BPD(The ultimate guide)

BPD

This brief guide will cover the BPD in detail, along with other personality disorder types, causes, treatments and assessment tools available for BPD.

A person with a personality disorder thinks, feels, and behaves differently.

There are several different types of personality disorders clustered into different categories on the basis of their characteristics.

A personality disorder is a persistent pattern of behaving and feeling, which is altered.

Initially in DSM IV, personality disorder used to be diagnosed on Axis-II, but in DSM 5 (2013), the axial system has been changed and now a single diagnosis with co-occurring symptoms is to be given.

What is BPD

A BPD is based on the criteria given in DSM 5 (2013).

This is considered a personality disorder and covers the main characteristic features of personality disorders.

BPD falls in cluster b (dramatic) and having a persistent pattern of behaviour and thoughts.

A person experiencing borderline symptoms having polarized thinking, impulsive, risky behaviour, spontaneous and impulsive.

They also experience an excessive shift of emotions and are unable to control anger outbursts.

Borderline Personality Disorder

Symptoms of Personality Disorder

There are a number of different personality disorders, such as the cluster A is categorized as suspicious, delusional, not interested in social interactions or not having social skills to maintain the social relationships, as well as inability to consider the consequences of their actions and lead towards illegal, and risky behaviour.

Similarly, Cluster B is categorized on the basis of dramatic symptoms.

The person experiencing cluster B personality condition will report feelings of emptiness, self-harm incidents or multiple failed suicide attempts, overly impressionistic, having a fragile self-esteem, and excessively praising oneself in situations.

Whereas, Cluster C, is categorized on the basis of anxious symptoms.

They are sometimes overly clingy to another person, are overly concerned with order, or tries to avoid social situations because of fear of criticism.

Types of Personality Disorder

The personality disorders are clustered into three:

Cluster A: Odd, Eccentric

In this cluster there are three disorders named:

1.      Paranoid Personality Disorder

2.      Schizoid Personality Disorder

3.      Schizotypal Personality Disorder

Cluster B: Dramatic, or Unpredictable

1.      Antisocial Personality Disorder

2.      BPD

3.      Histrionic Personality Disorder

4.      Narcissistic Personality Disorder

Cluster B

We will expand on this type as this is where BPD is housed.

1.     Antisocial Personality Disorder

A person with an antisocial personality disorder will be reckless, dangerous and unable to think about the consequences of their actions.

They are dangerous, aggressive and gets easily bored. They have no feeling of guilt or remorse.

They consider whatever they value is an opportunity and they have to avail it, no matter if they are hurting the feelings of others.

For the diagnosis of antisocial disorder, the age must be 18 years or older, as before the age of 18 years these symptoms are diagnosed as conduct disorder if happening before 15 years of age.

2.     BPD

They are dramatic and think as if other people are leaving them, they have an extreme feeling of emptiness, having intense emotions that last for a few days and then vanish.

They have weak self-esteem, as well as it is difficult for them to maintain stable relationships, they are driven by impulses and exercise self-harm or attempt suicide mostly for the purpose to seek attention.

They feel lonely at times and experience extreme anger. Sometimes they also report experiencing the psychotic features.

3.     Histrionic Personality Disorder

People with histrionic personality disorder are overly impressionistic, attention-seeking by their exaggerated dramatized body language, accent, or appearance.

They are selfish and consider themselves before anyone else. They require a lot of admiration and approval from others.

They try to keep everyone entertained and try to remain in the centre.

4.     Narcissistic Personality Disorder

They consider themselves to be superior to others. They consider as they are special and more deserving than the others.

They have a fragile self-esteem, as well as depend on others to acknowledge their importance and value.

They are selfish and think about themselves, tries to take benefit from others, and feels sad about the achievements of others.

Cluster C: Anxious, or Fearful

1.      Avoidant Personality Disorder

2.      Dependent Personality Disorder

3.      Obsessive Personality Disorder

Symptoms of BPD

People experiencing BPD are dramatic and think as if other people are leaving them, they have an extreme feeling of emptiness, having intense emotions that last for a few days and then vanish.

They have weak self-esteem, as well as it being difficult for them to maintain stable relationships, they are driven by impulses and exercise self-harm or attempt suicide mostly for the purpose to seek attention.

They feel lonely at times and experience extreme anger.

Sometimes they also report experiencing psychotic features.

Diagnostic Criteria of Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorder 5 (2013), has given the criteria for the personality disorder diagnosis, the overview of that criteria are given below:

A.     It is the enduring pattern and persistent pattern of behaviour which is not according to the particular culture the person is living.

This disturbing pattern is manifested in either, cognition, affectivity, interpersonal relationships or spontaneity.

B.     This pattern of behaviour is constant over time and prevail in a number of personal or social situations.

C.      The condition is affecting other areas of a person’s functioning such as work, academics, personal life etc.

D.     The pattern of behaviour became more consistent and spans over the course of years, as well as it appeared in teenage or young adulthood.

E.      The condition is not the symptom of any other mental disorder

F.      The condition and symptoms are not because of the impact of drug or substance and medical condition.

Borderline Personality Disorder

Diagnostic Criteria of BPD

The following criteria are extracted from the Diagnostic and Statistical Manual of Mental Disorder (2013).

A.     It is a persistent pattern of unstable relationships, self-esteem, emotions, and impulsivity. The symptoms of borderline needs to be any five of the following:

1.      The person tries to avoid being deserted and abandoned, and they go to any extreme to save themselves

2.      Unstable relationships, inability to maintain a balance and is characterized by the extreme devaluation and idealization

3.      Inability to maintain the stable self-image, their self-image keeps on altering on the basis of others opinions and ideas

4.      Impulsive and spontaneous, and this behaviour causes disturbance as well as prove dangerous for them at least in two areas

5.      Suicidal behaviour manifested by their threats, gestures or self-harm incidents

6.      Extreme shifts in emotions, going from extreme happiness to sadness or irritability.

7.      Extreme feelings of emptiness

8.      Uncontrollable anger, and inappropriate intense anger

Causes of Personality Disorder

There are a number of causes of personality disorder, but there is no one clear cause of personality disorder.

