What is Borderline Personality Disorder (BPD)?
Borderline Personality Disorder, or BPD, for short is one of the four main 'Cluster B' personality disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM).
How is the diagnosis for BPD made?
The DSM sets out the following 9 criteria for Borderline Personality Disorder, and you'd have to meet at least 5 of them, to be considered as having BPD. The criteria used by mental health professionals are as follows:
APA Diagnostic Criteria: (I'll explain the gobbledy-gook in a minute, read on)
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 behaviour covered in criterion 5.
2) A pattern of unstable and intense interpersonal relationships, characterised by alternating between extremes of idealisation 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 (eg, spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in criterion 5.
5) Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
6) Affective instability due to a marked reactivity of mood (eg, 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 (eg, frequent displays of temper, constant anger, recurrent physical fights.)
9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
The essential feature of Borderline Personality Disorder (BPD) is a pervasive pattern of instability or interpersonal relationships, self-image and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.
What the gobbledy-gook actually means:
To make broad, sweeping generalisations that are 99% accurate but still don't capture the true reality of BPD, if you're dealing with the following things, or acting in the following ways, you may get diagnosed with BPD:
- Self-harming behaviours like cutting etc
- Frequent thoughts of suicide, or actual attempts at suicide (10% of the patients diagnosed with BPD actually do kill themselves, God forbid.)
- Impulsive behaviour - overspending, shopaholic, over-eating, binge eating, one night stands, lashing out at others verbally and otherwise, actually sending the nasty, disturbing email you just wrote instead of deleting it…
- Living a life of extremes - and this comes through in your relationships and beliefs about yourself, others and life. Either it's all fantastic, wonderful and brilliant, or it's the dumps, terrible awful. There's an obvious lack of balance.
- Frequent, uncontrollable rage fits
- Take offence / get hurt very easily, and are hyper-sensitive to implied or actual criticism and rejection (more on this in a moment.)
- Difficult relationships with others; rely on other people to solve your problems for you, but then can turn on them and reject them for not being caring enough, understanding enough or interested enough. Don't take responsibility for solving your own issues and blame others a lot.
- Ungrounded emotions - get swept away by negative emotions and reactions very easily, and find it hard to regain your balance and sense of stability again.
- Don't like yourself very much; find it hard to form an accurate judgement of who the 'real you' actually is.
- A tendency to reject others before they reject you, ie, you'll provoke a fight, or overreact to something, or act unreasonably, or sabotage your relationship in some way, to 'test' how much the other person really cares for you.
- Over-reliance on other people for support, sense of self and 'soothing', which can cause others to feel suffocated in the relationship. This sets up the paradigm where you want more from others than they can reasonably be expected to give, it gets 'too intense', and they back away, reinforcing your feeling of being rejected, uncared for, and misunderstood. Unfortunately, the more you try to 'keep hold' of people, the faster they run away from you.