To appropriately diagnose an individual with Borderline Personality Disorder, the individual needs to exhibit at least five of the nine criteria mentioned in DSM-IV-TR. Some excerpts from the revised version of Kreisman and Straus, I hate you-Don’t leave me: Understanding the Borderline Personality, 2010.
1. Frantic Efforts to avoid real or imagined abandonment.
Similar to an infant, the borderline individual experiences difficulty discerning temporary absence to permanent departure. They determine short term isolation as long term abandonment. This fear of abandonment has been documented in alterations of blood flow in certain areas of the brain when women in particular have been exposed to memories of abandonment. In an attempt to alleviate this feeling of loneliness, they are immediately drawn to the next partner and hunt for the physical presence of others, despite how high the cost may be. For them, the solitude reminds them of the panic experienced as a child and can only be relieved by the presence of a lover, even if the results may be damaging in terms of violence.
2. Unstable and intense interpersonal relationships.
There are marked shifts from idealization of the partner to devaluation, from clinging behavior to isolation and avoidance. This is due to the need for intimacy and the fear of it primarily based on the assumption that with intimacy comes a loss of personal identity but the need for being cared for is in constant opposition. In an attempt to keep partners with them, the borderline personality will use manipulative strategies if they fear they are to be abandoned.
Due to the borderlines inability to see the whole picture, as they see either good or bad, a female borderline personality will return to abusive relationships under the guise that it is love. They are on a constant quest to find a significant other. As a result of self loathing the borderline type distrusts others genuine expressions of caring, they approach inaccessible partners and when they are accepted, somehow sabotage the relationship. This makes it extremely difficult for them to achieve real intimacy.
3. Marked and persistent identity disturbance manifested by an unstable self image or sense of self
Borderline individuals lack a cores sense of self. They often experience internal splitting whereby they consider themselves to possess different persona’s exhibiting binary characteristics. They see themselves as either good or bad. These changes occur rapidly, often within hours. Self-esteem is minimal and is only attained from impressing others, this becomes the primary route to loving themselves. They consider any positive efforts on their part to be them faking it, they never reach that level of confidence where they believe they have truly done well because of their own internal efforts. This manifests during childhood, where they may have felt inauthentic and is usually the result of abuse.
They demonstrate unrealistic attempts at perfection. By altering external situations, making drastic changes to lifestyle, they hope to achieve inner contentment. As a result of the uncertain identity, there have been incidences of homosexuality, bisexuality and sexual perversions.
4. Impulsiveness in at least two area that are potentially destructive, eg: substance abuse, sexual promiscuity, gambling, reckless driving, shoplifting, excessive spending or overeating
Behaviours may be sudden and contradictory as a result of strong momentary feelings of isolation and unconnected experiences. They are immersed in the feelings of the present with minimal emotional knowledge of the past and future. The lack of historical patterns, consistency and predictability contribute to the same mistakes being repeated. They have limited patience and a need for instant gratification which contributes to other behaviours associated with BPD such as rage, mood changes, impulsive outbursts or self destructive behaviours. These can include sexual binges, alcohol consumption etc, they become a way to avoid pain of abandonment and also a mechanism for self punishment.
5. Recurrent suicidal threats, gestures or behaviour or self mutilating behaviour
These reflect the BPD individuals overwhelming propensity for depression and hopelessness and need for manipulating others. Which in turn creates the opposite effect when those close to them stop responding. The threat there is fatal, however to continuously respond can result in unproductive confrontations. The risk of suicide persists throughout the lifecycle and is ten times higher where there is a history of childhood sexual abuse.
Self mutilation such as wounds inflicted to the genitals limbs or torso become a road map of the BPD individuals life. More recnt times, tattoos and piercings have reflected BPD tendencies. Some provoke others to inflict the violence and pain upon them. The pain has been noted to have an anesthetic effect following the incident as the body produces internal opiates to treat the pain. The calm euphoria after the incident relieves the anger and tension or overwhelming sadness.
6. Affective instability due to marked reactivity of mood with severe episodic shifts from to depression, irritability or anxiety, lasting for few hours each.
Abrupt mood changes are common and last only for few hours, their mood is not usually calm but swing from one extreme to another.
7. Chronic feelings of emptiness
As a result of a lack of core identity
8. Inappropriate, intense anger, or lack of control of anger, eg: frequent displays of temper, constant anger, recurrent physical fights.
Anger is the most persistent symptom of BPD after instability. These outbursts are unpredictable and often directed at the closest relations. It can represent a testing of devotion or a fear of intimacy, it eventually pushes away those that the BPD individual needs the most.
9. Transient, stress related paranoid thoughts or symptoms of severe dissociation.
The most common psychotic experience for the borderline involve feelings of unreality and paranoid delusions. Dissociation’s from usual perceptions with the feeling that those around her feel unreal. Some borderlines experience ‘internal splitting’ where they feel different aspects of their personality emerge in different situations, involving some or all of the five senses. The difference from other forms of psychosis is the duration is relatively short lived and the borderline resumes normal functioning following.
Borderline Personality Journal 