The Nine Personality Problems Associated With Borderline Personality Disorder (BPD) :
There is no clear demarcation between those who have borderline personality disorder (BPD) and those who do not ; this is because the personality problems that contribute to a BPD diagnosis lie on a continuum. I have described the symptoms of BPD in numerous other articles that I have previously published on this site, but, for the sake of convenience, will list them again :
- emotional instabilty
- chronic feelings of emptiness
- feelings of intense anger
- paranoid ideas and ‘dissociative’ symptoms
- suicidal behavior and self-harm
- fear of abandonment
- unstable relationships
- identity disturbance
Three Criteria That Contribute To A Diagnosis Of BPD :
According to DSM V (The Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition) an individual must display at least five of these symptoms to be diagnosed as suffering from BPD.
However, as implied above, an individual does not either have these personality problems or doesn’t have them – things are not that clear cut or black and white. So how is it decided whether or not each symptom is serious enough to count towards a diagnosis of BPD?
Essentially, it is a question of three considerations. For each of the above nine key symptoms, it is necessary to ask :
- Is the symptom chronic?
- Does the symptom cause the sufferer, or other people, significant problems?
- Does the symptom adversely affect multiple areas of the sufferer’s life?
Let’s briefly look at each of these in turn :
- CHRONIC – this means the symptoms are persistent and long-lasting. Signs of BPD often emerge during adolescence, and, in the absence of effective therapy (such as dialectical behavior therapy, or DBT), can endure for a lifetime (although often symptoms reduce in their level of intensity around about the time that the individual enters middle-age).
- CAUSES SIGNIFICANT PROBLEMS – problems may include extreme verbal aggression towards others at times of stress, impulsiveness, self-harm and highly unstable relationships.
- ADVERSE EFFECT ON MULTIPLE LIFE AREAS – this means the symptoms are pervasive and do not just adversely affect one isolated area of life but all, or most, areas, including friendships, relations with work colleagues, intimate relationships, finances (e.g. due to overspending or gambling), physical health (e.g. due to overeating, drinking and smoking excessively, addiction to other drugs, promiscuous, unsafe sex etc).
Essentially, the more of the above nine symptoms an individual has (as stated above, it is necessary to have a minimum of five to be diagnosed with BPD), and the more chronic, the more problematic and the more pervasive these symptoms are are, the more likely the individual is to be diagnosed with BPD.
However, diagnosis is not an exact science so there is always the possibility of unreliable diagnoses ; for example, person A may be diagnosed as having BPD by Dr X whereas person B may NOT be diagnosed as having BPD by the same doctor.
However, if both seek a second opinion from Dr Y, the diagnoses may be reversed (i.e person A is diagnosed as NOT having BPD whilst person B is diagnosed as having BPD. Of course, in the case of individuals suffering from particularly extreme (even within the context of the disorder) symptoms, diagnoses are likely to be more consistent and reliable.
David Hosier BSc Hons; MSc; PGDE(FAHE).