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What is Borderline Personality Disorder (BPD)?
A borderline writes:
"Being a borderline feels like eternal hell. Nothing less. Pain, anger, confusion, hurt, never knowing how I'm gonna
feel from one minute to the next. Hurting because I hurt those who I love. Feeling misunderstood. Analyzing everything. Nothing
gives me pleasure. Once in a great while I will get "too happy" and then anxious because of that. Then I self-medicate
with alcohol. Then I physically hurt myself. Then I feel guilty because of that. Shame. Wanting to die but not being able
to kill myself because I'd feel too much guilt for those I'd hurt, and then feeling angry about that so I cut myself or O.D.
to make all the feelings go away. Stress!"
Therapists use a book called "Diagnostic and Statistical Manual" (DSM) to make mental health diagnoses. They've
outlined nine traits that borderlines seem to have in common; the presence of five or more of them may indicate BPD.
However, please note the following:
*Everyone has all these traits to a certain extent. Especially teenagers. These traits must be long-standing (lasting
years) and persistent. And they must be intense.
*Be very careful about diagnosing yourself or others. In fact, don't do it. Top researchers guide patients through several
days of testing before they make a diagnosis. Don't make your own diagnosis on the basis of a WWW site or a book!
*Many people who have BPD also have other concerns, such as depression, eating disorders, substance abuse —
even multiple personality disorder or attention deficit disorder. It can be difficult to isolate what is BPD and what might
be something else. Again, you need to talk to a qualified professional.
DSM-IV Definition of BPD
1. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
2. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered
in (5).
3. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization
and devaluation. This is called "splitting."
Following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10:
The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate
human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant coherent understanding
of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area....people are
idolized one day; totally devalued and dismissed the next.
Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely
unaware of one feeling state while in the other.
When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure
his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in
other to preserve the all-good image of the other person.
Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of
trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become
rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.
4. Identity disturbance: markedly and persistently unstable self-image or sense of self.
5. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless
driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
6. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
7. 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).
8. Chronic feelings of emptiness.
9. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent
physical fights).
10. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality,"
whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"),
or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually
of one's identity, with the rest of the world.
There is no "pure" BPD; it coexists with other illnesses. These are the most common. BPD may coexist with:
*Post traumatic stress disorder
*Mood disorders
*Panic/anxiety disorders
*Substance abuse (54% of BPs also have a problem with substance abuse)
*Gender identity disorder
*Attention deficit disorder
*Eating disorders
*Multiple personality disorder
*Obsessive-compulsive disorder
Statistics about BPD
BPs comprise:
*2% of the general population
*10% of all mental health outpatients
*20% of psychiatric inpatients
*75% of those diagnosed are women
*75% have been physically or sexually abused
People with BPD may have other attributes that are not part of the DSM-IV definition, but that researchers believe are common
to the disorder. Many of these may be related to sexual or physical abuse if the BP has experienced abuse earlier in life.
Pervasive Shame: Toxic shame is experienced as the all-pervasive sense that a person is flawed and defective as a
human being. It is no longer an emotion that signals limits; it is a state of being, a core identity. Toxic shame gives you
a sense of worthlessness, the feeling of being isolated, empty, and alone in a complete sense.
Substance abuse: BPD and substance abuse disorders often go hand in hand. Another study reported that about 23 percent
of borderline patients had a diagnosis of substance abuse. Borderline substance abusers are likely to abuse more than one
drug (a frequent combination is drug and alcohol abuse), are more likely to be depressed, have more frequent suicide attempts
and accidents, have less impulse control, and seem to have more antisocial tendencies. See http://www.actassociation.com/News/dialectical.htm.
Undefined Boundaries: People with BPD have difficulty with personal limits; both their own and those of others.
Control Issues: Borderlines may need to feel in control of other people because they feel so out of control with themselves.
In addition, they may be trying to make their own world more predictable and manageable. They may choose a lifestyle where
all choices are made for them, such as the military or a cult, or they may align themselves with abusive people who try to
control them through fear.
Lack of Object Constancy: When a person is lonely, most of us can soothe ourselves by remembering the love that others
have for us. This ability is known as object constancy. Some people with BPD, however, find it difficult to evoke an image
of a loved one to soothe them when they feel upset or anxious. If that person is not physically present, they don't exist
on an emotional level.
Interpersonal Sensitivity: Some BP's have the astute ability to identify and use social and nonverbal cues of others.
They can empathize well with others and often understand and respect how others feel, and they can use these skills to see
through others. Some BPs may continue to use these social antennae to uncover triggers and vulnerabilities.
Situational Competence: Some people with BPD are competent and in control in some situations. For example, many perform
very well at work and are high achievers. Many are very intelligent, creative, and artistic. This can be very confusing for
family members who don't understand why the person can act so assuredly in one situation and fall apart in another.
Een Nederlandse site over BPD
BPD-Central
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