The factors contribute to personality disorders are biological, psychological, physical and socio-cultural.

The biological causes include the genes, heredity, family history, functioning of neurotransmitters and chemical substances.

The psychological causes of personality disorders are childhood trauma, stress, adverse family environment, low self-esteem, child neglect, and parental rejection.

Physical causes include brain dysfunction and psychiatric pathology.

The sociocultural causes include divorce, being deserted, deprivation of relationships, assault, abuse of death, and separation.

Assessment Tools for BPD

There are a number of tools for the assessment of borderline symptoms.

The type of scales is different:

Professional Settings

The tools used in professional settings are standardized and mostly require a certain level of skills on part of the examiner.

Few of them are mentioned here:

1.      Diagnostic Interview for DSM–IV Personality Disorders (DIPD–IV)

2.      Structured Clinical Interview for DSM–IV Personality Disorders (SCID–II)

3.      Structured Clinical Interview for DSM–V Personality Disorders (SCID–III)

4.      Structured Interview for DSM–IV Personality (SIDP–IV)

5.      International Personality Disorder Examination (IPDE)

6.      Personality Assessment Schedule (PAS)

Self-report Measures

There are a number of self-report measures as well which can be used by the person to get an idea regarding the presence and severity of the condition.

Few of them are mentioned here:

1.      MSI-BPD McLean BPD

2.      Personality Diagnostic Questionnaire, 4th Edition (PDQ-4)

3.      Zanarini Rating Scale for BPD (ZAN-BPD)

Treatment of BPD

There are different forms of treatment for personality disorders.

1.      Psychotherapy

2.      Medication

Psychotherapy:

It is one form of treatment, in this a mental health professional especially a psychologist deals with the client experiencing the personality disorder symptoms.

This is also called ‘talk-therapy’, this usually takes up to three months and sometimes more.

There are different therapies that can be used for personality disorder.

Dialectic Behaviour Therapy

This is the evidence-based therapy for personality disorders, especially for the treatment of the borderline disorder.

In this treatment approach, the skills to manage one’s emotions, as well as mindfulness is discussed in detail.

Arts Therapy

This type of therapy is useful to uncover the unconscious pattern and understand the person’s emotions, and feelings in a non-threatening environment.

It includes the use of dance, art, drama, and music.

Cognitive Behaviour Therapy

In CBT, the clinician looks for the discrepancy in the thoughts, emotions, and behaviour of the person along with the automatic thought patterns.

Schema Therapy

It is a long term talking therapy, which is based on the model of CBT and goes further deep into the core beliefs and schemas of the person, which influence their thoughts, behaviours, and actions.

Medication

There are no specific drugs made for personality disorders, but the combination of drugs for the symptoms of depression, anxiety, and psychosis are used for particular symptoms.

Borderline Personality Disorder

Frequently Asked Questions for BPD

What are the 9 symptoms of BPD?

The 9 symptoms of BPD are excessive fear of abandonment, a weak self-image, unstable relationships, self-harm, emotional swings, uncontrollable anger, extreme feelings of emptiness.

Can a person with BPD really love?

A person with a BPD (BPD) may have unstable emotions and relationships, but not always they are dysfunctional and are capable of developing feelings for someone.

How can you tell if someone has BPD?

You can tell the person is having BPD on the basis of these symptoms, fear of abandonment, a weak self-image, unstable relationships, self-harm, emotional swings, uncontrollable anger, extreme feelings of emptiness.

What is the difference between BPD and bipolar disorder?

The difference between BPD and bipolar disorder is that bipolar disorder is a mood disorder and BPD is a personality disorder.

Depression and manic symptoms fall specifically in the bipolar disorder domain.

What causes a personality disorder?

There are a number of causes of personality disorder, they can be biological, physical, 
psychological and sociocultural.

Is a personality disorder a mental illness?

Yes, it is a mental illness, and its criteria are given in the Diagnostic and Statistical Manual of Mental Disorder 5, published by the American Psychiatric Association.

What is the most common personality disorder?

The most common personality disorder is an obsessive-compulsive personality disorder, and the second most common is narcissistic personality disorder.

Please make sure to let us know what you think about the article as well as your comments and suggestions regarding the condition below in the comments section.

References

NICE

Mind.org.uk

NHS

RC PSYCH

Recommended Books

The BPD Survival Guide:

Everything You Need to Know About Living with BPD

Get Me Out of Here: My Recovery from Borderline

Personality Disorder

Loving Someone with BPD: How

to Keep Out-of-Control Emotions from Destroying Your Relationship

Personality Disorders & Mental Illnesses: The Truth

About Psychopaths, Sociopaths, and Narcissists (Personality Disorders, Mental

Illnesses, Psychopaths, Sociopaths, Narcissists)

Mental Health: Personalities: Personality Disorders,

Mental Disorders & Psychotic Disorders (Bipolar, Mood Disorders, Mental

Illness, Mental Disorders, Narcissist, Histrionic, Borderline Personality)

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Daniela Paez is a Clinical Psychologist with an MSc. In Clinical Neuropsychology from Bangor University. She has vast experience in working with children with disabilities, adolescents and their families, in extreme conditions of poverty and vulnerability. Additionally, she owns a private practice where she provides neuropsychological evaluation for children and adults, and treatment for mood disorders, anxiety, couple therapy, among other conditions.