What is Borderline Personality Disorder?
This Complex Psychological Condition is Mysterious to Patients and Caregivers
Jun 7, 2009
“Borderline Personality Disorder (BPD), the most common personality disorder seen in clinical settings, is excruciatingly painful to live with–both for the sufferer and those closest to him,” say Jerold J. Kreisman, M.D., and Hal Straus in Sometimes I Act Crazy: Living With Borderline Personality Disorder (John Wiley & Sons, Inc., 2004). “Yet despite the prevalence of BPD, it may be the most misunderstood and underdiagnosed mental illness.”
It took psychiatrists quite a while to put any definition at all on this common condition which, according to the National Alliance on Mental Illness, affects between .07 to 2 percent of the general population.
“The term ‘borderline’ was first employed more than sixty years ago to describe patients who were on the border between psychotic and neurotic but could not be adequately classified as either," according to Kreisman and Straus.
“Finally, in 1980, the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) classified the BPD diagnosis, for the first time utilizing specific, descriptive symptoms.
“BPD shares several characteristics with other personality dysfunctions, especially histrionic, narcissistic, antisocial, schizotypal, and dependent personality disorders. However, the constellation of self-descructiveness, chronic feelings of emptiness, and desperate fears of abandonment distinguish BPD from these other character disorders," Straus and Kreisman explain.
Symptoms of BPDKreisman and Straus say the diagnosis as it appears in the DSM-IV-TR has general global acceptance and is based on nine criteria. An individual must exhibit five of nine symptoms to be diagnosed with BPD.
- Frantic efforts to avoid real or imagined abandonment
- 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, for example, spending, sex, substance abuse, reckless driving, or binge eating
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
- Affective (mood) instability and marked reactivity to environmental situations, for example, intense episodic depression, irritability, or anxiety usually lasting a few hours and rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger, for example, frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoia or severe dissociative symptoms (feelings of unreality)
“Mood changes [criteria 1, 6, 7, and 8] and impulsivity [criteria 4 and 5] are the most important factors in risk for suicide,” say Kreisman and Straus.
BPD responds best to ongoing, regular therapy with a psychologist or licensed social worker and professional counselor. The behaviours and mindset associated with BPD are long-standing, and it will take much effort to clear them away and build healthier ways to associate both with the world and with the self.
This set of criteria is a concerted effort by the psychiatric community to define a mysterious but real disorder that was misunderstood or simply ignored for many years. The hope for those with BPD, if they receive regular therapy, is that symptoms will abate over the years and they can at last make peace with their demons, or at the very least, come to a truce.
Other good books to learn more about this complex condition include Lost in the Mirror: An Inside Look at Borderline Personality Disorder (Taylor Trade Publishing, 1996, 2001) by Richard Moskovitz, M.D. and
Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD (Marlowe & Company, 2004) by Robert O. Friedel, M.D.
Sources
- National Alliance on Mental Illness
- National Institute of Mental Health
- Sometimes I Act Crazy: Living With Borderline Personality Disorder (John Wiley & Sons, Inc., 2004) by Jerold J. Kreisman, M.D., and Hal Straus
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