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The Basics of Personality Disorders
Borderline Personality Disorder (also know as Emotionally Unstable Personality Disorder or EUPD in some places) is one of ten Personality Disorders that are listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). To start off at the basics, a Personality Disorder is described as a clinical syndrome that typically has long-standing symptoms and considerably change how the individual interacts with the world. There are 10 Personality Disorders in total; Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, and Anankastic (obsessive-compulsive).
While each Personality Disorder has it’s specific traits, there are many times where it’s possible for an individual to have more than one Personality Disorder at a time. Each Personality Disorder can also lead to significant impairment which can lead to further problems such as anxiety and depression, along with eating disorders and much more. As such, many Personality Disorders can be difficult to diagnose and are still often misdiagnosed which leads to even further impairment for the individual.
History of Borderline Personality Disorder
Borderline Personality Disorder (or Emotionally Unstable Personality Disorder now in some areas) is a Personality Disorder which is often hard to diagnose and often is misdiagnosed or not diagnosed at all due to the negative stigma that surrounds it. BPD was so called because it was thought to lie on the borderline between neurotic disorders (such as anxiety) and psychotic disorders (such as schizophrenia and bipolar disorder). It has also been strongly debated for many years whether BPD/EUPD is a result of a childhood of abuse or if it all boils down to genetics. Borderline Personality Disorder is a relatively new addition to the DSM, having only been added in 1980 in the DSM-III.
- 1938: Adolph Stern lists most of the diagnosis criteria and calls the group of people affected “the border line group.”
- 1941: Gregory Zilboorg describes the disorder as a mild version of schizophrenia.
- 1942: Helene Deutsch defines a type of people dependant on others personalities as having “as-if personality.”
- 1940s: Robert Knight introduces ego psychology and describes patients as being in “borderline states.”
- 1967: Otto Kernberg defines boundaries between psychotic and neurotic, and he places “borderline personality” in the middle.
- 1968: Roy Grinker does the first research on borderline personality disorder.
- 1975: John Gunderson publishes research to help diagnose BPD.
- 1980: BPD is included in the DSM-III.
- 1993: Marsha Linehan introduces dialectal behavior therapy (DBT) as an effective treatment.
- 1994: DSM-IV is published, defining further the symptoms of BPD required for diagnosis.
- 2008: The U.S. House of Representatives declares May as the National Borderline Personality Disorder Awareness Month.
9 Criteria of Borderline Personality Disorder
There are 9 main criteria which an individual must meet for a long-standing period of time before being diagnosed with Borderline Personality Disorder. In many cases the individual being diagnosed hasn’t realized the long-standing patterns and might not realize why they are taking the actions they take, which is why being diagnosed properly from a mental health professional is so important.
- Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. Even something as innocuous as a loved one getting home late from work or going away for the weekend can trigger intense fear. This leads to frantic efforts to keep the other person close. You may beg, cling, start fights, jealously track your loved one’s movements, or even physically block the other person from leaving. Unfortunately, this behavior tends to have the opposite effect—driving others away.
- Unstable relationships. People with BPD tend to have relationships that are intense and short-lived. You may fall in love quickly, believing each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships either seem perfect or horrible, with nothing in between. Your lovers, friends, or family members may feel like they have emotional whiplash from your rapid swings between idealization and devaluation, anger, and hate.
- Unclear or unstable self-image. When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don’t have a clear idea of who you are or what you want in life. As a result, you may frequently change jobs, friends, lovers, religion, values, goals, and even sexual identity.
- Impulsive, self-destructive behaviors. If you have BPD, you may engage in harmful, sensation-seeking behaviors, especially when you’re upset. You may impulsively spend money you can’t afford, binge eat, drive recklessly, shoplift, engage in risky sex, or overdo it with drugs or alcohol. These risky behaviors may help you feel better in the moment, but they hurt you and those around you over the long-term.
- Self-harm. Suicidal behaviour and deliberate self-harm is common in people with BPD. Suicidal behavior includes thinking about suicide, making suicidal gestures or threats, or actually carrying out a suicide attempt. Self-harm includes all other attempts to hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.
- Extreme emotional swings. Unstable emotions and moods are common with BPD. One moment, you may feel happy, and the next, despondent. Little things that other people brush off can send you into an emotional tailspin. These mood swings are intense, but they tend to pass fairly quickly (unlike the emotional swings of depression or bipolar disorder), usually lasting just a few minutes or hours.
- Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there’s a hole or a void inside them. At the extreme, you may feel as if you’re “nothing” or “nobody.” This feeling is uncomfortable, so you may try to fill the hole with things like drugs, food, or sex. But nothing feels truly satisfying.
- Explosive anger. If you have BPD, you may struggle with intense anger and a short temper. You may also have trouble controlling yourself once the fuse is lit—yelling, throwing things, or becoming completely consumed by rage. It’s important to note that this anger isn’t always directed outwards. You may spend a lot of time being angry at yourself.
- Feeling suspicious or out of touch with reality. People with BPD often struggle with paranoia or suspicious thoughts about others’ motives. When under stress, you may even lose touch with reality—an experience known as dissociation. You may feel foggy, spaced out, or as if you’re outside your own body.