likely to wear their glasses.

But what they are noticing is how much better the world appears through the glasses. They become less tolerant of a blurry world when they remove them.

Here are some other things you might notice about eyesight and wearing glasses.

Lazy eyes?

Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.

Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us focus on objects in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).

From the age of about 40, the lens in our eye progressively hardens and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “presbyopia” and at the moment there are no treatments for this lens hardening.

Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.

Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.

The wrong glasses?

Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause eyestrain and headaches.

Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children as their visual system is still in development.

But it is more common for kids to develop long-term vision problems as a result of not wearing glasses when they need them.

By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in blurry or uncomfortable vision during daily wear.

Registered optometrists in Australia are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.

What about dirty glasses?

Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. Cleaning glasses regularly with a microfibre lens cloth will help.

While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can harbour bacteria with the remote but theoretical potential to cause eye infection.

To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can reduce bacterial contamination by 96% – but care should be taken as alcohol can damage some frames, depending on what they are made of.

When should I get my eyes checked?

Regular eye exams, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses expire within two years and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.

Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as glaucoma, will be recommended more frequent checks.

An online prescription estimator is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.

Conditions such as diabetes or high blood pressure, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.

James Andrew Armitage, Professor of Optometry and Course Director, Deakin University and Nick Hockley, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.