Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a mental condition characterised by long-term emotional turbulence, intense and often unstable relationships with others, and a lack of sense of self.
People with BPD may experience:
- Fear of abandonment.
- Emptiness and boredom.
- Impulsiveness (e.g. spending, binge eating, reckless driving, shoplifting).
- Extreme irritability and displays of inappropriate anger.
- Self-harm and suicidal ideation.
Criteria outlined by the DSM IV or the ICD-10 are used to diagnose BPD.
For the DSM IV, the diagnostic criteria are as follows:
A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. Do not include suicidal or self-injuring behaviour covered in Criterion 5.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
- Identity disturbance - markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g. promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Do not include suicidal or self-injuring behaviour covered in Criterion 5.
- Recurrent suicidal behaviour, gestures, threats or self harming behaviour such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
- 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).
- Chronic feelings of emptiness.
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.
The ICD-10 lists BPD as Emotionally Unstable Personality Disorder, and there are two types:
- Impulsive type
At least three of the following must be present, one of which must be (2):
- Marked tendency to act unexpectedly and without consideration of the consequences.
- Marked tendency to engage in quarrelsome behaviour and to have conflicts with others, especially when impulsive acts are thwarted or criticized.
- Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions.
- Difficulty in maintaining any course of action that offers no immediate reward.
- Unstable and capricious(impulsive, whimsical) mood.
- Borderline type
At least three of the symptoms mentioned in A. Impulsive type must be present [see above], with at least two of the following in addition:
- Disturbances in and uncertainty about self-image, aims, and internal preferences.
- Liability to become involved in intense and unstable relationships, often leading to emotional crisis.
- Excessive efforts to avoid abandonment.
- Recurrent threats or acts of self-harm.
- Chronic feelings of emptiness.
- Demonstrates impulsive behaviour, e.g., speeding, substance abuse.
Cause of BPD
The cause of BPD is unknown, but it is thought that both genetics, upbringing, and past traumas can contribute, such as abandonment in childhood, sexual, verbal, or physical abuse, neglect, and brain abnormalities.
If you believe that you or a family member may have BPD, you will have to be referred to a mental health professional by your GP. They may also perform tests first to rule out any physical illness that may be causing the behaviour. It may take several sessions to receive a diagnosis, if at all.
There are several forms of psychotherapy used to treat individuals with BPD, such as dialectical behavioural therapy (DBT), schema therapy, and transference-focused psychotherapy. Individuals may also engage in cognitive behavioural therapy (CBT) for anxiety and depression. Psychiatric medications can also be used to treat symptoms, although they generally only relieve secondary symptoms caused by the disorder, or of co morbid disorders.
The Discouraged Borderline has avoidant, depressive or dependent features which leads to feelings of worthlessness that can make the individual either completely isolated due to fear of abandonment, or overly dependant on others for validation. The individual believes that nobody likes or wants to be around them and so engage in efforts to avoid abandonment or conflict.
The Impulsive Borderline features histrionic or antisocial characteristics, and is the most recognised subtype. They are more likely to have bouts of physical aggression, suffer poor impulse control, abuse substances, and self harm. Individuals feel a need for attention, positive or negative. They may feel wronged by other people or blame them for their emotional pain, and so can be confrontational and highly sensitive.
The Petulant Borderline has negativistic (passive-aggressive) features and are fearful and anxious. They shut others out and are possessive and controlling due to fear of abandonment. They sometimes use self-harm and suicidal gestures to gain control of situations or to get their needs met, and may evoke guilt and anxiety in others. They have an inability to self soothe, and often use food, alcohol and sex to try to eradicate feelings of emptiness. They can often be reclusive and socially anxious.
The Self-Destructive Borderline have depressive or masochistic features. Individuals with this subtype feel that no one cares about them and therefore does not care for themselves. They suffer from chronic emptiness and loneliness and engages in self destructive behaviour in order to feel something. Self harm is prominent in this subtype and there is high risk of suicide.
Borderline Personality Disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
Borderline Personality Disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
Millon, Theodore (2006). "Personality Subtypes Summary”. The Official Website for Theodore Millon, Ph.D., D.Sc.. DICANDRIEN, Inc. http://millon.net/taxonomy/summary.htm.