Borderline Personality Disorder (BPD) - The Emotionally Unstable

Borderline Personality Disorder (BPD)

What Is Borderline Personality Disorder?

As with any personality disorder, Borderline Personality Disorder (BPD) can be extremely difficult to understand and to come to grips with. BPD can also have devastating effects on the family and friends of a person who suffers with the personality disorder.

Generally, those inflicted with Borderline Personality Disorder are extremely sensitive to the way that other people treat them and they may over-react whenever they perceive criticism or hurtfulness.

A Borderline personality's feelings about someone often shift suddenly from positive to negative within an instant, especially if they believe there is a risk of abandonment or loss.

However, this alone should not be taken as an indication of the disorder being present, as Borderline Personality Disorder goes a lot deeper than this.

What Are The Symptoms Of BPD?

Typically, the classic symptoms of a Borderline personality are unstable relationships, affective distress, impulsiveness and problems with an unstable self-image.

Borderline personalities often show extreme variability between anger, depression and anxiety and are extremely sensitive to any and all kinds of emotional stimulation.

The negative emotional states of a Borderline personality tend to fall into four categories: destructive/self-destructive feelings, fragmentation (lack of identity), feeling victimized and generally extreme emotions.

It's important to understand that Borderline personalities view the world as being hostile and full of dangers; living out in the big wide world is seen as being a risk. Borderline personalities may hide themselves away from the outside world in order to reduce this perceived risk factor.

Borderline Personality Disorder is also characterized by high levels of chronic stress, emotional abuse in relationships, dissatisfaction with relationship partners and even unwanted pregnancies; issues which are also often related to other personality disorders.

Impulsive behaviour is not uncommon for BPD's and can include alcohol/drug misuse, promiscuous/intense sexual behaviour, gambling and recklessness in general.

Whilst research indicates that BPD's can be novel, fun and that they have a high level of intimacy, studies also show that Borderline personalities are hyper-sensitive to signs of rejection and, in relationships, they often become insecure, preoccupied and/or avoidant at perceived external risk factors.

Borderline's tend to either idealize or demonize others, often switching between one or the other (Splitting). This undermines the relationships between friends, family and associates.

The most significant trait of the Borderline Personality Disorder is the process of self-harming.

In may cases, without the right treatment and the right diagnosis, self-harming can gradually worsen over time sometimes leading (in very extreme cases) to suicide.

However, self-harming is not always carried out with the intention of suicide although it is very common.

Why Do BPD's Self Harm?

Many BPD sufferers show mixed feelings about why they actually harm themselves, although most admit that they do not do it with the intention of suicide.

They most certainly do not do it for attention either - the self-harm is often carried out in private on a part of their body which will not be seen publicly.

Many reasons have been given for the act of self-harm including to help regulate internal memories, thoughts and emotions, to release anger, to slow down racing thoughts and to escape from emotional pain or periods of dissociation.

In terms of personal experience, many self-harmers seem to have an overwhelming sense of anger and frustration as a result of the underlying factors that contribute towards Borderline Personality Disorder.

They need to release this anger and frustration bit by bit to prevent it from sending them over the edge.

They cannot take these feelings out on other people, as other people may be innocent and ultimately other people do not deserve to be physically abused, therefore they take it out on themselves instead - it's their only release.

Borderline's care less about their physical self but are majorly concerned with their emotional self.

How Is BPD Diagnosed?

According to the DSM-IV-TR, there are a total of nine criteria, five of which must be present for an official diagnosis of Borderline Personality Disorder.

Although BPD was previously classed as a subset of Schizophrenia, BPD is now used more generally to explain emotional dysfunction and instability.

BPD is described as:

"a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
  5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
  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 anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms "

Whilst the onset of BPD (Borderline Personality Disorder) often occurs during adolescence, therapists are reluctant to offer an official diagnosis to a patient who is not yet eighteen years old.

The DSM-IV states "To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year."

What Causes BPD?

As with most personality disorders, the causes of the disorder are not fully understood.

However, it's not unusual for someone inflicted with BPD to have experienced abandonment, childhood trauma or abuse.

Other more diverse possibilities have also been suggested, such as genetic predisposition, brain abnormalities and neurobiological factors.

Many studies have shown a strong link between childhood sexual abuse and BPD. Incidentally, there have also been many reports of incest during the childhood of BPD sufferers.

Further research also shows how parents (of both genders) have often detached themselves emotionally during childhood and therefore the children's emotional needs had not been catered for sufficiently.

Rather interestingly, one study showed that if one identical twin was diagnosed with BPD the other twin also met the criteria in 35% of cases therefore many of the traits present in BPD could be influenced by genes.

Rather than having just one single cause, Borderline Personality Disorder (BPD) seems to be caused by a variety of different factors.

How Is BPD Treated?

