Borderline Personality Disorder

Borderline personality disorder (BPD) is in Cluster B, but I didn't discuss it in my Cluster B post because I think BPD deserves a post of its own. People with BPD have high impulsivity, drastic mood swings, terror of abandonment, and extremely volatile relationships. Such individuals also have self-images that vary significantly from one moment to the next. 

Relationships with people with BPD can be very difficult, since these individuals have intense fear of being abandoned. They also have black-and-white thinking. Their loved ones tend to be either placed on an ivory tower or (with only small provocation) viewed a hateful, evil person. This is often seen in relationships with therapists, parents, and significant others. A person with BPD may feel an intense attachment to her therapist, to the point of crossing personal boundaries, and then feel abandoned and hateful when the therapist tries to set clearer boundaries. People with BPD often respond to environmental stimulus in extreme ways, not understanding or caring what the repercussions of their responses might be. In the example of the therapist, a patient who feels abandoned might become violent, verbally abusing the therapist or attacking her physically. 

People with BPD often self-harm, and make multiple attempts at suicide. Often, the attempts at suicide can be viewed as a manipulative attempt to get attention, though sometimes the suicide is completed. (After all, the more often someone attempts, the more likely it is that completion will eventually happen.) Patients with BPD can also experience psychotic or dissociative symptoms. They might have hallucinations or paranoia. 

BPD often occurs with other disorders - bipolar disorder is very common. I imagine this has a lot to do with the mood swings, impulsivity, and psychotic and dissociative symptoms. As I've said in previous posts, I have been diagnosed with both bipolar disorder II and BPD. I am still very skeptical of the BPD diagnosis, because all of my symptoms that fit in the BPD category can be explained by my bipolar disorder - and I don't have the characteristic difficulty with relationships and fear of abandonment which are so strongly associated with BPD. 

Another disorder that often occurs with BPD is PTSD. This is most likely because people with BPD have often gone through traumatic experiences such as sexual, physical, or emotional abuse as a child. 

In order to be diagnosed with BPD, an individual must have five or more of the following traits: 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 - 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 - intense dysphoria, irritability, or anxiety; 7) chronic feelings of emptiness; 8) inappropriate, intense anger or difficulty controlling anger; 9) transient, stress-related paranoid ideation or severe dissociative symptoms.

I have a former friend who has been diagnosed with BPD. She experienced most of these symptoms. One incident that really sticks out in my mind is that when we were going on a distance drive from city-to-city, we stopped at a truck stop along the way. She went into the bathroom, and I stepped into the book shop. When she found me she was frantic - she'd thought I'd abandoned her in the middle of nowhere and that she'd have no way of getting home. At the time I didn't understand the symptoms of BPD, and I was shocked at her attack. I mean, why on earth would I abandon her in the middle of nowhere? Especially for no reason at all? I told this story to a BPD guest speaker for our class. She laughed and said that her best friend will hop behind an aisle while shopping and she'll freak out and think he left her. Even though he's done this many times, she still freaks out every time. 

Unfortunately I lost my friend who had BPD. As I said, at the time I didn't understand BPD. She was having a particularly hard time with her mental illness at the same time that I was having a particularly hard time with my own. We got into fight after fight after fight. Then one day she invited me to a party. I refused - I was isolating because I was very depressed. She decided that I had decided to "friend dump" her and she friend dumped me first. I've made several attempts to rekindle the relationship, but it is unfortunately dead. 

That brings me to a point that I think is very important. BPD is highly stigmatized in our society. It's even highly stigmatized among mental health workers - many of whom won't take more than one BPD patient at a time. There are people who'll say you should never be friends with someone who had BPD. I think this stigma is tragic. Every person with BPD that I have met was a wonderful person despite their problems. By understanding the symptoms of BPD, and by talking to them about how we should respond when the affected person is in a "mood," we can have a healthy and wonderful relationship with someone who has BPD. 


This is a series of posts summarizing what I'm learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher's textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness - Biology
Contemporary Viewpoints on Treating Mental Illness - Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome - The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression - an Overview
Personality Disorders - Clusters and Dimensions
Personality Disorders - Cluster A
Personality Disorders - Cluster B
Personality Disorders - Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria - Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder - The Basics
Suicide - An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 10: Personality Disorders. Abnormal Psychology, sixteenth edition (pp. 328-366). Pearson Education Inc.