What is Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is the most common Personality Disorder affecting approximately 7 in every 1000 people. Called ‘Borderline’ by psychoanalyst Adolph Stern in 1938 to describe patients who did not fit neatly into a diagnosis of psychosis or neurosis, but stood on the ‘borderline’ of other conditions. Please see our section on What is Borderline Personality Disorder for more information on BPD.
Signs and symptoms of Borderline Personality Disorder
Patients will typically present impulsive, unstable behaviour and emotions, have difficulties in interpersonal relationships and have a chronic fear of abandonment. Often sufferers will behave in a manner that others deem inappropriate and can be impulsive, seeing things in very black and white terms.
Between 1975 and 1978 BPD was becoming more widely understood and recognized as a condition. Otto Kerberg, and Gunderson and Kolb made leaps forward in characterizing the condition, these characteristics were defined as
- Striking fluctuations from periods of confidence to times of absolute despair
- Markedly unstable self-image
- Rapid changes in mood
- Fears of abandonment and rejection
- A strong tendency towards suicidal thinking and self-harm.’
- Transient psychotic symptoms, including brief delusions and hallucinations, may also be present. (Although these are usually brief and appear at times of emotional distress, this is distinct from schizophrenia where these are ‘core’ symptoms)
Diagnosis of Borderline Personality Disorder
Diagnosing BPD is not as clean cut as some mental health disorders and the diagnosis criteria itself has come into question. These days instead of relying upon one way of assessing a patient with BPD type symptoms, a practitioner will usually use different methods to ensure the accuracy of diagnosis and to rule out other disorders/comorbid conditions.
According to the Diagnostic and Statistical Manual of Mental Disorders, the manual used to diagnose BPD and other mental health disorders by psychiatrists(DSM-IV), the key features of borderline personality disorder are; Instability of interpersonal relationships, self-image and affect, combined with marked impulsivity beginning in early adulthoodand present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation. (Not including self harm/suicidal behavior as categorized below)
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (for example, spending, sex, substance abuse, reckless driving, binge eating). (Not including self harm/suicidal behavior as categorized below)
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
- Affective instability due to a marked reactivity of mood (for example, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (for example, frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
Although the DSM-IV is used in the diagnosis of BPD, as outlined above there are other ways a person is assessed, for example you may be given a structured clinical interview or personality assessment. It is therefor of the upmost importance that if you feel you, or someone you know may fit this diagnosis, you speak to your GP or healthcare professional. They will be able to offer advice based on your own personal circumstances and needs.
Behaviours often present in BPD
- Self-damaging behavior
- Chronic fear of abandonment (which can lead to disturbed behavior within a relationship)
- Poor impulse control (reckless or self damaging sex, spending, drugs)
- Interpersonal relationship problems (jealousy, erratic behavior, possessiveness)
- Splitting – switching between love/hate – idealizing/demonizing someone (often swinging from one to the other)
- Bouts of depression
- Bouts of psychosis
- Self-harm and suicidal thoughts, intentions, even attempts
- Mood swings (either very high in mood or very low)
- Uncontrollable anger
- No real sense of self, sexuality confusion, swings in life direction/dreams (this can lead to swings in sexuality/relationships, jobs)
- Black and white thinking
There is much literature showing that BPD overlaps considerably with other categories of personality disorder, with ‘pure’ borderline personality disorder only occurring in 3 to 10% of cases (Pfohl et al., 1986)
BPD has many characteristics that are similar to depressive and anxiety disorders, impulsive, dissociative and identity disorders. Also as it often has associations with past trauma there are overlaps with PTSD. This means it can be difficult to determine whether symptoms are from BPD or from a comorbid condition, this again needs to be assessed by someone able to consider individual circumstances and symptoms.
People with BDP often have comorbid (occurring at the same time) conditions such as:
- Eating Disorder
- Substance Misuse(e.g. drugs or alcohol)
- Other Personality Disorders
- Bi-polar can also be co-present although BPD is sometimes clinically confused with this condition.
Stigma attached to Borderline Personality Disorder
Because of the lack of awareness about the condition, those with BPD can often be looked upon as ‘attention seeking’ and their erratic behaviour is often misunderstood or misinterpreted. This can make them more difficult to treat. Unfortunately the view that a BPD sufferer’s self abusive behavior is ‘acting out’ or not to be taken seriously often leads a sufferer into further isolation and personal conflict. One in Ten people with BPD will successfully complete suicide. You may also like to read Borderline Personality Disorder – A tribute to Louise Wright.
Further help on Borderline Personality Disorder
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