According to the American Psychiatric Association, Borderline Personality Disorder (BPD) is typified by an unstable or poorly developed self-image, rapidly changing personal goals, intense but unstable relationships colored with neediness due to real or imagined fear of abandonment and an impaired ability to recognize the needs and feeling of others.
Borderline Personality Disorder is associated with an increased likelihood of feeling slighted or insulted, impulsive behavior, increased risk-taking, and hostility.
The prevalence of BPD in the population is estimated to be between 1.6% and 5.9%. This disorder is seen more in females than in males as most of the people diagnosed are women (75%).
The 5th edition of the diagnostic and statistical manual of mental disorder has two sets of diagnostic criteria for Borderline Personality Disorder, the main diagnostic criteria, and the alternate diagnostic criteria.
Main Diagnostic Criteria
The following are used to make a diagnosis of Borderline Personality Disorder can be made for an individual when there are (5), or more of these symptoms are present in different environments or contexts:
- Distressed efforts to keep away from true or imagined abandonment.
- A form of unstable and extreme interpersonal relations described as alternating between extremes of devaluation and idealization.
- Identity disturbance: significantly and relentlessly unstable self-image.
- Impulsive behavioral patterns in at least two aspects that are possibly self-damaging (e.g., substance abuse, sex, spending, binge eating, or reckless driving).
- Recurring suicidal patterns, threats, gestures, or self-harming behavior.
- Affective instability because of a significant reactivity of mood (e.g., irritability, anxiety, or intense episodic dysphoria that typically lasts a few hours, rarely more than days)
- Chronic empty feelings.
- misplaced and intense anger or trouble controlling anger (e.g., always angry or often temperamental).
- Short-lived stress-related paranoid thoughts or extreme dissociative symptoms.
Alternative Diagnostic Criteria
It was noted by the American Psychiatric Association (APA) that the traditional set of diagnostic criteria for personality disorders had some shortcomings; for example, several people got multiple diagnoses of Personality Disorders, and sometimes, a person could be found to fit the criteria for up to four personality disorders.
To address the shortcomings in the traditional approach to diagnosing personality disorders, APA put forward an alternative method for the diagnosis of personality disorders.
The new approach to diagnosis is based on the thought that personality disorders arise from impairments in the elements of personality functioning and the pathological aspects of the big 5 personality traits.
Elements of personality functioning
For Borderline Personality Disorder to be diagnosed, there should be moderate or greater impairment in personality functioning, shown by difficulties in two or more of the elements of personality traits.
- Identity: people with BPD may have a poorly developed and unstable self-image. This is often evidenced by the symptoms such as persistent feelings of emptiness and brief episodes of delusions, especially under stress, e.g., that he or she has left his or her body. Such feelings could be disturbing and distressing to the individual.
- Self-direction: people with BPD tend to be very unstable when it comes to their plans. They tend to change goals and aspirations often. Sometimes, changing of their plans may result in switching careers, course of study, or area of specialization.
- Empathy: People with BPD often find it challenging to recognize the feelings and needs of others. They tend to be more prepared to believe that other people have an act towards them negatively. They, therefore, often get insulted or hurt easily.
- Intimacy: people with BPD often have very intense and unstable relationships. They often go from periods of extreme idealization of their partner to periods of the extreme devaluation of the same partner, depending on their perception of their partner leaving them.
Pathological Personality Traits
In addition to impairments in two of the elements of personality functioning, a person must have at least four of the following pathological personality traits, and at least one of the four must be impulsivity, risk-taking, or Hostility:
- Emotional lability: people with BPD may find that their emotional responses are more intense and out of proportion to the events to which they are reacting. Emotional lability is a feature of extreme neuroticism.
- Anxiousness: people with BPD might find that they experience intense feelings of nervousness, tenseness, and panic. They often experience this in response to stressful situations between them and those they are close to. Anxiousness is also one of the features of extreme neuroticism.
- Separation insecurity: people with BPD are often scared of being left alone by those close to them. This fear of rejection is often more than what is expected. This intense fear of separation is also a feature of extreme neuroticism.
