Written by Dr. Eric Perry
“Let us keep courage and try to be patient and gentle. And not mind being eccentric, and make distinction between good and evil.” ~Vincent Van Gogh
The purpose of this article is to educate readers on a serious mental illness that is said to affect 1.6% to 5.9% of adults in America. This is from 4 million to 14 million people. The purpose of this article is NOT to vilify or shame individuals who suffer from this serious illness. Officially recognized in 1980 by the psychiatric community, borderline personality Disorder is a cluster B personality disorder. Borderline personality disorder can be referred to by other names but for the sake of clarity, I will refer to it as BPD in this article. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectation of the culture. The disorder causes distress or problems functioning, and lasts over an extended period of time.
It is a pervasive disorder of emotion regulation. Individuals who suffer from BPD are unable to manage or control their emotions. Crisis after crisis, they will crash and burn repeatedly throughout the day. It does not take a huge trigger for a BPD to ping-pong between extreme emotions. BPD will manifest itself in the context of relationships and usually begins in adolescence or early adulthood. It is long-term, encompasses all emotions and is associated with a wide variety of behaviors. BPD can exhibit itself in varying emotions such as depression, anxiety, and hypo-manic behavior. One person may self-harm, another may have an addiction while another may struggle in relationships. BPD can have different presentations at different times. A person with BPD may be Another day, they may be social. Another day, they may have panic attacks. Overall, there may be a pattern of instability of interpersonal relationships, self-image, and impulsivity. About 85 percent of people with BPD also suffer from other mental illness. Over half the BPD population suffers from a major depressive disorder.
The Diagnostic and Statistical Manual of Mental Disorders also known as the DSM-5 is a handbook used by mental health professionals as the authoritative guide to the diagnosis of mental disorders. The DSM-5 contains descriptions, symptoms and other criteria for diagnosing mental disorders. It is currently in its 5th edition which was published in 2013. A mental health professional experienced in diagnosing and treating mental disorders can evaluate an individual and determine if they can be diagnosed as BPD. To be diagnosed with borderline personality disorder at least 5 of these 9 behaviors must be present. The behaviors must be persistent and exhibited over a long period of time.
1. Frantic efforts to avoid real or imagined abandonment
Individuals with BPD are unable to be alone. They need to have people around them. Individuals with BPD have an extreme fear of being abandoned. They will experience intense and inappropriate emotions if they feel they are being abandoned. If a person is late to meet someone with BPD or cancels a date with them they may experience severe panic or become abnormally furious. The perceived abandonment makes them feel they are worthless, bad or disgusting people. They will do anything to avoid being abandoned. A person with BPD may go to the extreme of threatening self-harm or suicide. They may react impulsively and actually self-harm. A person with BPD will do almost anything to avoid the real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships
Individuals with BPD will have very intense and unstable relationships that are characterized by alternating between the extremes of idealization and devaluation. They may meet someone and immediately idolize the person and want to spend all their time with them. They may immediately share intimate personal information of their lives and may immediately engage in risky sexual behavior. A person with BPD may fall in love with a person immediately only to hate them shortly after. They will fluctuate between love and hate with nothing in between. It is as if they put the individual on a pedestal only to later knock them down. These dramatic shifts in how they view the once idolized person reflects the disillusionment the person with BPD feels once their unreachable expectations are not met.
3. Identity disturbance: Markedly and persistently unstable self-image or sense of self
A person who suffers from BPD may have a fluid, distorted or unstable self-image. An individual with BPD may have a difficult time knowing what they value, believe, prefer or enjoy. They may feel empty, lost and as if they do not exist at all. They may often play a character in their lives and constantly change depending on their environment. A person with BPD may have sudden and dramatic shifts in their identity. They may have sudden changes in their life goals, values, vocational aspirations, and relationships. Their opinions, careers, sexual identity, values and friends can change overnight.
4. Impulsivity in at least two areas that are potentially self-damaging
a) Gambling
b) Overspending
c) Engaging in risky sexual behavior
d) Wreckless driving
e) Substance abuse
f) Binge eating
5. Recurrent suicidal behavior, gestures, threats or self-mutilating behavior
A person suffering from BPD will threaten self-harm or exhibit suicidal behavior as a result of feeling negative emotions. Self-harm occurs in 50 to 80 percent of people with BPD and is usually in the form of cutting but may also be exhibited as bruising, burning, head banging or biting. These self-destructive acts are usually preceded by perceived threats of separation or rejection. Self-mutilation may occur during dissociative experiences and may be used to reaffirm the ability to feel after a dissociation or to distract oneself from emotional pain.
6. Affective instability due to a marked reactivity of mood
A person with BPD will have intense episodic dysphoria or anxiety usually lasting a few hours and only rarely more than a few days. This is different from bipolar disorder mood swings which occur for weeks or even months. The mood swings with BPD are shorter and can occur within the day. There is a ping-pong of intense emotions. For some, peaks can be between depression and elation, anger and anxiety or depression and anxiety. Dysphoria is a state of unease or generalized dissatisfaction with life. A person with BPD can exhibit a combination of the following forms of dysphoria: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity and feelings of victimization.
