Borderline Personality Disorder (often abbreviated as BPD) is presently classified as an Axis II, Cluster B personality disorder (though it is significant to note there are continually ongoing arguments between psychiatrists drafting the forthcoming DMS-V, as many believe BPD belongs to the mood disorders group instead), alongside major depression and bipolar). Its hallmark traits, according to the DSM-IV, are:
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:
- Frantic efforts to avoid real or imagined abandonment. [Note: Do not include suicidal or self-injuring behavior, which is covered in Criterion 5];
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation 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., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Do not include suicidal or self-injuring behavior. It is covered in #5.]
- Recurrent suicidal behavior, gestures, threats or self-injurious such as cutting, interfering with the healing of scars (excoriation) or picking at oneself;
- 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 anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights);
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.
Additionally, BPD is an immensely complex diagnosis where one size certainly does not fit all. According to Theodore Millon, a heralded psychologist known for his extensive and revolutionary work on personality disorders, identified four subtypes of BPD. Respectively, an individual with Borderline may exhibit none, one, or more of the following traits:
- Discouraged borderline: including avoidant, depressive, or dependent features
- Impulsive borderline: including histronic or antisocial features
- Petulant borderline: including negativistic (passive aggressive) features
- Self-destructive borderline: including depressive or masochistic features
As with the majority of behavioral health illness, the causes of Borderline Personality Disorder are complex and still not fully understood. In clinical studies, a very common thread is a history of childhood trauma, abuse or neglect, and may also include environmental factors, genetic predisposition, neurobiological abnormalities, and Post-Traumatic Stress Disorder (PTSD). Therefore, people with BPD have likely been suffering for a very long time from various forms of repression, making the societal stigma even more dangerous and hideously erroneous.
Perhaps the predominant difficulty of having Borderline Personality Disorder, in addition to the baneful elements of the condition, is the gross societal stigmatization of the illness. Despite the absence of imperial evident in clinical studies backing up this theory, people with BPD are often stereotyped as being highly manipulative or exceedingly difficult, when, in truth, the illness is deeply painful ones that leaves suffers feeling constantly hopeless, empty, and hollow. As people with BPD are acutely sensitive to the way they are treated by others—or perceive of the way they are being treated by others—such bias is gravely harmful, and must be resisted as it is for other behavioral health illnesses, such as Major Depression and Bipolar Disorder. Rather than victim blame, as is often the case with BPD—as if anyone would elect to have such an intensely deleterious illness—it must be viewed as something that adversely effects people, not as a hallmark trait of their very identity. Perhaps if the DSM-V does elect define Borderline Personality Disorder as an Axis 1 Mood Disorder, it would garner the truth that has long been dangerously absent from the vast majority of public consciousness, and a BPD diagnosis would no longer feel like a Scarlett letter.
Since suicidal and/or self –harming behavioral (approximately 8–10% of people with BPD eventually commit suicide) is a core diagnostic criterion for a Borderline diagnosis, and thus exceedingly challenging to manage, the illness should be treated with the seriousness and caution others are—not as some poor personality trait that is at least somewhat deliberate. As most individuals with BPD also have a co-morbid illness that occur concurrently, most commonly Clinical Depression, Bipolar Disorder, an Eating Disorder, dissociative disorders, and/or substance addiction (a very common problem in people with BPD due to impulsivity or as a coping mechanism), it is a particularly and potentially severe diagnosis and must be taken extremely seriously. Studies show that individuals with BPD (a diagnosis that is deeply gendered and likely somewhat fraught, as 75% of those diagnosed with BPD are female) and Major Depression have higher recovery rates when their BPD is treated first, and the latter subsequently.
Fortunately, there are many ways, with the proper therapy, to treat both simultaneously, as many symptoms overlap. Dialectical Behavioral Therapy (DBT), which was developed by Marsha Linehan, which is a therapeutic model that merges Cognitive Behavioral Therapy (CBT), Hegelian philosophy, and Zen Buddhism, originally developed to treat Borderline Personality Disorder, has been proven effective at treating Major Depression and Bipolar Disorder as well. An infinitely important and hopeful factor is that the American Psychiatric Association (APA) has determined that as BPD treatment have advanced, the remission rate can reach up to 86% within 10 years of acute treatment. And so there is much room for hope—but much of it still lies with us: in the solidarity we must extend to people with BPD rather than pervasive, and possibly fatal, inherently sexist stigmatization and victim blaming. For everyone wants to be well, and having a behavioral health illness is never anyone’s fault. It’s something the suffering want freedom from. And that freedom is real and can be found.