What is BPD?
So, what is Borderline Personality Disorder anyway?
According to the #DSM (The Diagnostic and Statistical Manual of Mental Disorders (DSM), Borderline Personality Disorder is "a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts.” Diagnosed in those with 5 or more of the following symptoms:
Frantic efforts to avoid real or imagined abandonment. - A borderline has an extreme fear of abandonment, which can be real or perceived. This could be someone leaving their life for good, or something as simple as emotional dismissal. Leading them to believe the person doesn't truly care for them and will inevitably leave sooner or later.
A pattern of unstable and intense interpersonal relationships, characterized by extremes between idealization and devaluation. - This can be an intimate relationship, immediate family, close friends, co-workers, etc. New relationships start out passionately but then start to roller coaster from one extreme to another. A person with #BPD generally sees things as either "all good" or "all bad," with no middle ground. They often swing from extreme love and idealization to extreme dislike or devaluation. This can be with a new lover, friend, or even job. This is known as #Splitting. (See: What is Splitting in BPD)
Identity disturbance with markedly or persistently unstable self-image or sense of self. - This is a distorted and unstable self-image or sense of self. Things like goals, behavior, and beliefs can change frequently. It's a constant, often subconscious feeling of not knowing who you are. There's a general discontentment of not knowing how to live because they don't really know what they even like.
Impulsive behavior in at least two areas that are potentially self-damaging (ex. spending, sex, substance abuse, reckless driving, etc.) - A person with #BorderlinePersonalityDisorder has a tendency to act this way as a way to relieve whatever the emotion is that's overwhelming them at the time. It only serves as a bandaid though, and they are left picking up the pieces of their impulsive behavior after each episode.
Recurrent suicidal threats or behavior, or self-harming behavior. - often shown through behaviors like cutting. This generally isn't a suicide attempt, but more an attempt to physically "let out" their internal pain. #Suicide attempts can sometimes be a cry for help but can be extremely dangerous as many have actually died not intending to. However, often it's not a cry for help, but that they don't actually see that there's any other option to cure the constant pain they are in.
Emotional instability in everyday life (ex. intense sadness, irritability, or anxiety generally lasting a few hours, and less often, up to a few days) - Defined as the tendency to experience rapid and intense mood swings that are difficult to control. Moods fluctuate intensely, and go from one extreme to another, triggered by things around them, or moments in a conversation. It's very hard to tell what the next trigger will be, as the person with #BPD often doesn't even realize what their triggers are.
Chronic feelings of emptiness - This is experienced as a feeling of numbness and "nothingness" so to speak. It's a feeling of disconnection from both self and others. It's also associated with feelings of purposelessness and unfulfillment. Like, "there's nothing inside me, I'm a hollow shell." A person with #BPD will try to fill the empty space with other things, such as another person, purchases, etc. They have a need to feel whole and look to the world to complete them.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) - This usually involves screaming and yelling, but it can sometimes even get physical. It can be sudden and very intense, and it leaves those close to them on edge, "walking on eggshells" all the time. The person with #BorderlinePersonalityDisorder doesn't enjoy acting this way anymore that the people around them enjoy being around it.
Transient, stress-related paranoid ideation or severe dissociative symptoms. - This is a feeling of extreme paranoia that everyone, even those they think they are close to, are out to get them, or conspiring against them in some way. They have difficulty trusting due to fear of people's intentions, hear negative voices, and can even be seen as psychotic and delusional.
For more on these see: 9 Symptoms of BPD
Diagnosis of Borderline Personality Disorder can be done by a licensed mental health specialist and the process includes a thorough interview of the patient, research on previous medical evaluations, and sometimes even talking with the individual's friends and family.
#BorderlinePersonalityDisorder is classified as a"Chronic" disorder. Which in regards to illness, means persisting for a long time or constantly recurring.
DSM symptom criteria was developed by a team of psychologists and psychiatrists considered to be experts in BPD. It's based on the best research available at the time, however, the symptom criteria may be refined if new research findings ever call for it. The latest version of the DSM was released in 2013, and the criteria for Borderline Personality Disorder remained the same in it as it did in the previous version.
According to the American Psychiatric Association (#APA), Borderline Personality Disorder is nearly that of #Schizophrenia and #BiPolar Disorder combined.
BPD is estimated to affect about 1.4% of the United States adult population. That's a little over 4.5 million people in just the U.S. and it appears to be on the rise.
Roughly 3 out of 4 of the individuals diagnosed with Borderline Personality Disorder are women. New research however is showing that men have been commonly misdiagnosed, leading it to seem like it's more prevalent in women when in reality it's about equal. BPD shares a lot of symptoms with other disorders, and men tend to be more on the internalized side when it comes to their emotions. So, they've commonly been diagnosed with depression, anxiety disorder, or PTSD instead.
History of BPD
Borderline Personality Disorder became officially diagnosable after being added to the DSM in 1980. However, this is far from when it started affecting people.
Progression of Borderline Personality diagnosis:
1938: Adolph Stern lists most of the diagnosis criteria and calls the group of people affected “the borderline group.”
1941: Gregory Zilboorg describes the disorder as a mild version of schizophrenia.
1942: Helene Deutsch defines a type of people dependent on others' personalities as having an “as-if personality.”
1940's: Robert Knight introduces ego psychology and describes patients as being in “borderline states.”
1967: Otto Kernberg defines boundaries between psychotic and neurotic, and places “borderline personality” in the middle.
1968: Roy Grinker does the first research on borderline personality disorder.
1975: John Gunderson publishes research to help diagnose BPD.
1980: BPD is included in the DSM-III.
1993: Marsha Linehan introduces Dialectal Behavior Therapy (DBT) as an effective treatment.
1994: DSM-IV is published, further defining the symptoms of BPD required for diagnosis.
2008: The U.S. House of Representatives declares May as the National Borderline Personality Disorder Awareness Month.
2013: DSM-V is published, criteria for Borderline Personality Disorder remains the same.
Current: Research continues
Before being fully recognized as its own disorder, BPD was thought of as a sort of catchall for those who didn't fall into the categories set for other disorders. Such as bipolar, depression, schizophrenia, or anxiety disorder. It was thought to exist on the border between psychotic and neurotic behavior. Leading to a name most can agree is not very fitting for a disorder that affects emotions, moods, and relationships. I myself didn't even understand my own diagnosis in my early adult years due to the misleading name. However, it does commonly overlap with other disorders. In fact, 85% of those diagnosed with #BPD have a comorbid disorder. The wide range of symptoms, which can vary from person to person, serve to further complicate the diagnosis.
Unfortunately, #BPD is a rather common disorder; with over 3 million cases each year, in the United States alone.
Even after being defined, Borderline Personality Disorder carried a negative stigma that it was untreatable and those diagnosed with it are often viewed very negatively for it.
There are many myths that still exist about the treatment of BPD and the diagnosis itself. Most notably that it's untreatable. While the treatment itself may be in-depth, the notion that it's untreatable is simply not true.
DBT therapy holds the title for the most success with BPD patients.
For more information see: What is DBT Therapy?
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