7. Chronic feelings of emptiness, worthlessness or sadness
Individuals with BPD may feel there is nothing beneath the surface for them. They may feel as if they are hollow. When not in the chaos of extreme fluctuating emotions they may experience the feeling of emptiness. A person with BPD may become bored and engage in risky behaviors as listed in point #5. One can argue that by engaging in these behaviors they are able to avoid feeling empty. A person with BPD will experience extreme feelings of sadness and loneliness associated with their feelings of emptiness.
8. Inappropriate intense anger or difficulty controlling anger
A person with BPD may display intense and uncontrollable emotional responses when triggered. The response will be disproportionate to the event or situation. There are frequent displays of temper, constant anger or recurrent physical fights. These emotions are often elicited when they perceive a caregiver or lover is being neglectful, withholding, uncaring or abandoning. This is often followed by shame, guilt, and feelings of being evil. People with BPD often feel emotions easier, faster and more intensely.
9. Transient, stress-related paranoia ideation or severe dissociative symptoms
Individuals suffering from BPD may experience dissociation. Dissociation can be thought of as disconnecting from one’s mind. It can occur in response to a painful event or painful memories. The mind will automatically redirect the attention of the event in order to avoid feeling intense emotions. This loss of contact with reality may occur in response to real or imagined abandonment and last for minutes or hours. The person experiencing dissociation may become emotionless and appear flat. The return of the caregiver’s nurturance may result in remission of symptoms. A person who suffers from BPD may also exhibit paranoid ideation. Paranoid Ideation is not the same thing as delusional paranoia which is based on false thought and beliefs. An example of delusional paranoia is believing the government has bugged a person’s home. A person with paranoid ideation will believe they are being harassed, persecuted and be suspicious of others motives and intentions. They may see two people talking and assume they are talking about them.
This article is not meant to diagnose or be a guide for self-diagnosis. The sole purpose of this article is strictly for educational purposes. The purpose of this article is to educate readers on a serious mental illness that is said to affect 1.6 % to 5.9 % of adults in America. This is from 4 million to 14 million people. The purpose of this article is NOT to vilify or shame individuals who suffer from this serious illness. If you feel you or someone you know meet the necessary criteria please seek the help of a mental health professional. This article is not meant to be used for self-diagnosis.
The thoughts expressed in this blog post are my own and are not meant to create a professional relationship with the reader. This blog does not replace or substitute the help of a medical professional. Please note, I am unable to answer your specific questions as I am not fully aware of all of the circumstances.
Kindly,
Dr. Perry
“I help ambitious and high achieving individuals manifest a life of success and fulfillment in order to achieve the life they truly desire.”
Dr. Eric Perry | drericperry.com
© 2023 ALL RIGHTS RESERVED
Good info! I can recognize some of those traits in a few people I know actually – thanks for bringing more awareness to it. 👍🏽
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Glad you liked it and thank you for your comment ✨✨✨
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Thank you for this information. It’s always nice to see someone else’s description and perspective of BPD. 🙂
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Hi Eric. Great article. I have been diagnosed with BPD, and fill all 9 criteria, so there’s no chance that I had gotten a misdiagnoses. 😛
“Individuals with BPD are unable to be alone. They need to have people around them.”
This isn’t true for me. I need to be alone. Not all the time, I still crave affection and company, but most of the time I enjoy being by myself. It might also be because I’m less able to get hurt if I isolate myself more than putting myself “out there”. Then again, I’m an introvert as well, so time for myself is so important and a necessity.
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Hi Rayne thank you so much for your comment ✨✨✨
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This is me too. Now anyway. I used to need company almost constantly though. I do think there’s a big self-isolating factor in it for me however.
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I am in the same boat Aura Gael! I used to constantly need someone around me. Even if we weren’t talking or acknowledging one another – just doing our own thing. Now I totally treasure my alone time! I can finally be at peace by myself. This is partially due to the DBT classes I have taken over the years as well as a lot of self care and growth. Glad to hear there are others out there and I’m not alone!
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I really appreciate you making this.
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Thank you for reading and leaving a comment✨ I always appreciate the feed back.
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Me, too. It’s a very sad situation for some I know and love. Also, it’s easy to try to read an article like this and wonder about one self. But we all may have a small degree of one or more factors but not be Bipolar. The key discriptors are crucial: extreme, intense, etc.
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Reblogged this on Lost Dudeist Astrology.
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Thank you!
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You are welcome! Great piece!
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Thank you so much for your comment! I appreciate your feedback!
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Another highly informative and educational article. Thank you!
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Thank you for reading and I am pleased you like it! ✨✨✨
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Thank you for writing this. It helps me understand better someone who I was in an email friendship with. Unfortunately it didn’t end well and I couldn’t understand where her mostly unfounded accusations came from, but I realise now she was probably afraid and felt I had disappointed her or let her down. It doesn’t undo what she said but it helps me understand better what she must have been feeling.
