Fear of abandonment, unstable or changing relationships, self-image issues or lack of self-esteem, anxiety disorders…. Do you suffer from Borderline Personality disorder (BPD)? Learn more about this often undiagnosed but serious mental disorder.
What is BPD and how serious is it?
Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood. This marked instability in functioning, affect, mood, interpersonal relationships, and, at times, reality testing is associated with major depression, psychoactive substance abuse, and psychotic disorders. In many instances, the comorbid disorder is diagnosed accurately, but the clinician misses the borderline diagnosis.
Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders including panic disorder, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder. Nearly 75% or more of those living with BPD also qualify for an anxiety disorder. 70-75% of patients with BPD have a history of at least one deliberate act of self-harm, and the mean estimated rate of completed suicides is 9%.
How is it diagnosed?
There are 9 criteria to diagnose BPD but in order to make the diagnosis, one doesn’t need to meet all of them. BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as followed:
Criterion 1: Frantic efforts to avoid real or imagined abandonment including panic, depression, rage, (this does not include suicidal or self-mutilating behavior mentioned in criterion 5). Examples of that are:
- I am going to live my life the way I want. People with BPD think rebellion help them escape from pain.
- I’m so freaked out by the idea of being alone or being left that I will do whatever it takes to stay in a relationship that is not working. Upon separation or fear of rejection, people with BPD react in desperate ways when it isn’t even warranted.
- When a person suffering from BPD feels loss of control over people’s relationship, they tend to divide people. It can even happen in a healthcare environment where they might for example lie about the nurses to the doctor so the nurses can fight one another. This is call splitting mechanism.
Criterion 2: A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. In other words, intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger and are subject to change without notice or predicating event. People with BPD may also seem overly reliant or dependent upon friends, lovers, or family members.
Criterion 3 : Markedly and persistently unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school, career choices, religion etc.)
Criterion 4: Impulsivity in at least two areas that are potentially self-damaging Impulsive or risky behavior often includes sex, substance abuse, binges (for example eating at inappropriate hours of the day, drinking excessively or simply eating too much), or charging a lot of money on credit cards. These behaviors are often considered to be dangerously impulsive and can put oneself or others at risk ; this does not include suicidal or self-mutilating behavior covered in criterion 5.
Criterion 5: Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Self-injurious behavior includes suicide and suicide attempts. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts.
Criterion 6: Affective instability due to a marked reactivity of mood. Examples are:
- Intense episodic dysphoria (profound state of unease or dissatisfaction)
- Irritability or anxiety usually lasting a few hours and only rarely more than a few days.
Criterion 7: Chronic feelings of emptiness and/or boredom
Criterion 8: Inappropriate, intense anger or difficulty controlling anger. Example:
- Yelling at a friend for being late at a lunch date
- Frequent displays of temper, constant anger
- Recurrent physical fights
- Holding grudges
Criterion 9: Transient, stress-related paranoid ideation or severe dissociative symptoms such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.
BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.
Dialectic behavior therapy (DBT) is the mainstay of treatment. Medication may be necessary for impulsivity, anxiety, affective instability and psychosis. Hospitalization may be necessary because of suicidal or other self-injurious behavior.
If you think you might meet the criterion for BPD, talk to a mental health professional.