Borderline Personality Disorder

A short version of the definition of BPD: In general, people with BPD feel worthless, empty, moody, needy, depressed, and have difficulty managing their emotions. They have trouble with boundaries--both their own and respecting others. They are looking for that all-loving "other" who will provide the unconditional love they cannot give themselves. BPs often act inconsistently, act impulsively in ways they later regret, see other as either all good or all bad, and base their beliefs on feelings instead of facts. Borderlines are people in pain. BPs commonly manage their intense pain in two ways: they act in or act out. BPs who act in may mutilate themselves, make suicide attempts, express self-hate, or seek outpatient or inpatient therapy. Other BPs manage their pain by trying to foist it on others. They blame loved ones for all their problems, criticize, make unfair accusations, act emotionally or physically abusive, put others in no-won situations, and use emotional blackmail to get the love they need. A longer, clinical definition of BPD used by clinicians: The DSM-IV diagnostic criteria for borderline personality disorder reads as follows: A pervasive pattern of instability of interpersonal relationships, self-image, and affects moods, 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 (5). People with BPD feel isolated. Anxious. Terrified at the thought of being alone. Caring, supportive people are like friendly faces in the middle of the crowd, offering smiles, help, and warm hugs. But the moment they do something that suggests an imminent departure — or do anything that the BP interprets as a signal that they’re about to leave — the BP panics and reacts in a variety of ways, from bursting into rage to begging the person to stay. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. People with BPD look to others to provide things they find difficult to supply for themselves, such as self-esteem, approval, and a sense of identity. Most of all, they are searching for a nurturing caregiver whose never-ending love and compassion will fill the black hole of emptiness and despair inside them. For someone with BPD, the potential loss of a relationship can be like facing the loss of an arm or leg — or even death. When their fears of abandonment seem to be confirmed, they may erupt into a rage, make accusations, sob, seek revenge, mutilate themselves, have an affair, or do any number of destructive things. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. This trait refers to borderline patients’ profound and often terrifying sense that they do not know who they are. Normally, we experience ourselves consistently through time in different settings and with different people. But this continuity of self is not experienced by the person with BPD. Instead, borderline patients are filled with contradictory images of themselves that they cannot integrate. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, shoplifting, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5). People with BPD may also try to fill the emptiness and create an identity for themselves through substance abuse, bingeing and purging, indiscriminate sexual activity, shoplifting, compulsive shopping, drinking, or substance abuse 5. Recurrent suicidal behavior, gestures, or threats, or self- ­mutilating­ behavior. About 10 percent of all people with BPD commit suicide. This does not include BPs who engage in risky behavior that results in death, such as drinking and driving. Self-mutilation is another BPD behavior that is very difficult for family members to understand. Examples include cutting, burning, breaking bones, head banging, needle poking, skin scratching, pulling out hairs, and ripping off scabs — all without suicidal intent. 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). Dysphoria is the opposite of euphoria. It’s a mixture of depression, anxiety, rage, and despair. Affective instability (mood changed) 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. Patients commonly report that they feel empty inside, that there is “nothing to me,” that they are different people depending on whom they are with." This is very associated with lack of identity. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Borderline rage is usually intense, unpredictable, and unaffected by logical argument. It is like a torrential flash flood, a sudden earthquake, or a bolt of lightning on a sunny day. And it can disappear as quickly as it appears. Some borderlines, however, have the opposite problem: they feel unable to express their anger at all for fear they will lose control if they express even the slightest anger. 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. Have you ever arrived home from work without remembering how you got there? You’ve traveled the route so many times that your brain had its own little adventure while your eyes and reflexes do the driving. This “out of it” feeling is a mild type of dissociation. People who are severely dissociating, however, feel unreal, strange, numb, or detached. They may or may not remember exactly what happened while they were “gone.” The degree of dissociation can vary from the car-trip-home variety to the extreme dissociation characterized by multiple personality disorder (this is why it is now called “dissociative identity disorder”). People with BPD may have other attributes that are not part of the DSM-IV definition, but that researchers believe are common to the disorder. Many of these may be related to sexual or physical abuse if the BP has experienced abuse earlier in life. Pervasive Shame: Toxic shame is experienced as the all-pervasive sense that a person is flawed and defective as a human being. It is no longer an emotion that signals limits; it is a state of being, a core identity. Toxic shame gives you a sense of worthlessness, the feeling of being isolated, empty, and alone in a complete sense. Substance abuse: BPD and substance abuse disorders often go hand in hand. Another study reported that about 23 percent of borderline patients had a diagnosis of substance abuse. Borderline substance abusers are likely to abuse more than one drug (a frequent combination is drug and alcohol abuse), are more likely to be depressed, have more frequent suicide attempts and accidents, have less impulse control, and seem to have more antisocial tendencies. See http://www.actassociation.com/News/dialectical.htm. Undefined Boundaries: People with BPD have difficulty with personal limits — both their own and those of others. Control Issues: Borderlines may need to feel in control of other people because they feel so out of control with themselves. In addition, they may be trying to make their own world more predictable and manageable. They may choose a lifestyle where all choices are made for them, such as the military or a cult, or they may align themselves with abusive people who try to control them through fear. Lack of Object Constancy: When a person is lonely, most of us can soothe ourselves by remembering the love that others have for us. This ability is known as object constancy. Some people with BPD, however, find it difficult to evoke an image of a loved one to soothe them when they feel upset or anxious. If that person is not physically present, they don’t exist on an emotional level. Interpersonal Sensitivity: Some BP’s have the astute ability to identify and use social and nonverbal cues of others. They can empathize well with others and often understand and respect how others feel, and they can use these skills to “see through others.” Some BPs may continue to use these social antennae to uncover triggers and vulnerabilities. Situational Competence: Some people with BPD are competent and in control in some situations. For example, many perform very well at work and are high achievers. Many are very intelligent, creative, and artistic. This can be very confusing for family members who don’t understand why the person can act so assuredly in one situation and fall apart in another.