- Depression: people with BPD sometimes feel down, miserable, and like nothing is right with the world. When they feel like this, they also get pessimistic about the future, and they consider suicide and might even attempt it. Depression is also a feature of extreme neuroticism.
- Impulsivity: people with BPD often act without much planning or thought. They tend to act in response to whatever happens around and to them. When they are exposed to high levels of stress, they may resort to self-harm. Impulsivity is a feature of very low levels of conscientiousness.
- Risk-taking: people with BPD may sometimes engage in potentially dangerous and risky activities without thought of the consequences on themselves. They can sometimes seem oblivious to the danger of some of their actions. This happens in a different area of life and different environments i.e., it is pervasive. Risk-taking behavior also signifies low levels of conscientiousness.
- Hostility: people with BPD may get inappropriately or excessively angry or irritable in response to perceived insults. This is often seen in several social contexts. Hostility is a feature of low levels of agreeableness.
Features Associated with BPD
The following features are associated with a borderline personality disorder but not diagnostic of it:
- Patterns of undermining themselves when a goal is about to be accomplished, such as leaving therapy just when therapy is working.
- Psychotic like symptoms for example; hallucinations
- Feeling more secure with pets and inanimate objects than humans
Borderline personality disorder could also be associated with other mental disorders like bipolar disorder, depression, substance abuse, eating disorders especially bulimia nervosa, post-traumatic stress disorder, attention – deficit hyperactivity disorder and other personality disorders.
Development and Course of BPD
Borderline Personality Disorder (BPD) often begins in early adulthood. Its symptoms are greatest in the young adult years, and they decrease as with advancing age.
Symptoms like self-harm and suicidal behavior reduce as age increases. While other symptoms like intense emotions, impulsively, and intense relationships are often for life.
People with BPD who go for treatment often show significant improvement within the first year of treatment. Studies suggest that after about ten years of treatment, about half of those diagnosed with BPD may no longer meet the criteria for Borderline Personality Disorder.
Borderline Personality Disorder BPD more common among first-degree relatives of those with the disorder than in the general population. The same is seen in relatives of people with Substance Use Disorder, Antisocial Personality Disorder, and Depressive or Bipolar Disorder.
Differentials of BPD
Borderline personality disorder BPD sometimes co-occurs with depressive or bipolar disorder. In situations like this, the individual must show clear symptoms of Borderline Personality Disorder outside of episodes of depressive or bipolar disorder.
Borderline Personality Disorder has symptoms similar to some other personality disorders.
- Histrionic Personality Disorder and Borderline Personality Disorder are both characterized by attention-seeking behavior. People with BPD may harm themselves and have intense emotional outbursts when they feel abandoned, while people with HPD would rather act dramatically to get attention.
- People with BPD and Schizotypal Disorder may have paranoid ideas. The ideas occur transiently in people with BPD and are often in response to stress, while these ideas are more constant in people with Schizotypal Personality D
- BPD, Paranoid Personality Disorder, and Narcissistic Personality Disorder are characterized by excessive anger out of proportion to the causal event. Both Paranoid Personality Disorder and Narcissistic Personality Disorders lack the self-harm that characterizes BPD.
- People with BPD and people with Antisocial Personality Disorder may be manipulative. People with Antisocial Personality Disorder are often manipulative to gain power, profit, or pleasure. In contrast, people with BPD are manipulative to gain more concern from their loved ones and caregivers.
- People with Dependent Personality Disorder and people with BPD may be excessively scared of abandonment. People with BPD often respond to this fear by anger outbursts, while people with Dependent Personality Disorder often respond with more submissiveness or the immediate seeking of replacement relationships.
BPD and Substance Use Disorders also have certain features in common. Substance Use Disorder is a differential of Borderline Personality Disorder.
If you are concerned that you or someone you care about might have a Borderline Personality Disorder, don’t worry. You could get further information with competent mental professionals at BetterHelp.
Diagnostic and Statistical Manual of mental disorders: DSM-5 (5th ed.). Washington [etc.]: American Psychiatric Publishing. 2013. pp. 645, 663–6.