Borderline personality disorder DSM-5

What are the criteria of borderline personality disorder according to DSM-5?

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A person can be diagnosed with a borderline personality disorder if they meet the following 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

A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

Identity disturbances i.e. 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). 

Recurrent suicidal behavior, gestures, 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 

Borderline Personality Disorder

A borderline personality disorder is defined as impulsive and unstable behavior about interpersonal relationships, self-image, and mods. It has a long history and originally this term was used to describe a condition that was presumed to be in the middle of psychotic and neurotic disorders. The main characteristic of BPD is affective instability and impulsivity. Affective instability can be described as rapid changes of emotion. Due to this people suffering from BOD have highly unstable and volatile interpersonal relationships. They tend to lean towards the over idealization of friends, family, or partners that in the end result in disappointment and anger due to disillusionment. They also have abandonment issues and try their hardest to avoid such an outcome from occurring in real life. As mentioned before they have high impulsivity that results in erratic behaviors without any fear of the consequences.

Symptoms of Borderline Personality Disorder

  • Extreme dread of being abandoned and therefore resorting to behaviors that are unpredictable and even extreme to prevent it from happening
  • Unstable and erratic interpersonal relationships. Extreme emotional turbulence in thoughts and behaviors. They could idealize their partner one moment and in the next moment suddenly hate or despise them.
  • Frequent and rapid changes in perception of self may lead to changing of goals and values and constantly viewing self in a deprecating way. 
  • Bouts of paranoia are caused due to stress and loss of touch from reality. These episodes can last from a few minutes to a few hours. 
  • Engaging in impulsive, irresponsible, and risky behavior. That could include  partaking in gambling, rash driving, unprotected  sexual intercourse, spending sprees, binge eating or drug abuse, or sabotaging self-growth and success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to the fear of separation or rejection
  • Terrible mood swings. The person could go from being extremely happy to being extremely afraid or irritable in a short span of time.
  • Feeling dejected, hollow, and empty from within,
  • Being unreasonable sarcastic or losing temper at minor inconveniences. Resorting to physical fights to resolve issues etc. 

Causes

The world of mental disorders is still an enigma for researchers and mental health practitioners. It is still not known what are the causes that lead to the development of Borderline Personality Disorder just like many other disorders. But there have been a few links observed between some factors environmental factors (childhood, past trauma, etc) and Borderline Personality Disorder that might be the cause.  The factors are listed as follows.

Genetics

Genetics might play a major role in the development of BPD. Studies conducted on twins and biologically related family has revealed that personality disorders may be inherited or strongly associated with other mental health disorders among family members. Therefore BPD might have some hereditary connection.

Brain abnormalities.

Reach has also shown that changes in the structure of certain areas of the brain that control emotion regulation, impulsivity, and aggression can also be the cause of BPD. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Risk factors

Some risk factors can lead to the development of BPD or increase the chances of developing BPD at some point in the person’s lideSome factors related to personality development can increase the risk of developing a borderline personality disorder. They are as follows:

  • Hereditary 

If someone in the family already has BPD then you are genetically predisposed to developing BPD. The risk is higher if that person is a close blood relative. For example, mother, father, or siblings

Traumatic childhood

Childhood trauma and abuse can lead to a lot of negative consequences and one of them could be BPD. Verbal, physical, or sexual abuse or even being abandoned or neglected can cause a harsh impact on the child’s mental development causing them to be susceptible to many mental health disorders.  

Types of Borderline Personality Disorder

BPD has been classified into four types of disorders based on the characteristics and severity of the symptoms. A person can be diagnosed with more than one type of BPD disorder at the same or even different points in their life.  The four types of BPD are as follows

Impulsive Borderline Personality Disorder

Impulsivity is one of the central characteristic symptoms of borderline personality disorder.  People with Borderline Personality Disorder often display erratic behavior with high impulsivity which could be dangerous for them as well as the people around them. They engage in such impulsive behaviors without caring for their apparent consequences.

People with this type of BPD may display the following types of characteristics

  • Charismatic
  • Energetic
  • Elusive or detached
  • Flirtatious
  • Engaging or motivating

The impulsive behaviors and actions could be as follows:

Bingeing behaviors:

They could indulge in binge eating, careless and excessive use of money, or indulge in hypersexuality. 

Risky and self-destructive/ harming  behaviors

  • Engaging in unprotected sexual intercourse (even unprotected oral sex) 
  • sexual engagement with multiple partners
  • driving under the influence 
  • substance abuse
  • alcohol addiction
  • rash driving,
  •  gambling, 
  • porn addiction
  •  gambling
  •  
  • Aggressive behaviors:
  • Emotional and violent Outbursts
  • physical fights or verbal fights
  • breaking or hitting things
  • Screaming and yelling fits
  • Bullying and destroying property or things. 

