Borderline Personality Disorder

DSM CRITERIA

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:

• 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.

• Markedly and persistently unstable self-image or sense of self.

• Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating).

• Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.

• Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

• Chronic feelings of emptiness.

• Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, or recurrent physical fights).

• Transient, stress-related paranoid ideation or severe dissociative symptoms.

CHARACTERISTICS

Behavioural

People with Borderline Personality Disorder have unusual levels of energy caused by unexpected bursts of impulsivity. They also have intense and chaotic relationships that lead to paradoxical behaviours that, despite seeking attention and affection, they do so in a contrary and manipulative way, causing rejection from others. This is extremely difficult for them since they are excessively dependant on others, which is why they frequently assume behaviours aimed at protecting themselves from separation.

Their social adaptation is superficial because they actually provoke fights and conflicts frequently and have recurrent behaviours of self-mutilation or suicide, as well as frequent emotional blackmail and acts of irresponsibility (suicide, pathological gambling, abuse of psychoactive substances, big binges on food).

Cognitive

They have a lower capacity to process information due to their problems focusing attention and the consequent loss of relevant data. Due to this inability to keep their thought processes stable, their lack of purpose to stabilize their attitudes or emotions and instability in setting long-term goals or values ​​is characteristic. They get bored easily.

They maintain frequent self-reproaches, self-punishment, and self-criticism. And, they also have rigid, inflexible, impulsive thinking and a low tolerance for frustration and serious difficulties in learning from past experiences.

Their perception of important people in their environment fluctuates rapidly from idealization to devaluation. They generally blame others when things go wrong. They have these traits - fluctuating thoughts and ambivalent attitudes - towards others and towards themselves. They live with unstable and extreme images of themselves, lacking a stable sense of who they are.

They are characterized by holding anticipatory thoughts of abandonment, and this constant prediction of such abandonment by someone they love leads them to express anxiety, guilt, depression, and hostility. They have an inordinate fear of being looked down upon and a terrifying feeling about loneliness.

Emotional

They have affective instability due to a notable reactivity of the state of mind, and they can experience a very high emotional activation, being very sensitive to negative emotional stimuli. These conflicting emotions range from feelings of emptiness or boredom to feelings of shame, intense hatred, or self-directed anger.

Such intense, inappropriate, and easily triggered anger — involving a loss of emotional control — occurs, especially when frustrated or disappointed. During this loss of control, they show high physical agitation and arousal. Another characteristic is that his state of mind does not match reality.