Up and Down in Life


Borderline Personality Disorder (BPD) is a complex and serious mental illness that is frequently underdiagnosed or misdiagnosed.

The DSM IV-TR criteria for BPD includes:

  1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-injuring behavior covered in Criterion 5]
  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., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-injuring behavior covered in Criterion 5]
  5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
  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, worthlessness.
  8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.

A patient must exhibit at least 5 of the 9 criteria over a significant period of time to meet criteria for BPD.

It is important to note that BPD is highly treatable given compassionate, evidence-based treatment, support from family and friends who are educated about BPD, and patient education about borderline personality disorder.

“The borderline individual is faced with an apparently irreconcilable dilemma.  On the one hand, she has tremendous difficulties with self-regulation of affect and subsequent behavioral competence.  She frequently but somewhat unpredictably needs a great deal of assistance, often feels helpless and hopeless, and is afraid of being left alone to fend for herself in a world where she has failed over and over again.  Without the ability to predict and control her own well-being, she depends on her social environment to regulate her affect and her behavior.  On the other hand, she experiences intense shame at behaving dependently in a society that cannot tolerate dependency, and has learned to inhibit expressions of negative affect and helplessness whenever the affect is within controllable limits.  Indeed, when in a positive mood, she may be exceptionally competent across a variety of situations.  However, in the positive mood state she has difficulty predicting her own behavioral capabilities in a different mood, and thus communicates to others an ability to cope beyond her capabilities.  Thus, the borderline individual, even though at times desperate for help, has great difficulty asking for help appropriately or communicating her needs.” — Marsha Linehan, PhD

Quoted From Source:  Florida Borderline Personality Disorder Association

Recommended books:

  • Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship. Shari Y. Manning, PhD
  • Skills Training Manual for Treating Borderline Personality Disorder. Marsha M Linehan, PhD

Featured image Source: Up and Down in Life on a Rollercoaster

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