Research shows that BPD is not affected significantly by any medication.

However, some medications were shown to subtly alter mood and help prevent the risk of suicide but the long term effects of these medications are still unknown and prescribing medication to BPD patients is not recommended.

Whilst there is a variety of treatment available for Borderline Personality Disorder, the disorder is not curable.

The most effective treatments for BPD to be analyzed so far are two forms of CBT (Cognitive Behavioural Therapy) - Dialectical Behaviour and Schema-focused - and two forms of Psychodynamic treatments - mentalization based and transference-focused.

By Sparkster

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Comments 17 comments

gsidley profile image

gsidley 4 years ago from Lancashire, England

A well-written, informative hub giving a useful overview of a common mental health problem.

Voted up. (Plus I'm your latest follower!)


mcleodgi profile image

mcleodgi 4 years ago

Thanks for speaking so informatively on this. After years of knowing her, I personally started to suspect that a mother of a now former friend of mine has it. She fits most of the symptoms you've described. The damage it did to my friend and her siblings (two of whom have moderate and severe autism) was incalculable. As a result, my friend and her siblings were some of the most confused people I'd ever met and genuinely very ignorant about how the real world really works. My friend, bless her, was trying to get out of the influence-the only bad part was that she started to act as if running in the dead opposite direction from where she was morally was the answer. Her mother basically hates anyone who's not Baptist or like her and from what my friend told me, she started to spew a bunch of vicious lies about me after I started coming out of the spiritual closet about practicing metaphysics. That I was supposedly poisoning my friend's mind being one of them. They're a very politically fundamentalist family.


sparkster profile image

sparkster 4 years ago from United Kingdom Author

Thanks for the comments. I've only ever known a couple of Borderline personalities, one of them was real bad and was given a real hard time over it. People would verbally assault and attack him over it yet he clearly had a lot of underlying problems that were extremely difficult for him to cope with.


nurseleah profile image

nurseleah 3 years ago from West Virginia

This is a truly well-informed article on borderline personality disorder. You are right on about the traits. I am glad you described the reasons people self-injure. Many folks believe it is purely for attention, and that most often is not the case. In the identical twin studies that you referenced, did you see any studies of brain scans of twins comparing one without borderline to one with borderline? I'm not aware of any, but if there are some studies like that, I would love to read them. Thank you for a great hub!


sparkster profile image

sparkster 3 years ago from United Kingdom Author

Hi nurseleah, thanks for your comment. It has been acknowledged that twins may have inherited similar traits during their upbringing, though MRI scans reveal that in many people with BPD the amygdala, hippocampus and oribtofrontal cortex of the brain were either smaller than expected, or unusually small. These parts of the brain are responsible for mood regulation and they are affected by early upbringing.


nurseleah profile image

nurseleah 3 years ago from West Virginia

Thank you for getting back to me on this, sparkster!


Ruby 2 years ago

My sister meets a lot of these traits, I suspect that she has either a narcissistic or borderline personality. I have never brought it up but she often can be needy, but then hates me and tells me to die - or outbursts of anger over little things another person would shrug about. My sister also has low self-esteem and gets extremely worried over silly situations. Never brought it up, but the hard thing is she is only 14. One minute she is nice and asks me to do something (eg make a cup of tea) and if I say no (for whatever reason) she becomes extremely mad and insults me. It's tricky.


ologsinquito profile image

ologsinquito 22 months ago from USA

You've described this very well. Now, on to read your article on covert narcissism.


Sarah Kessler profile image

Sarah Kessler 22 months ago from Seattle

It's important to remember that borderline is a form of post-traumatic stress disorder (like what soldiers have when they come back from war). Psychiatrists are even beginning to refer to borderline as CPTSD, or Complex Post-Traumatic Stress Disorder. Just like a loud noise can trigger a fight or flight response for someone who's been at war, something in a social interaction, like any indication of abandonment, can cause a nearly identical physiological response in someone with BPD. For this reason, many people with BPD are actually prescribed the same medication as veterans with great success. This is not a personality flaw, but rather a deep wound a person has from their past, that can be made worse by genetic factors.


sparkster profile image

sparkster 22 months ago from United Kingdom Author

Sarah, whilst you make valid points in that there are major similarities and overlaps in both BPD and c-PTSD and the treatments are often the same, there are also major distinct differences in each - psychiatrists do not refer to BPD as c-PTSD, they are two different conditions. Symptoms of BPD, such as fear and avoidance of abandonment, identity disturbance, and impulsive behaviour is what differentiates BPD from c-PTSD.


