Borderline Personality Disorder


Borderline Personality Disorder is perhaps one of the most controversial diagnoses in modern psychology, with a wide array of professional view points. Unlike most of my other topics, its something I have difficulty writing freely about. I have tried to compose my information as accurately and thoroughly as possible, but I suggest you continue to do your own research. I have included other websites on my links page that may be helpful in your attempt to understand this very complicated disorder.

Diagnostic Features

People with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment. A feeling of impending separation or rejection, or the loss of an external structure, can lead to drastic changes in self-image, affect, cognition, and behavior. Borderline individuals are sensitive to environmental circumstances. They experience very intense abandonment fears and sometimes inappropriate anger or agitation even when faced with a realistic time limited separation or when there are unavoidable changes in plans (ex: sudden despair because someone important to them is late or must cancel an appointment). They often believe that this abandonment means they are horrible or bad. Many of these abandonment fears are related to an intolerance of being lonely and a need to have others with them, or a part of their life. A Borderline individual's efforts to avoid abandonment may include impulsive actions such as self injury, or suicidal behaviors.

An Individual with Borderline Personality Disorder has a pattern of unstable and intense relationships. They may idealize a person at one moment, try to spend a lot of time together, and share many intimate details early in a relationship. They may quickly switch from idealizing other people to devaluing them. They may feel that the other person doesn't care, or that the other person sees how "terrible" they are. Borderline individuals can empathize with and be very nurturing to other people usually with the hope that the person they are nurturing will be there for them. Some people with Borderline Personality Disorder may have an unusually high degree of interpersonal sensitivity, insight and empathy. These individuals are prone to sudden and dramatic shifts in their perspective of others.

There may be an identity disturbance characterized by a persistently unstable self-image, or sense of self, which may change dramatically. There may be sudden changes in opinions and plans about career, sexual identity, values, and friendships. A Borderlines self-image is usually based on a feeling of being bad or "evil." A pessimistic attitude may be observed. They may sometimes feel that they do not exist at all. These experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, support, or nurturing. People with Borderline Personality Disorder may show worse performance in unstructured work so school situations.

Individuals with this disorder may be impulsive in at least two areas that are potentially self damaging. They may binge eat, abuse substances, engage in unsafe sex, gamble, spend money irresponsibly, or drive recklessly. They may display recurrent suicidal behavior, gestures, or threats, or self harmful behavior. Recurrent suicidally is often the reason that these individuals seek help. These self-destructive acts are usually brought on by feelings of separation or rejection or by expectation that they assume increased responsibility. Self injury may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by confirming the individuals sense of being "terrible."

Individuals with Borderline Personality Disorder may display affective instability that is due to a reactivity of mood. (ex: irritability, or anxiety usually lasting a few hours and only rarely more than a few days) These feelings may be disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes reflect the person's extreme reaction to interpersonal stresses. Individuals with this disorder may be troubled by chronic feelings of emptiness. They may be easily bored and therefore constantly seek something to do. They may not know how to control anger. They may display extreme sarcasm, enduring bitterness, or verbal outbursts. Such expressions of anger are often followed by shame and guilt and contribute to the feeling of being bad. During periods of extreme stress, individuals may exhibit paranoid ideation or severe dissociative symptoms. These episodes usually occur in response to real or imagined abandonment, and don't last long. The real or perceived return of someones nurturance may result in a remission of symptoms.

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Diagnostic criteria for Borderline Personality Disorder

(from DSM IV Diagnostic And Statistical Manual of Mental Disorders, Fourth Edition)

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more, but not necessarily all) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsively in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating, etc). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., frequent displays of temper, constant anger, recurrent physical fights)

7. Chronic feelings of emptiness

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9. Transient, stress-related paranoid ideation or severe dissociative symptoms


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Statistics

2% of the General Population is diagnosed with Borderline Personality Disorder

It is seen in 10% of individuals in outpatient mental health clinics

It is seen in 20% of psychiatric inpatients

It ranges from 30% to 60% of clinical populations with Personality Disorders

75% of those diagnosed are females


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