Guest Author - Karen Huber
Borderline personality disorder is a mental illness characterized by instability of emotions, relationships, life goals, and uncertain self-identity. Borderline personalities are frequently impulsive, display anger, do not like to be alone, and can engage in self-injury, such as wrist cutting, bulimia, and drug overdosing. While specific causes of the illness are unknown, genetic and social factors are influential in its development. Risk factors include poor family life, childhood abandonment, and sexual abuse. Borderline personality disorder occurs more in young women and is more common than bipolar disorder, with which it shares many symptoms.
Borderline personalities are extremely sensitive to rejection and do not control their emotions. They are prone to mood swings and other disorders, like depression, anxiety disorders, and negative self-image issues. In addition to being unable to express feelings clearly, borderline personalities are obsessed with controlling their feelings and dependent on their perceptions of other people's wishes. They do not trust others or themselves, feel powerless, worthless, and unable to discipline themselves; can experience periods of “blackouts,” and perceive their surroundings surreal or unfamiliar. Family or friends of these personalities often see a different picture of their actions. They see someone who is manipulative, accusing, angry, and feel like they have to be extremely careful about their actions with this person. Borderline personality disorder is often confused with bipolar disorder for these similarities.
There must be five symptoms present for a diagnosis of borderline personality disorder within the DSM-IV guidelines. They include:
“1. frantic efforts to avoid real or imagined abandonment.
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. identity disturbance: markedly and persistently unstable self-image or sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. 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).
7. chronic feelings of emptiness.
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. transient, stress-related paranoid ideation or severe dissociative symptoms.”1
Diagnostic methods for borderline personality is observation, examination, and psychological tests, of which there are several. The Diagnostic Interview for Borderline Patients (DIB-R) is a well-known test with four areas of functioning: affect, cognition, impulse action patterns, and interpersonal relationships. The Structured Clinical Interview (SCID-II) has 12 groups of questions for each of the twelve personality disorders, and the Personality Disorder Beliefs Questionnaire (PDBQ) is a short, self-administered test. Other assessments tests the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD. Online, free tests are available at BpdFamily.com.
Treatment for borderline personality disorder consists of individual talk therapy, like cognitive, behavioral, and interpersonal therapies, and dialectical behavioral therapy, which involves discussion of weekly issues, recording them on diary cards, and following a treatment hierarchy. The second phase of dialectical behavioral therapy involves weekly group therapy to learn skills in four modules: core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Also helpful are drugs that deal with specific symptoms, such as antidepressant drugs and mood stabilizers, antipsychotic drugs.
1Patty Fleener, M.S.W. “Borderline Personality Disorder DSM IV Criteria.” BPD Today. http://www.borderlinepersonalitytoday.com/main/dsmiv.htm