DSM
According to the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition), “A person who suffers from borderline personality disorder has labile interpersonal relationships characterised by instability”. This pattern of interacting with others will have persisted for years, and is usually closely related to the individual’s self-image and early social interactions. The pattern is present in a variety of settings (i.e. not just at work or home), and is often accompanied by a similar lability (fluctuation back and forth, often in a quick manner) in a person’s affect (mood) or feelings. Relationships and the person’s affect may often be characterised as shallow. A person with this disorder may also exhibit impulsive behaviours and exhibit a majority of the following symptoms:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterised by alternation 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. spending, sex, substance abuse, reckless driving or binge-eating.
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood, e.g. intense episodic dysphoria, irritability or anxiety, which usually lasts for between a few hours and several days.
7. Chronic feelings of emptiness
8. Inappropriate, intense anger, or difficulty controlling anger, e.g. frequent displays of temper, constant anger or recurrent physical fights.
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Anyone with six or more of the above traits and symptoms may be diagnosed with Borderline Personality Disorder. However, the traits must be long-standing (pervasive), and there must be no better explanation for them, e.g. physical illness, a different mental illness or substance misuse.
ICD
The ICD (International Classification of Diseases) also provides a description of BPD. The ICD 10 calls the disorder by its European name - ‘emotionally unstable personality disorder’. The ICD describe BPD as a:
“Personality disorder characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.”
(www.who.int/classifications 2005)
Borderline Personality Disorder is one of ten personality disorders recognised by the DSM IV. A personality disorder is a type of mental illness; in order to be diagnosed, certain criteria must be met. With personality disorders, the symptoms have usually been present for a long time. These symptoms have an overall negative affect on the sufferer’s life. Many people with BPD are prone to impulsive behaviour. This impulsiveness can manifest itself in negative ways. For example, self-harm is common among individuals with BPD and, in many instances, this is an impulsive act. Sufferers of BPD can also be prone to angry outbursts and even criminal offences as a result of impulsive urges (mainly male sufferers). Another common feature of BPD is affective liability; sufferers have trouble stabilising moods - as a result, mood changes can become erratic. Other characteristics of this condition include the distortion of reality, a tendency to see things in ‘black and white’ terms, excessive behaviour such as gambling or sexual promiscuity, and proneness to depression. To learn more about symptoms and diagnostic criteria, please go to the section on diagnostic criteria. These traits can sometimes make it very difficult for a person to maintain a relationship with someone with BPD, as their behaviour and actions can be difficult to tolerate and hard to understand. It is important for those close to a BPD sufferer to educate themselves on the condition so that they can empathise with what the sufferer is going through and how they are feeling. BPD is not usually diagnosed prior to adolescence. It has been suggested that BPD symptoms can sometimes improve as time goes on, or even that they can disappear altogether. This is not always the case, however, as BPD can continue to affect sufferers well into later life. Traits from other mental illnesses and psychological conditions from the DSM IV can often co-exist in BPD patients. These are usually anxiety disorders, eating disorders, obsessive-compulsive disorder (OCD) and bipolar disorder (also known as manic depression). Is Borderline Personality Disorder a Mental Illness? Yes. A mental illness is an illness that primarily affects a person’s behaviour, as opposed to their physical well-being. BPD is considered by medical practitioners to be a severe psychiatric disorder and is recognised as such by the DSM IV. Often, mental illness is not taken as seriously as physiological illness, even though it is very common and can be very debilitating. It is often viewed as moodiness, craziness or a weakness, when it is in fact a genuine illness that can be caused by physiological factors. People have as little control over the development of a mental illness as they do over whether they catch a cold or not. As with physical illness, mental illness requires treatment, and is not something that someone can just will to go away. Why the name Borderline? The name borderline was coined by Adolph Stern in 1938. The name was used for patients who were on a ‘borderline’ between neurosis and psychosis. However, the symptoms of BPD are not as simple as this description might make them sound: the diagnosis of BPD is based upon signs of emotional instability, feelings of depression and emptiness, and identity and behavioural issues, rather than signs of neurosis and psychosis. However, the ‘borderline’ label has remained, even though the definition has changed. Throughout Europe, the same disorder has been given the more appropriate, and less misleading, title of ‘Emotionally Unstable Personality Disorder.’
