Borderline Personality Disorder

Dialectical Behavior Therapy

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. 

 

Attention: 

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

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

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

9 criteria for Borderline Personality Disorder by DSM-V 

Diagnostic and Statistical Manual of Mental Disorder Fifth Edition (DSM-V) issued by American Psychiatric Association posits nine criteria. 

  1. Frantic efforts to avoid real or imagined abandonment. 

  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremees of idealization and devaluation. 

  3. Identity disturbance: markedly and persistently unstable self-image of sense of self. 

  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, recless driving, binge eating.) 

  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 

  6. 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.) 

  7. Chronic feelings of emptiness. 

  8. Inappropriate, intense anger or dfificulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights.) 

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

 

How DBT organizes the symptoms

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. And yet, Dr. Linehan sees BPD symptoms as skills deficit.  Their behaviors are far from manipulation because they have no intention to do so. They really do not know how to conduct themselves in any other way.  Dr. Lihenan reorganized the DSM criteria into 5 areas of dysregulations and deficits. 

  • 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 you 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 very extreme of both ends of the spectram.  This is why Dr. Lihenan calls BPD symptoms as dialectical failure.  (Dialectical means going the middle path.) 

  • Emotional Vulnerability - Self Invalidation :  Individuals with borderline personality disorder 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 them. Over time, they lose confidence in their perceptions and emotions and start feeling ashamed of their emotions and they become totally self-critical.  To survive in the reality that they don't understand, they learn to scan how other people react to an event.  Often they label themselves incapable and tell themselves that they are useless becuase they just can't behave like everyone else.  As they lose confidence in their emotions, they reosrt to reasons.  They might place impossibly high expectations on themselves in all aspects and do not accept anything but the best and perfect.  They can sometimes look as if they are over taken by emotions, and at other times, they appear emotionaless, overly logical person.  

  • Active Passivity - Apparent Competence:  In the hight of emotional crisis with people who are close to them, Individuals with borderline personality disorder act and tell people around them that they are helpless and they can't solve their problems. They overly depend on others and demand solutions from them. To do so, they magnifies the problem so that it is taken seriously.  This is probably why they are seen as manipulative and have difficulty staying in an intimate relationship.  They can be, on the other hand, very competent in some areas.  They might be considered as an excellent employee at work.  They can be thanked for helping others solve their problems . When their mood is stable, they can behave differently.  In the therapy, they can show complete understanding of new skills learnt (apparent competence), yet they say it is impossible to apply them outside of therapy (active passivity).  Their apparent competence can disguise the magnitude of  their problems.  

  • Unrelenting crises  - Inhibited Grieving:   Because of the emotional volunerability, crises keep happening to the individuals with borderline personality disorder.  It is a vicious cycle of them getting triggered by what seems to be non meaningful event to others, them not being able to recover fully from one crisis before the next one hits, and them applying maladaptive solutions such as self-harm, suicidal communication,  anger outburst, etc., eliciting negative reaction from others.   While they are controlled by emotions at the time of crises (which is short-term by default), deep in their soul, they are extremely afraid of emotions.  They often have "unprocessed" traumatic emotional experiences and they avoid by all means the cues related to that specific experience.  In a way they are grief phobic because they can't tolerate the process.  These unresolved traumatic events accumulate, and contribute to their very fragile self image that they have.    

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 a 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 changes can occur in the corse 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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