Borderline Personality Disorder
General Description of Borderline Personality Disorder
People with Borderline Personality Disorder (BPD) are frequently emotionally chaotic. Their moods may change rapidly, over the course of minutes or hours. They may exhibit “splitting” which is black-and-white thinking that can switch their thinking of a person (generally close friends or family of the BPD victim) from being “all good” to “all bad” without any cause obvious to a casual observer.
They may exhibit long-term dissatisfaction and unhappiness with relationships, jobs, education, and nearly every other aspect of their lives. They may seem to be unsure of who they are and be constantly re-inventing themselves or trying to “find themselves” via their predictably unpredictable shifting of activities, friends, and jobs. They may “act in” by self-harm methods including cutting, burning, self-mutilation, and suicide. They may “act out” by rages, threats, false accusations, and other methods to control and manipulate the people around them in an attempt to soothe their chaotic emotions.
“High functioning” Borderlines may be virtually undetectable to casual acquaintances, coworkers, and even long-term friends. They can be highly capable and successful in their field of work. But their close interpersonal relationships tend to be a disaster. Family members may be the only ones who see the destructive behaviors. This can be particularly troublesome for them as they may encounter disbelief from others when they explain how their family member behaves in private.
“Low functioning” Borderlines are much easier to detect. They may appear unstable or “crazy” even to people who don’t know them well.
The American Psychiatric Association describes the behavioral patterns that identify BPD as follows:
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the widely-used American Psychiatric Association guide for clinicians seeking to diagnose mental illnesses, defines Borderline Personality Disorder (BPD) as: “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.”
BPD is classed on “Axis II”, as an underlying pervasive or personality condition, rather than “Axis I” for more circumscribed mental disorders.
A DSM diagnosis of BPD requires any five out of nine listed criteria to be present for a significant period of time. There are thus 256 different combinations of symptoms that could result in a diagnosis, of which 136 have been found in practice in one study.
The criteria are:
Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization 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, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
- Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
- 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, worthlessness.
- 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
BPD is often misdiagnosed. As an Axis II disorder, many insurance companies will not pay for treatment for BPD because they classify it as an incurable disorder, even though this is probably not accurate in many cases. Sometimes it is diagnosed as Post Traumatic Stress Disorder or Complex Post Traumatic Stress Disorder. Borderlines may also be scared out of therapy by the diagnosis, therefore therapists may refuse to disclose the diagnosis.
Further, BPD is often accompanied by numerous other mental illnesses ranging from anxiety disorders, mood disorders such as depression and Bipolar Disorder, eating disorders, and even other personality disorders such as Narcissistic Personality Disorder. So it is no surprise that sorting out this mess of problems takes time. The National Alliance on Mental Illness has published estimates that it typically takes five years of therapy to arrive at the BPD diagnosis:
Why is BPD so misunderstood?
Borderline personality disorder, historically and even presently, is a disorder that has met with widespread misunderstanding. There are many reasons for the confusion. With the nine possible symptoms there exist over 200 different ways for the disorder to present itself, and this heterogeneity is further complicated by the fact that BPD rarely stands alone. A high rate of co-occurrence exists with other disorders, which typically include major depression, bi-polar disorder, substance abuse, eating disorders, and anxiety disorders.
To compound the problems, unfortunately another diagnosis is often assessed instead, BPD is often missed or ignored. Data indicate, on average, that five years elapse before BPD is accurately diagnosed in a patient. Lastly, medications are often a source of confusion. It is not uncommon for an individual with BPD to be on three, four, five, six or more medications. To date, no one medication has been specifically researched and approved for BPD.
Borderline Personality Disorder Books
These books are good starting points to understanding the illness, regardless of whom is affected by it.
Stop Walking on Eggshells: Taking Your Life Back When Someone You Care about Has Borderline Personality Disorder
by Paul T. Mason & Randi Kreger
Excellent introductory book on BPD and how to protect yourself from some of the damage that can be done in a relationship with a BPD victim.
I Hate You, Don’t Leave Me: Understanding the Borderline Personality
by Jerold J. Kreisman
One of the earliest books to discuss BPD in terms that everybody can understand, and still highly informative.
Sometimes I Act Crazy: Living with Borderline Personality Disorder
by Jerold J., M.D. Kreisman
This is a well-reviewed follow-up to the classic “I Hate You, Don’t Leave Me”.
by Dr. Leland Heller
Dr. Leland Heller discusses various mental disorders including BPD and the psychiatric treatments he advocates for them.
Protecting Your Family and You
These are books that may help you protect yourself and your family from an abusive and vindictive ex, particularly those with a personality disorder.
Divorce Poison: Protecting the Parent-Child Bond from a Vindictive Ex
by Richard A. Warshak
Excellent book on fighting the parental alienation that is so commonly inflicted upon children by BPD parents. This applies to hostile parents who don’t have BPD, also.
Understanding the Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship
by Christine Ann Lawson
Extensive discussion on variations in BPD among mothers with the illness and how they are likely to harm their children.
Take Back Your Life: Recovering from Cults and Abusive Relationships
by Janja Lalich
Tobias and Lalich spent a combined total of 24 years in “restrictive groups” (i.e., cults), and both are currently involved in providing post-cult counseling and therapy. This work also applies to recovering from relationships with BPs.
High Conflict People In Legal Disputes: Third Printing
by Bill Eddy
Excellent book for judges, lawyers, and litigants to help understand why some people are willing to harass with litigation and fight to the bitter end over even minor disputes. This book discusses all four DSM-IV Axis 2 Cluster B personality disorders.
Adult Children of Parental Alienation Syndrome: Breaking the Ties that Bind (Norton Professional Book)
by Amy J. Baker
PAS (Parental Alienation Syndrome) is a hotly debated topic. Whether it is a syndrome or not, parental alienation is real and does great damage to children and the targeted parent. This book delves into the adult aftermath of parental alienation.
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