When the topic of Borderline Personality Disorder (BPD) comes up, you’ll probably hear the conversation focusing on the issue of anger and rage. Indeed, people who suffer from BPD often struggle with explosive emotional flare-ups. Those episodes capture everyone’s attention.

Other symptoms of BPD such as self-harm, impulsive actions, and unstable relationships stand out as well. However, people with BPD also suffer greatly from profound anxiety. Some people with BPD describe their anxiety as excruciatingly painful and debilitating. Quite often their anxiety centers on deep fears of abandonment. They believe that others will inevitably leave them and, once that happens, they will be left totally unable to cope.

America is still standing, and it looks like health care reform will eventually get past the latest hurdles. Whether or not you agree or disagree with what happened, everyone can agree that lots of people got pretty darn uptight. Actually, uptight is too tame of a word for what has been happening. Words like anger, rage, or temper tantrum describe the reactions better. The response to this bill has included racial slurs, name calling, personal insults, spitting, death threats, exaggerations of calamity, and a few acts of violence (such as breaking windows, throwing bricks, and cutting a gas line). These extreme behaviors seem more consistent with a bunch of middle-school kids gone wild than mature adults participating in a democratic process.

Just to let you know, this blog is not a venue for expressing political opinion. And both sides have some very legitimate perspectives. Our concern in this blog is mental health, not politics. So, let’s get to the point. Anger can be a very useful emotion. Anger is great when you’re being attacked by a bear. Anger allows you to gather your physical and mental resources to protect yourself or your family. Anger increases your heart rate so that you’re ready to run, pumps blood into the large muscles so that you’re more powerful, and narrows attention so that your focus is on the attacker.

People with social anxiety (technically called social phobia) fear public speaking, being assertive, going to parties, meeting new people, speaking up to authority figures (like a teacher or boss), eating in public, or similar situations in which they believe that others may evaluate or scrutinize them. Anxiety in those with social phobia usually includes physical symptoms such as sweating, rapid heart rate, upset stomach, flushed face, and shakiness. The prominent emotions are fear and dread. The difference between shyness and social phobia is one of degree—those with social anxiety have a very very bad case of shyness that leads to severe limitations in life.

For example, a man who fears public speaking might believe that his voice will give out, he’ll forget his lines, he’ll not be able to answer questions, people will laugh at him, or he will be so frightened that he’ll lose control and run off stage. A woman with concerns about meeting other people may be afraid that when she speaks her voice will shake, that others will reject her, or that she might embarrass herself by saying something inappropriate. People with social phobia believe that they will certainly be humiliated, embarrassed, or shown to be inadequate. It’s no wonder that those with social anxiety tend to withdraw from others. And the more they withdraw, the more anxiety wins control.

Obsessions are unwanted thoughts, images or impulses (such as that doorknob is contaminated or I think I might have left the stove on). Compulsions are the rituals or actions that a person performs in order to reduce the feelings of anxiety or distress caused by the obsession (like washing hands repeatedly, or checking to be sure the stove is off over and over again). People with OCD suffer. They often have trouble getting through day to day responsibilities, keeping healthy relationships, or enjoying life.

Our best friends, dogs, can also suffer from OCD. The cause of OCD in animals, like people, is thought to involve genetics, environments, and sometimes illness. A dog with OCD may be genetically predisposed to the disorder. The pet could be stressed by separation anxiety, or bored. Occasionally, an illness can cause an animal to show signs of OCD. Pets with OCD show repetitive behaviors that seem to have no purpose. These behaviors can lead to infections, poisonings, obstructions, and very annoyed owners. Most animals do these things from time to time (especially when young, bored or anxious). But dogs with OCD do these behaviors over and over and over again. Common OCD behaviors include:

• Tail chasing
• Licking
• Scratching
• Barking at nothing
• Running after lights or shadows
• Eating or chewing (after puppyhood)

It’s tax time. Our accountant called to ask for another piece of paper. The regular drawer in which I stow stuff to do with mortgages is stuffed with large folders from various mortgage and title companies that we have dealt with over the last decade. Couldn’t find the paper—took out everything and slowly sorted through each folder—thinking that maybe the paper got stuck in with another stack. Anxiety starts to build.

I start looking in another drawer, another filing system. This one contains recently paid bills, car insurance, health records, and stuff like that. Thought maybe that paper would be in with the mortgage payments—no paper. Although I am quite aware that I could call the title company and get another copy, this quest is getting too important. By now, my heart rate has increased and my mind is quickly filling with obsessional thoughts: “What if I die and my kids have to sort through this mess?” and “What’s wrong with me that I can’t remember where I put that paper?” Then, “Am I getting early dementia?” Finally, “If I make it though this, I vow to get better organized!”

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV), a book that defines and describes the symptoms of emotional problems, has been in the revision process for years. Health professionals (and insurance companies) routinely use the manual to guide diagnosis and treatment. Recently, considerable attention has been given to the proposed changes in preparation for the fifth edition of the book (to be released in 2013). The possible changes to the section on personality disorders will certainly generate much discussion and controversy.