What comes to mind when you hear the term Borderline Personality Disorder? For many people who are unfamiliar with the disorder, split personality is often a common misconception. Split personality refers to a personality that is not always one way, but often changes in intensity and duration in such a way that it is impossible to predict when the person will switch up. Borderline Personality Disorder (BPD) is best described to the families of many of my child and adolescent clients as an emotional disorder characterized by impulsivity, intense emotions, intermittent anger outbursts, severe bouts with depression or anxiety, repeated suicidal ideation, and self-injurious or risky behaviors. As a therapist, I am often challenged with the duty of educating families, properly, to the symptoms most indicative of BPD. This article will discuss some of the most common symptoms and the symptoms you should aim to identify in someone you suspect might need therapeutic intervention.
Individuals with BPD tend to exhibit a pervasive pattern of unstable relationships with others (interpersonal difficulties leading to multiple emotional outbursts, let-downs, anger, and even suicidal thoughts), challenges with accepting self-image (self-esteem issues, distorted perceptions of self), marked labile affect (changes in mood that are extreme from one minute to the next), impulsivity (acting before thinking through decisions and considering the consequences), difficulty with perceived abandonment (unable to relax in relationships and be confident in the relationship’s permanency), and recurrent suicidal thoughts and gestures that often results in multiple hospitalizations and crisis intervention services. For families or friends coping with a loved one with BPD, it is very difficult to identity symptoms if the individual is personable, charming, intelligent, has authority in some fashion (government worker, mental health professional, etc.), or has achieved success in some way. Many suffering individuals, primarily adolescents who are rarely diagnosed with BPD, suffer until symptoms push the individual over the edge and ultimately to a psychiatric hospital.
According to the DSM-5, BPD is diagnosable when an individual exhibits 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
- Identity disturbance: markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood (e.g., 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 (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms
It is important to mention that individuals with BPD symptoms could also have what is called co-occurring disorders which include: Substance abuse disorder (alcohol dependency or abuse, PTSD symptoms, severe depression, or psychosis). Many of my young clients are not diagnosed with BPD but often exhibit BPD traits that will most likely result in a formal diagnosis by age 18. These kids are some of the most depressed and anxious, primarily because BPD-like symptoms result in emotional instability and it is difficult to cope with depression or anxiety while also coping with BPD. As a result, hospitals see more and more BPD clients for attempted suicide, risky behaviors leading to injury, psychotic symptoms (most often delusions), or substance abuse that has placed the individual in harms way (e.g., selling drugs on the corner and being raped for drugs, being influenced to prostitute for money or attention, etc.).
Some of the most common symptoms of BPD that families and friends of a loved one should look for include but are not limited to:
- Self-injurious behaviors: Sadly, SIB is one of the hallmarks of BPD. Many clients report that cutting is not done for attention but to “feel something again.” BPD, for some clients, drains their emotions and can result in feeling numb or as some of my kids report “unreal.” Individuals who dissociate (an occurrence similar to severe daydreaming) will cut themselves to “wake up” or feel motivated in some way. It is also important to mention that some SIB is used as an attempt to gain attention and most SIB’s for these individuals include minor injuries.
- Suicidal ideations: Suicidal thoughts are another hallmark of BPD. The emotional challenges, the unstable relationships, the fear, the uncertainty, the SIB, and pervasive feeling of abandonment or fear of abandonment often leads to suicidal thoughts. Suicidal thoughts are sometimes the only way sufferers can either express to others that they are truly hurting or their only way out of pain and chaos. It is not the best decision but sufferers often have tried multiple forms of therapy, medication, and crisis intervention that has failed them.
- Risky behaviors: Risky behaviors include having multiple sexual partners, using drugs and alcohol and becoming impaired, driving fast without adhering to rules, becoming irate in public or on their job, etc. Risky behaviors include behaviors that can result in some degree of harm.
- Multiple attempts at attention-seeking: Expressing passive death wishes (“I wish I were dead” or “the only choice for me is suicide”), engaging in SIB (e.g., SIB that only results in minor cuts or scratches), running away from home (e.g., in regards to children and adolescents), gambling large amounts of money, etc can all be related to an individual attempting to get the attention they emotionally crave. It is very disturbing to think that someone would go to the extreme for attention, but it has happened. You should be aware of it.
- Anger outbursts, aggression, intermittent emotional outbursts: Anger outbursts in public, on the road, or at work are not only embarrassing but detrimental. Many individuals who struggle with BPD can be overly reactive, emotional, fearing abandonment, and angry. If you observe any of these symptoms it is important to ask your loved one why they are becoming so angry and what you can do to help. For many sufferers of BPD, they are unaware of how their anger and emotional outbursts affect others.
Do you know someone suffering from BPD? Do any of these symptoms sound similar? If so, were you able to identify BPD? As always, I enjoy your comments and look forward to continuing our discussion of a very real and traumatizing diagnosis.
I wish you well
Clearview Women’s Center. (2016). Borderline Personality Disorder in DSM-V. Retrieved online 2/12/2016 from, https://www.clearviewwomenscenter.com/borderline-personality-disorder-dsm-v.html.
Psychologytoday. (2011). Borderline Personality Disorder: Big changes in the DSM-5. Retrieved online 2/11/2016 from, https://www.psychologytoday.com/blog/here-there-and-everywhere/201112/borderline-personality-disorder-big-changes-in-the-dsm-5.