Borderline
Personality
Disorder

What is a personality?

characteristic patterns of thinking, feeling, and behaving derived from genetics along with experiential factors

tends to be steady in lifetime

What is a personality disorder?

a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving

includes trouble with perceiving and relating to situations and people

Additional
Reading

The Art and Science of Personality Development
by Dan P. McAdams
ISBN: 978-1-4625-2932-2

Borderline personality disorder is . . .

a chronic condition characterized by pervasive instability in:

  • moods

  • interpersonal relationships

  • self-image

  • behavior

This instability often disrupts family and work life, long-term planning, and an individual's sense of identity.

different types of bpd:

  • Complex: other disorders are present, which affects the person's experiences (ex: has both depression and bpd)

  • Pure: only bpd present, which is extremely rare

  • Externalized: the "classic" borderline, or someone who externalizes their symptoms.

  • Internalized: the "quiet" borderline, or someone who internalizes their symptoms

note: there are over 200 known "types" of bpd due to many combinations of symptoms

History of BPD

  • originally thought to be at the "border" of psychosis and neurosis

  • has been called: “borderline psychotic” “borderline schizophrenia” “pre-schizophrenia”

  • also called “emotional dysregulation disorder” & “emotionally unstable personality disorder”

  • came into official use in 1980 in the DSM-III

  • Symptoms of the disorder have been recognized for almost three thousand years

dsm-5 criteria for bpd:
must meet 5 or more criteria

  • 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 2 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

Causes are both genetic and environmental:

  • 5x more likely when a close family member is diagnosed with BPD

  • Twin studies show over 50% heritability rate (higher with monozygotic than dizygotic)

  • abuse, neglect, or separation as young children*

  • 40-71% report being sexually abused

  • considerably more likely victims of violence, including rape

  • Approx. 70% of individuals had childhood maltreatment

  • individual vulnerability (resilience) to environmental situations

  • predisposed aggression, which may have impaired regulation circuits

  • differences in amygdala function or size

  • differences in prefrontal cortex

  • differences in neurotransmitter function and availability

Differential diagnosis: other conditions that may explain the symptoms someone is experiencingrule out: the expert is trying to discount or disprove possible or probable diagnoses

Other similar disorders:

  • Depressive & bipolar disorders

  • Other personality disorders

  • Personality change due to another medical condition

  • Substance abuse disorders

  • Identity problems

  • Autism Spectrum Disorder

  • Symptoms overlap with many disorders

  • Also can be confused with dissociative identity disorder

  • Easily misdiagnosed with bipolar disorder

Comorbid Disorders

Patients with borderline personality disorder have been shown to have high rates of comorbid disorders, namely:

  • Mood disorders 80% to 96%

  • Anxiety disorders 88%

  • Substance abuse disorders 64%

  • Eating disorders 53%

  • Attention deficit hyperactivity disorder (ADHD) 10%-30%

  • Bipolar disorder 15%

  • Somatoform disorders 10%

References

Personality:https://www.psychologytoday.com/us/basics/personalityhttps://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

BPD:https://www.psychologytoday.com/us/conditions/borderline-personality-disorder

History of BPD:https://www.psychologytoday.com/us/conditions/borderline-personality-disorderBorderline Personality Disorder Demystified (Revised Edition) by Robert O. Friedel, MD

dsm criteria:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/dsm-5 page 663

causes:https://www.psychologytoday.com/us/conditions/borderline-personality-disorderhttps://www.webmd.com/mental-health/borderline-personality-disorderhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/https://www.ncbi.nlm.nih.gov/books/NBK430883/

other diagnoses:DSM-5 pg 666https://www.ncbi.nlm.nih.gov/books/NBK430883/

comorbid disorders:https://www.ncbi.nlm.nih.gov/books/NBK430883/

Additional Readings

  • Borderline Personality Disorder Demystified (Revised Edition) by Robert O. Friedel, MD (ISBN: 978-0-7382-2024-6)

  • Dr. Daniel Fox, PhD: https://www.youtube.com/user/lcruz71

  • MedCircle: https://www.youtube.com/playlist?list=PLG1WzYaHQeh5y3dwgHWvLpeyr7uK1_nOd

  • BPD Central: https://www.bpdcentral.com/

  • The Black Sheep Project: https://www.blacksheepproject.org/

  • National Education Alliance for Borderline Personality Disorder (NEA-BPD): https://www.borderlinepersonalitydisorder.org/

  • Treatment and Research Advancements for Borderline Personality Disorder (TARA4BPD): http://www.tara4bpd.org/

  • Articles on The Mighty