Discouraged Borderline Personality Disorder

This type of BPD is also known for being termed as the quiet borderline personality disorder. People with such type of BPD experience fear of abandonment and they go to extreme lengths to prevent such an event from occurring.  It should be noted that this event could be real or even imagined. Also patients with discouraged BPD channel and direct their emotion towards self more than patients with other types of BPD. Therefore they have a tendency to blame themselves and be guilty instead of turning the blame towards other people. 

The following types of people could be found in Discouraged BPD:

  • The  perfectionists
  • Extremely successful and revered
  • High Functioning
  • Introverted or isolated or alienated and detached in groups
  • Feel as if no one wants them or they don’t have a connection with anyone in this world
  • Need validation and approval from others but also prefer to maintain a distance. 
  • Engage in self-harm or suicidal behaviors
  • Feel lonely and empty a lot of the time

Signs of discouraged BPD include:

  • Attention-seeking or Clingy
  • Codependency 
  • Neediness 
  • Unstable moods/ angry and emotional outbursts at being triggered.  

Self-Destructive Borderline Personality Disorder

When someone with BPD is tormented with hatred towards self and resentment and bitterness then they have a self-destructive borderline personality disorder.  In these cases, the individuals are usually unaware of what is happening to them.

A few examples of the behaviors displayed by people with this type of BPD is as follows:

  • Drug abuse and addiction/Substance abuse
  • Consumption of illicit or recreational substances and prescription medication abuse
  •  
  • Engaging in thrall seeking and risky Risky activities
  • To obtain an adrenaline rush or to even attain distraction they engage in such activities even when they aren’t fully prepared. 
  •  
  • Self-mutilation
  • Self-harm such including cutting, burning, scratching, or hitting
  •  
  • Suicide ideation and Threats of suicide
  • Due to their unstable moods and behavior, they are prone to self-destructive thoughts and even use these threats as a way to seek attention

Petulant Borderline Personality Disorder

Individuals with Petulant borderline personality Disorder have a unique characterization. Their moods are unpredictable and they can switch from aggressive anger or rage to being petulant and sulky. They possess an unhealthy obsession for control due to the feeling unworthy or unloved by their near and dear ones. This type of BPD is associated with manipulation and extreme relationship dissatisfaction. Substance abuse and other damaging behaviors typically follow.

Following are some Example behaviors observed in people with petulant borderline personality disorderIrritability and impatience

  • Obstinacy and insolent
  • Passive-aggressiveness
  • Unpredictable mood swings

Conclusion 

In this article, we learned about the criteria of borderline personality disorder and also understood the various types of borderline personality disorders. 

Frequently Asked Questions

What is high functioning BPD?

A high-functioning BPD is also referred to as discouraged BPD. In this form of borderline personality disorder, the person will experience extreme and very intense negative emotions. The emotions could be a shame, guilt, anger, sadness, or even jealousy and despair.  is also referred to as discouraged or high functioning borderline personality disorder. 

What are the 5 types of borderline personality disorder?

The four types of BPD include 

impulsive, 

discouraged, 

Self-destructive,

Petulant

Each of these four types of BPD has different characteristics.

Do people with BPD have empathy?

Research through the decades has very clearly shown that people with borderline personality disorder are very sensitive to negative and unpleasant emotions and possess poor cognitive empathy. But it has also been noticed that they tend to have at times superior emotional empathy. However, more research is needed on this topic to gain clarity on the matter

Previous research has demonstrated that patients with borderline personality disorder (BPD) are more sensitive to negative emotions and often show poor cognitive empathy, yet preserved or even superior emotional empathy. However, little is known about the neural correlates of empathy

Is hypersexuality a symptom of BPD?

It has been observed that in some cases of borderline personality disorder the patients tend to be markedly impulsive, seductive, and extremely sexual.  Also, it has been found that Sexual promiscuity, sexual obsessions, and hypersexuality are very common symptoms for both men and women with BPD.

Are borderlines psychopaths?

Borderline Personality Disorders characteristics or symptoms are highly represented in individuals who display psychopathy. On the other hand traits or characteristics found in psychopathic individuals is also very prevalent in patients suffering from Borderline personality disorder. So it could be said that there is a possibility that some borderlines turn out to be psychopaths.

References

DSM-IV and DSM-5 criteria for the personality … – psi.uba.ar. (n.d.). Retrieved January 16, 2022, from https://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf 

Mayo Foundation for Medical Education and Research. (2019, July 17). Borderline personality disorder. Mayo Clinic. Retrieved January 16, 2022, from https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237 

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