What is borderline personality disorder?
Borderline personality disorder (BPD) is characterised by:
- marked instability in functioning,
- affect,
- mood,
- interpersonal relationships,
- and, at times, reality testing.
BPD is associated with significant morbidity due to common comorbid conditions, including:
- dysthymia (long-standing, low-grade depression),
- major depression,
- substance abuse,
- and psychotic disorders.
Approximately 70-75% of patients with BPD have a history of at least one deliberate act of self-harm, and the mean estimated rate of completed suicides is 9%.
How do I know if someone has BPD?
BPD is a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterised by extremes between idealisation and devaluation (also known as "splitting")
- Identity disturbance: Markedly or persistently unstable self-image or sense of self
- Impulsive behaviour in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behaviour, gestures, or threats, or self-harming behaviour
- Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, 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 (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms
A team of psychologists and psychiatrists, who are considered experts in BPD, developed the DSM symptom criteria. Many of the workgroup members are considered preeminent BPD researchers and work directly with BPD patients. The symptom criteria were established based on the best research available. However, it is important to keep in mind that the symptom criteria may be refined as new research comes out.
There are a number of psychological disorders and medical problems that can cause symptoms very similar to those associated with BPD. For this reason, it is important to see a clinician who can listen to your concerns, conduct a thorough assessment, and make an accurate diagnosis.
How do doctors diagnose BPD?
A complete assessment for BPD may include several components. Your therapist or doctor may ask you to participate in an interview, during which they will ask you questions about your symptoms, physical health, and past and present life situation. He or she may also ask you to fill out a written questionnaire about BPD symptoms.
Finally, if you are willing, your clinician may ask to talk to family or loved ones to get complete information on the ways that your symptoms are affecting you.
