By Dr. Perry, PhD
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“Let us keep courage and try to be patient and gentle. And not mind being eccentric, and make distinction between good and evil.” ~ Vincent Van Gogh
The purpose of this article is to educate readers on a serious mental illness that is said to affect 1.6% to 5.9% of adults in America. This is between 4 million to 14 million people. The purpose of this article is NOT to vilify or shame individuals who suffer from this serious illness. Officially recognized in 1980 by the psychiatric community, borderline personality Disorder is a cluster B personality disorder. Borderline personality disorder can be referred to by other names but for the sake of clarity, I will refer to it as BPD in this article. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectation of the culture. The disorder causes distress or problems functioning, and lasts over an extended period of time.
It is a pervasive disorder of emotion regulation. Individuals who suffer from BPD are unable to manage or control their emotions. Crisis after crisis, they will crash and burn repeatedly throughout the day. It does not take a huge trigger for a BPD to ping-pong between extreme emotions. BPD will manifest itself in the context of relationships and usually begins in adolescence or early adulthood. It is long-term, encompasses all emotions and is associated with a wide variety of behaviors. BPD can exhibit itself in varying emotions such as depression, anxiety and hypo-manic behavior. One person may self-harm, another have an addiction and another may struggle in relationships. BPD can have different presentations at different times. One day, a person may be low. Another day, they may be social. Another day, they may have panic attacks. Overall, there may be a pattern of instability of interpersonal relationships, self-image and impulsivity. About 85 percent of people with BPD also suffer from other mental illness. Over half the BPD population suffers from major depressive disorder.
The Diagnostic and Statistical Manual of Mental Disorders also known as the DSM-5, is a handbook used by mental health professionals as the authoritative guide to the diagnosis of mental disorders. The DSM-5 contains descriptions, symptoms and other criteria for diagnosing mental disorders. It is currently in its 5th edition which was published in 2013. A mental health professional experienced in diagnosing and treating mental disorders can evaluate an individual and determine if they can be diagnosed as BPD. To be diagnosed with borderline personality disorder at least 5 of these 9 behaviors must be present. The behaviors must be persistent and exhibited over a long period of time.
1. Frantic efforts to avoid real or imagined abandonment
Individuals with BPD are unable to be alone. They need to have people around them. Individuals with BPD have an extreme fear of being abandoned. They will experience intense and inappropriate emotions if they feel they are being abandoned. If a person is late to meet someone with BPD or cancels a date with them they may experience severe panic or become abnormally furious. The perceived abandonment makes them feel they are worthless, bad or disgusting people. They will do anything to avoid being abandoned. A person with BPD may go to the extreme of threatening self-harm or suicide. They may react impulsively and actually self-harm. A person with BPD will do almost anything to avoid the real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships
Individuals with BPD will have very intense and unstable relationships that are characterized by alternating between the extremes of idealization and devaluation. They may meet someone and immediately idolize the person and want to spend all their time with them. They may immediately share intimate personal information of their lives and may immediately engage in risky sexual behavior. A person with BPD may fall in love with a person immediately only to hate them shortly after. They will fluctuate between love and hate with nothing in between. It is as if they put the individual on a pedestal only to later knock them down. These dramatic shifts in how they view the once idolized person reflects the disillusionment the person with BPD feels once their unreachable expectations are not met.
3. Identity disturbance: Markedly and persistently unstable self-image or sense of self
A person who suffers from BPD may have a fluid, distorted or unstable self-image. An individual with BPD may have a difficult time knowing what they value, believe, prefer or enjoy. They may feel empty, lost and as if they do not exist at all. They may often play a character in their lives and constantly change depending on their environment. A person with BPD may have sudden and dramatic shifts in their identity. They may have sudden changes in their life goals, values, vocational aspirations and relationships. Their opinions, careers, sexual identity, values and friends can change overnight.
4. Impulsivity in at least two areas that are potentially self-damaging
c) Engaging in risky sexual behavior
d) Wreckless driving
e) Substance abuse
f) Binge eating
5. Recurrent suicidal behavior, gestures, threats or self-mutilating behavior
A person suffering from BPD will threaten self-harm or exhibit suicidal behavior as a result of feeling negative emotions. Self-harm occurs in 50 to 80 percent of people with BPD and is usually in the form of cutting but may also be exhibited as bruising, burning, head banging or biting. These self-destructive acts are usually preceded by perceived threats of separation or rejection. Self-mutilation may occur during dissociative experiences and may be used to reaffirm the ability to feel after a dissociation or to distract oneself from emotional pain.
6. Affective instability due to marked reactivity of mood
A person with BPD will have intense episodic dysphoria or anxiety usually lasting a few hours and only rarely more than a few days. This is different from bipolar disorder mood swings which occur for weeks or even months. The mood swings with BPD are shorter and can occur within the day. There is a ping-pong of intense emotions. For some, peaks can be between depression and elation, anger and anxiety or depression and anxiety. Dysphoria is a state of unease or generalized dissatisfaction with life. A person with BPD can exhibit a combination of the following forms of dysphoria: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity and feelings of victimization.
7. Chronic feelings of emptiness, worthlessness or sadness
Individuals with BPD may feel there is nothing beneath the surface for them. They may feel as if they are hollow. When not in the chaos of extreme fluctuating emotions they may experience the feeling of emptiness. A person with BPD may become bored and engage in risky behaviors as listed in point #5. One can argue that by engaging in these behaviors they are able to avoid feeling empty. A person with BPD will experience extreme feelings of sadness and loneliness associated with their feelings of emptiness.
8. Inappropriate intense anger or difficulty controlling anger
A person with BPD may display intense and uncontrollable emotional responses when triggered. The response will be disproportionate to the event or situation. There are frequent displays of temper, constant anger or recurrent physical fights. These emotions are often elicited when they perceive a caregiver or lover is being neglectful, withholding, uncaring or abandoning. This is often followed by shame, guilt and feelings of being evil. People with BPD often feel emotions easier, faster and more intensely.
9. Transient, stress-related paranoia ideation or severe dissociative symptoms
Individuals suffering from BPD may experience dissociation. Dissociation can be thought of as disconnecting from one’s mind. It can occur in response to a painful event or painful memories. The mind will automatically redirect attention of the event in order to avoid feeling intense emotions. This loss of contact with reality may occur in response to real or imagined abandonment and last for minutes or hours. The person experiencing dissociation may become emotionless and appear flat. The return of the caregivers nurturance may result in remission of symptoms. A person who suffers from BPD may also exhibit paranoid ideation. Paranoid Ideation is not the same thing as delusional paranoia which is based on false thought and beliefs. An example of delusional paranoia is believing the government has bugged a person’s home. A person with paranoid ideation will believe they are being harassed, persecuted and be suspicious about others motives and intentions. They may see two people talking and assume they are talking about them.
This article is not meant to diagnose or be a guide for self-diagnosis. The sole purpose of this article is strictly for educational purposes. The purpose of this article is to educate readers on a serious mental illness that is said to affect 1.6 % to 5.9 % of adults in America. This is between 4 million to 14 million people. The purpose of this article is NOT to vilify or shame individuals who suffer from this serious illness. If you feel you or someone you know meet the necessary criteria please seek the help of a mental health professional. This article is not meant to be used for self-diagnosis.
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