Sarah Kessler profile image

Sarah Kessler 22 months ago from Seattle

This is true, but the presence of these difference is up for debate. http://apt.rcpsych.org/content/15/3/172.full


sparkster profile image

sparkster 22 months ago from United Kingdom Author

I think you misunderstood the article you've posted a link to. The main symptoms of c-PTSD are characterized by fragmented identity/dissociation, dehumanization, flashbacks and nightmares and reliving traumatic experiences. Borderlines tend to suffer with unstable self-image (not dissociation), emotional instability and self-harming behaviour (cutting). Whilst there is an overlap where self-image/identity and trauma is concerned, people suffering with c-PTSD do not generally self-harm or resort to splitting (idealizing/demonizing others) or any other form of abuse that Borderlines usually perpetrate.

The article seems to document the links between the pathophysiology of PTSD and of attachment disorders, and associated symptoms present in Borderlines as a result of severe forms of abuse, with a view to researching better treatments for those with PTSD. The article implies that BPD and c-PTSD are extremely similar in terms of dissociation and identity (but not the same) but having known and worked with BPDs and having suffered with PTSD myself I find the explanations proposed highly exaggerated.

Of course, just as the symptoms of BPD can overlap with, or mimic, the symptoms of PTSD, BPD can also overlap (and often does) overlap with other personality disorders - Borderline Narcissism, for example, and this does also seem to have been touched upon in the article where it mentions lack of empathy (malignant narcissism) and lack of shame/guilt (anti-social personality/sociopathy). All personality disorders that exist can overlap with each other in such a way.


Sarah Kessler profile image

Sarah Kessler 22 months ago from Seattle

Not all people with BPD self-harm, and many people with the disorder suffer dissociation and depersonalization, including myself. Someone who is successful in recovery from borderline does not self-harm, but that would not change their diagnosis to c-PTSD. Giving or taking one or two symptoms cannot change the diagnosis unless the two are, in essence, fluid and interchangeable by nature. I've worked with psychiatrists who have spoken of the debate about whether or not the terms are identical because any one diagnosis could really go either way. For instance, mine could have been either one. Because there is no exact "test" to determine one disorder from another, and the symptoms of each of these specific disorders can be identical, the diagnosis is very subjective. A person's BPD can also lean more towards narcissism or more toward self-harm depending on the source of the trauma. Borderline is named "borderline" because it borders on many different psychological disorders.


sparkster profile image

sparkster 22 months ago from United Kingdom Author

"Someone who is successful in recovery from borderline does not self-harm, but that would not change their diagnosis to c-PTSD." - Exactly!

"Giving or taking one or two symptoms cannot change the diagnosis unless the two are, in essence, fluid and interchangeable" - Exactly!

"I've worked with psychiatrists who have spoken of the debate about whether or not the terms are identical because any one diagnosis could really go either way. For instance, mine could have been either one." - I've studied psychiatry (and psychology) for over 20 years and have never known or heard of this happening before, nor has it ever been mentioned to me or presented in any material. It seems to be a lot more common for BPD's to be misdiagnosed with Bi-Polar Disorder and vice versa.

"A person's BPD can also lean more towards narcissism or more toward self-harm depending on the source of the trauma." - Agreed.

"Borderline is named "borderline" because it borders on many different psychological disorders." - I would rephrase that: Borderline is named "borderline" because it borders on many different personality disorders.


sparkster profile image

sparkster 22 months ago from United Kingdom Author

* BPD is not always the result of trauma/abuse. It used to be classed as a subset of Schizophrenia but it is now used to describe emotional instability/dysfunction.


norm 2 months ago

I've got diagnosed borderline. I've also got c-PTSD. The borderline came from unconscious abuse. The c-PTSD from the shock of realizing all the shocking things abuse victims have to face. Borderline is a 'lifestyle', its always with me, it is me, it make me nervous. c-PTSD is a physically taxing dead weight that makes me depressed and slow, but jumpy in public beyond words. Borderline is only realtionships. c-PTSD is everybody and every thing I come into direct contact with. And for the record, I self-harm but never by cutting. I abuse stimulants in binges of a few days long. I believe its too tire me out physically and then to be 'reborn' as my dopamine returns to normal over the course of the rest of the week. A sense of self-control that I can't manage to achieve otherwise with any regularity. The highs aren't too bad a side-effect either. I sometimes feel borderline is me shifting from narcissism to psychopathy in oscillation. Its as if I feel "I must succeed!" and then "Ahh, who the hell cares." and back again. Finally, since I was diagnosed and started self-recovery online about two years ago I've made great strides on the emotional level (cognitive) with things such as splitting and patience, however I still lose it on minor physical 'annoyances' like loud noises and bright lights. In fact if I could reach out and strangle the sun to death out of the sky right now I would.


Breezy 5 days ago

Excellent, Sparkster!! One slight correction, if I may be so bold: new research is proving that BPD can be cured, and is not a life long, permanent disorder for everyone. :) PM me on FB, remind me to look up some links to studies. Marshugs!

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