Borderline Personality Disorder

Dialectical Behavior Therapy

Attention:　

Psychologists in Japan cannot diagnose individuals for mental health disorders. Self diagnosis is very dangerous, too.

The purpose of this page is not to give you a diagnostic tool, but to help you decide on the next step that you may want to take.

For a formal diagnosis, please visit a psychiatrist near you.

9 criteria for Borderline Personality Disorder by DSM-V

Were you told by your loved one that you might have borderline personality disorder? Do you feel that way yourself?

You must be very disturbed in this very moment not knowing what is happening to you.

Diagnostic and Statistical Manual of Mental Disorder Fifth Edition (DSM-V) issued by American Psychiatric Association posits nine criteria for the diagnosis of borderline personality disorder.

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., spending, sex, substance abuse, reckless driving, binge eating.)
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.

How DBT organizes the symptoms

Borderling Personality Disorder (BPD), Dr. Linehan says, is one of the most stigmatized disorders as individuals are seen to be all over the place manipulating people around them. On the contrary, Dr. Linehan sees BPD symptoms as skills deficit rather than intentional misbehaviors. In other words, individuals do not know how to conduct themselves in any other way in given moment. From the consept of skills deficit, Dr. Lihenan reorganized the DSM criteria into 5 areas of dysregulations.

Emotion dysregulation: High sensitivity to stimuli, high intesnsity of emotional expression, and slow come back to the emotional base. (1,6,8)
Bahavior dysregulation: Impulsivity to highly riskly or undesirable behaviors (including self-harm) on one hand (1,4,8), and avoidance of painful experience on the other (9)
Cognitive dysregulation: Polarization of thoughts such as black and white thinking, inflexibility, paranoia, or disociative responses (9). Often suicidal ideation (5).
Interpersonal dysregulation: Chaotic relationship with someone very close to them on the one hand, and the fear of abandonment on the other (2).
Self dysregulation: Difficulty dealing with a fragile image of self and rigid self-imposed rules (such as perfectionism) that goes with the image (3,7).

Disorder of Polarizaton

Individuals with borderline personality disorder can look very contradictory to the eyes of others. If all behaviors are on the spectrum, they demonstrate both extremes of the spectrum. They choose to act one extreme way or the other without being able to take the middle path or to tolerate the contraditions. Following are some examples of polarized behaviors.

They are over taken by emotions, or they are too logical and cold. Individuals with BPD have high sensitivity to stimuli. Anything and everything in their environment can trigger their emotional reaction. They are particularly sensitive to perceived expectations and evaluations from others. For them, the intesnsity of their emotional response is congruent to the intensity of the event. Yet people tell them that they are over reacting, having paranoia, or being difficult. They feel like they are living a parallel reality because no one understands their reactions. Over time, they lose confidence in their perceptions of reality and start feeling ashamed of their emotions, which leads to self-criticism. They scan how other people react to an event, and they wonder why their reaction is so different from that of others. And they flip. As they lose confidence in their emotions, they reosort completely to reasons and idealization. Once in that space, they place impossibly high expectations on themselves in all aspects and do not accept anything but perfection.

They feel so competent at work/school, and so helpless in a close relationship. When their mood is stable, they behave without any traits of BPD. They might be considered as excellent employees at work. They can be thanked for helping others solve their problems . In the therapy, they can show complete understanding of new skills learnt. At the same time, in the hight of emotional crisis, individuals with BPD tell others that they are helpless and they can't solve their problems. They overly depend on others and demand solutions from them. If people don't respond, they magnify the problem so that it is taken seriously. This is probably why individuals with BPD are seen as manipulative and have difficulty staying in an close relationship. Their apparent competence in some areas of life disguises the magnitude of their problems, which they only show to the close family members, partners and friends.

They are in unrelenting daily crises while not facing deep grief. Because of the emotional volunerability, individuals with BPD get triggered by what seems to be meaningless event to others. Because it happens so often, they cannot recover fully from one crisis before the next one hits. They then use maladaptive solutions to call for help such as self-harm, suicidal communication, anger outburst, etc. Deep in their soul, on the other hand, they often have "unprocessed" traumatic emotional experiences. They avoid the cues related to that specific experience by all means because they can't tolerate reliving the experience. These unresolved traumatic events accumulate, and contribute to their very fragile self image. In a way, attending to daily crises compensates for not dealing with the trauma.

But aren't we all like that sometimes?

Going back to DSM-V, personality traits are patterns of perceiving, relating to, and thinking about the environment and onself. So, all of us can feel and act like what is described above sometimes in life without having borderline personality disorder. Only when similar patterns started showing up before early adulthood, and when these patterns are inflexible, deviate markedly from the expectations of one's culture, are demonstrated in many social situations, and are causing significant social distress in you and people around you, it is diagnosed as disorder. Personality change can occur in the course of psychotic disorders, anxiety, depression, PTSD, accute stress disorder, substance use disorders or due to another medical condition such as stroke. Behavior traits might be also due to developmental disorders such as autism and ADHD. So, please do not jump to conclusion that you have borderline personality disorder just because you can relate to the behaviors described above. Seek help from a psychiatrist to diagnose you properly if "wondering" is adding to your distress.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Linehan, M. (1993). Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

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