Borderline Personality Disorder

BPD Ribbon


I am NOT Borderline. I have Borderline Personality Disorder. It is NOT a curse. It is NOT a death sentence. It is simply a label that summarizes my symptoms and helps explain why these symptoms developed. It also allows doctors to generally identify my issues, and enables them to bill my insurance. Borderline does NOT mean I’m crazy. There is NOTHING wrong with my personality. It simply means that I have experienced a developmental delay emotionally. With or without treatment, I will mature emotionally. I am NOT crazy, manipulative, or a liar. On the contrary, I am honest, intelligent, and compassionate. Borderline is highly stigmatized in society and the media, but we are NOT how Borderline is often portrayed.


 DSM IV Diagnostic Criteria for Borderline Personality Disorder

Published by the American Psychiatric Association

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) 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. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). 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., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  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.

DSM V Diagnostic Criteria for Borderline Personality Disorder
Published by the American Psychiatric Association

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

  1. Significant impairments in personality functioning manifest by:
    1. Impairments in self-functioning (a or b):
      1.  Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
      2. Self-direction: Instability in goals, aspirations, values, or career plans.

AND

  1. Impairments in interpersonal functioning (a or b):
    1. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
    2. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.
  2. Pathological personality traits in the following domains:
    1. Negative Affectivity, characterized by:
      1. Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
      2. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stressed; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart of losing control.
      3. Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.
      4. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
    2. Disinhibition, characterized by:
      1. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
      2. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
    3. Antagonism, characterized by:
      1. Hostility: Persistent of frequent angry feelings; anger or irritability in response to minor slights and insults.
    4. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
    5. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
    6. The impairment in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Subtypes of Borderline Personality Disorder

Typical Treatment for Subtypes of BPD


Description:
Borderline Personality Disorder (BPD) is an often misunderstood, serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. It is a disorder of emotional dysregulation. This instability often disrupts family and work, long-term planning, and the individual’s sense of self-identity.

The disorder was officially recognized in 1980 and given the name Borderline Personality Disorder. It was thought to occur on the border between psychotic and neurotic behavior. This is no longer considered a relevant analysis and the term itself, with its stigmatizing negative associations, has made diagnosing BPD problematic.

Facts:

  1. There are over 200 ways in which BPD presents because the five of nine criteria needed to diagnose the disorder may present in a large number of different combinations.
  2. BPD rarely stands alone. There is high co-occurrence with other disorders.
  3. BPD affects between 1 – 2% of the population.
  4. More females are diagnosed with BPD than males by a ratio of about 3-to-1, though some clinicians suspect that males are underdiagnosed.
  5. 7 % of patients self-injure.
  6. Approximately 10% of individuals with BPD complete suicide attempts.
  7. A chronic disorder that is resistant to change, we now know that BPD has a good prognosis when treated properly.
  8. In many patients with BPD, medications have been shown to be very helpful in reducing the severity of symptoms and enabling effective psychotherapy to occur. Medications are also often essential in the proper treatment of disorders that commonly co-occur with BPD.

Theories of Origins and Pathology
Clinical theorists believe that biogenetic and environmental components are both necessary for the disorder to develop. These factors are varied and complex. Many different environments may further contribute to the development of the disorder. The best explanation appears to be that there is a confluence of environmental factors and a neurobiological propensity that leads to a sensitive, emotionally labile child.

Co-occurring Disorders
Major Depressive Disorder = 60%
Dysthymia (chronic, moderate to mild depression) = 70%
Eating Disorders = 25%
Substance Abuse = 35%
Bipolar Disorder = 15%
Antisocial Personality Disorder = 25%
Narcissistic Personality Disorder = 25%

Treatment
Hospitalization
Medications
Individual Psychotherapy

  • Psychodynamic
  • Cognitive-Behavioral
  • Supportive

Group Psychotherapy

  • Dialectical Behavioral
  • Cognitive-Behavioral

Family Therapy


What It Feels Like To Be Borderline
“I have two halves: logical/emotional, strong/fragile, dependent/independent, smart/naive, content/depressed, child/adult, helpful/helpless, needy of affection/fearful of rejection, etc. I’m ALWAYS at war with myself. The two sides NEVER get along. I can’t allow one side to “win” because both sides have their purpose and importance. The logic gives me understanding and the emotions give me empathy.”

“…it is having the hugest contradictory feelings you could ever experience all at the same time.”

“It’s like being a child that’s been beaten, ignored, and violated then dumped on the side of the road in the slums to fend for themselves. With each year they sit on the side of that road getting older until they’ve become an adult. The adult doesn’t know how to be an adult because all the while they’ve been a wounded child sitting on the side of the street. They didn’t know who they were or where to go or how to act. A borderline is a deeply hurt wounded adult with the emotional capacity and experience similar to a child. We are not 100% children trapped in an adult’s body….many of us are very smart successful creative fully functioning adults capable of many a great things.”

“I hate you. That is not true, but sometimes I think it is. I will not answer the phone when you call, even though I want to talk to you. I will not call you, even though it is all I want to do. I will not reach out to you, even though every part of me wants to. I will be mad at you, I will want to hurt you, and I will drive you away because I am afraid to let you closer. I need your constant attention, your reassurances, but I will greet them with cold indifference. I will be jealous of the attention you give others, and I will get mad at you for ignoring me. I will feel close to you and care for you one day, only to be mad and want you out of my life the next.

I am an emotional amnesiac, maybe I always have been. I take each event, each day, each conversation as a separate event, always looking for signs that you might hurt me. When I feel neglected, I will get mad and forget that the day before you told me how much you cared. I am an inconsistent mess. There is a part of me who is happy and confident and another part that is insecure and needy. These days, I never know which one it will be. Every time I think I am in control, that I know you care and I feel comfortable with our relationship, the fear and doubt will come back. Maybe with time it will go away completely, but doubt it. All it will take is another close relationship, another new friend, another day and it will be back.

You ask what you can do and I do not know what to say. The needy part of me wants your constant attention, it needs your words and thoughts, your presence. But I know that is not the answer, I must accept the limitations on our relationship. The scared part of me wants you out of my life because it would be easier. The hateful part of me wants to hurt you because it thinks you have hurt me. All I can ask you to do is to understand, to not give up. I will ignore you at times, I may be rude to you, I may try to hurt you. I may hide from you and wait for you to reach out to me, so I know you will care. It is not fair to do these things, but I will. I cannot ask you to put up with this, it is not fair and no matter how I act, I care too much to put you through this. But you asked, and this is all I have to tell you.”


Demi Lovato Lyrics

By Demi Lovato