Borderline Personality Disorder
Full description of Borderline Personality Disorder. Definition, signs, symptoms, causes of Borderline Personality Disorder.
Description of Borderline Personality Disorder
Most people with a borderline personality disorder are women and it's estimated 1-2% of American adults have Borderline Personality Disorder. Borderline personality becomes evident in early adulthood but becomes less common in older age groups.
People with borderline personality are unstable in their self-image, moods, behavior, and interpersonal relationships. The Merck Manual states "their thought processes are more disturbed than those of people with an antisocial personality, and their aggression is more often turned against the self. They are angrier, more impulsive, and more confused about their identity than are people with a histrionic personality."
People with a borderline personality often report being neglected or abused as children. Consequently, they feel empty, angry, and deserving of nurturing. They have far more dramatic and intense interpersonal relationships than people with cluster A personality disorders (odd or ecentric personality disorders such as paranoid personality disorder, schizoid personality disorder). When they fear being abandoned by a caring person, they tend to express inappropriate and intense anger. People with a borderline personality tend to see events and relationships as black or white, good or evil, but never neutral.
When people with a borderline personality feel abandoned and alone, they may wonder whether they actually exist (that is, they do not feel real). They can become desperately impulsive, engaging in reckless promiscuity , substance abuse, or self-mutilation. At times, they are so out of touch with reality that they have brief episodes of psychotic thinking, paranoia, and hallucinations.
According to the Merck Manual, people with a borderline personality commonly visit primary care doctors. Borderline personality is also the most common personality disorder treated by therapists, because people with the disorder relentlessly seek someone to care for them. However, after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, caretakers, including doctors, often become very frustrated with them and view them erroneously as people who prefer complaining to helping themselves.
BPD DSM IV Diagnostic Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and 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-mutilating behavior covered in Criterion 5.
- a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization 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., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
- recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- 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, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- transient, stress-related paranoid ideation or severe dissociative symptoms
Causes of Borderline Personality Disorder
The cause of Borderline Personality Disorder is unknown but may be a result of genetic and environmental factors, brain abnormalities or a combination. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones. And since personality is shaped in childhood, these factors could play a significant role in the development of Borderline Personality Disorder.
Risk factors for developing Borderline Personality Disorder include:
- Hereditary predisposition. You may be at a higher risk if a close family member, a mother, father or sibling, has the disorder.
- Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
- Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.
For comprehensive information on borderline and other personality disorders, visit the HealthyPlace.com Personality Disorders Community.
Sources: 1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association. 2. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006.
Last Updated: 29 March 2017
Reviewed by Harry Croft, MD