First a bit about personality disorders in general…
The Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5), published by the American Psychiatric Association in 2013, has identified ten personality disorders, along with three other “unspecified” categories of personality disorders.
A personality disorder is a pattern of “inner experience and behavior” that is significantly different from the person’s cultural expectations of behavior.
Individuals with personality disorders have major problems in at least two of the following categories: thinking, mood, relationships, or impulses. These problems typically start in adolescence or early adulthood and are evident in a wide range of areas in the person’s life. They tend to affect work, school and social functioning and impact the way a person cares for themselves.
A diagnosis of a personality disorder is usually only given after all other possibilities are ruled out, including other serious mental health diagnoses, substance abuse, or certain medical conditions.
Borderline Personality Disorder (BPD) is characterized by problems in relationships, self-image, mood and behavior and is noticeable in almost all areas of a person’s life. Individuals with BPD typically struggle with:
- Fears of abandonment (real or imagined) – they will frantically try to avoid the abandonment of others
- Unstable and intense relationships – they bounce back and forth between loving and hating people and typically experience a lot of “drama”
- Personal identity – they feel unstable and have a hard time figuring out who they are
- Impulsivity – they may have trouble with self-damaging behaviors that include sexual activity, substance abuse, risk-taking, binge-eating
- Suicidal ideation and behavior – a pattern of thinking about suicide, making suicidal gestures or threats, or self-harm
- Unstable mood – their moods can go up and down within hours or days, and they can be very reactive
- Feeling chronically empty inside
- Difficulty controlling anger
- Sometimes feeling extremely paranoid or “detached” from the world around them.
At least five or more of the above symptoms must be present to qualify for this diagnosis.
According to the National Education Alliance for Borderline Personality Disorder (NEA BPD), BPD affects about 14 million Americans (or 5.9% of adults) at some time in their life. 20% of patients admitted to psychiatric hospitals likely have BPD, and BPD affects about 10% of people in outpatient mental health treatment.
What if I think I have it?
If you think you might meet the criteria for BPD, you’re probably feeling some mixed emotions. On the one hand, it may be a relief. There’s a name for your struggles and other people have similar problems. It might be nice to know you’re not alone. On the other hand, figuring this out could bring more questions than answers. A BPD diagnosis is serious, and should not be made or taken lightly.
So what should you do if you think your symptoms may apply?
- Don’t assume it’s BPD before ruling out other possibilities. Other diagnoses, such as bipolar disorder or anxiety disorders can have similar symptoms. Additionally, many individuals who meet the criteria for BPD have significant trauma in their past. Once they work through the trauma, the problematic symptoms may improve. It is important to get an accurate diagnosis, because diagnosis informs treatment. An experienced mental health clinician can help sort this out (see #4).
- Track your symptoms. Keeping a mood/behavior log can be helpful. (Find one here.) It doesn’t have to be fancy. For 5-7 days, try keeping track of your habits: hours of sleep, exercise, and eating, as well as your mood throughout the day, making note of any triggers, strong emotional reactions, and behaviors. This can help you identify predictable patterns as well as provide valuable information for your mental health provider.
- Take care of yourself. We all need to do this, but for those who have chronic mental health conditions this is especially important. Sleeping (not too much, but enough), eating right, exercising, taking your meds and avoiding drugs and alcohol are essential for individuals with the symptoms of BPD, and can make the symptoms less intense.
- Seek professional help. Most importantly, do your due diligence and find a mental health professional who is familiar with this condition and who has experience treating it. (A good resource is the therapist listing at Psychology Today,where you can enter your zip code and filter results by interests and experience.) You will most likely need a team, which ideally would include an individual counselor, group therapy and a psychiatrist.
Borderline Personality Disorder can be a confusing and overwhelming condition, but symptoms can be managed. If I can answer any questions, please contact me here.