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Another great awareness post. 👍🏼😊 Shared it on my twitter
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I am glad you liked it! And thank you for the share ✨
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Thank you for writing about this topic. I was diagnosed years ago with Bipolar, so several points hit home with me. I truly hope more people seek help if they are dealing with anything talked about in this article. Asking for help is difficult, but help is available.
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Thank you so much for your comment ✨ mental illness is nothing to be embarrassed about or ashamed and indeed we in the mental health profession are here to help✨ have a great day
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Great info.
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Thank you!
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Great post!
-nc
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Thank you!
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Insightful…ive read a few books in this I.was married to one..I definitely have some of these traits as well…I think a diagnises is an opinion that boxes us into a foundation we seem to find comfort it..it seems difintive it came from a dr…I believe we all have traits of lots of different things based on our life experineces..if we bix ourselves into a title we become STUCK…its an idea you can apply to be aware and heal traits stuck from past pains…it’s definitely not a sentence to live…courageously LIVE!
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I agree that we are all more than our diagnosis but it is important to be aware of our health both body and mind and address any issues we may have. Have a wonderful day and thank you for you reading and your comment✨
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Thank you for sharing as well..
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I think a diagnosis is something that is helpful. It is helpful for me to understand that I behave and react in certain ways for a legitimate reason and I’m not broken beyond belief. It is also helpful to know that I’m not alone.
It can be helpful to others as well to help them understand my seemingly irrational behaviors and why I have them and it gives a good starting point for recovery.
My diagnoses do not define me, they are explanations of why.
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Thank you for sharing this insight Rose ✨
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Exactly..I love and honor “it does not define you”….beautiful!
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I agree with Rose on this one. My diagnosis didn’t put me in a box or label me and make me feel like a leper. I felt empowered by discovering more about myself, and was told by my therapist that I can work on myself and actually transform myself to having acute BPD to having little or no symptoms at all. I was told this isn’t permanent and there are ways to help myself grow.
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Really informative post. Thank you for sharing. 🙂 — Suzanne
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Thank you for reading and commenting! Have a great weekend Suzanne✨
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Reblogged this on perfectlyfadeddelusions.
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I found this really interesting, thank you for your time into helping people understand it. I have Aspergers however in my autism assessment the psychiatrist was stuck between aspergers and BPD … I now find myself wondering whether he should have chose Aspergers. Blog posts like this make it much easier to understand BPD as the Internet is filled with so much rubbish that doesn’t make sense!
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I am so happy this post brought some clarity to you. Have a wonderful Sunday ✨
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Highly informative write-up! Thanks for the share.
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I am glad you found it helpful. Thank you for the comment!
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Thanks for this article. I recently met someone who told me that they had BPD as well as anxiety (which is what I’m dealing with) – and I realised I knew very little about it. What’s more, I realised that what I thought I knew was probably wrong anyway, as these things often are until you go looking for yourself. Your article was thus very timely!
As expected, my preconceptions were largely nonsense. I’m glad you’ve left me equipped with a little better knowledge than when I arrived. Kudos.
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I am glad this blog post clarified some of your preconceptions and thank you so much for your comment!
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Thanks for writing this article. I heard of the disorder recently from a counselor who was offering me guidance with some issues happening in my personal life. I see a lot of the issues and symptoms mentioned above as the result of drug abuse as well. Another great read!
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Glad you liked it and thank you for your comment!
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That was very interesting. I think I have BPD tendencies, but after many yrs of psychotherapy and group I’m doing pretty well. Still have trouble with relationships though, esp the idealizing/demonizing problem. I have a hard time finding that happy medium.
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Thanks for sharing, as disturbing as it is to read, it is sad to know that there are many people affilcted with this mental illness.
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Thanks for liking my post. It showed that this was one of your recent posts. One of my cousins shared yesterday that she has been diagnosed with BPD and working through it. I’ve never heard of it! Incredible timing for this information.
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If anyone is in a successful relationship with someone with BPD, I would love to hear about it. Romantic or platonic. I could definitely use any encouragement/tips.
Or, if you do have BPD, do you have any advice for the people in the lives of others with BPD? What has helped you or improved your relationships? What has NOT helped or caused your relationship to fail?
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Hi 🙂 I’m struggling with painful and limiting mental health problems for many years now. It started with a depression that was never healed with the meds, and because of that I was diagnose with Bipolar Disorder after two years. My main problems are emocional instability – daily roller coaster -, extreme sensitivity to others, vulnerability, fear of rejection and of not being considered by others. This leads to problems in maintaining personal relationships. I also struggle with anxiety and feelings or emptiness. Also, I don’t have motivation or energy and I feel exhausted very easily. Before this, I worked in a environmental NGOs and I was passionate about it and about life in general. Someone told me that my symptoms are more of BPD. Besides all the difficulties not having a proper diagnoses thus a proper treatment doesn’t help at all.
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Hi Sofia, please feel free to contact me directly if you are in need of support with this. Best wishes, Eric
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Hi Eric, thank you, I will. Best wishes, Sofia.
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Thanks for writing about this. Awareness is crucial for all mental health issues!
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My pleasure and thank you for your comment!
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Hello,
This important information is expressed well and compassionately. Thank you for this.
Compassionate, intelligent work is so needed in the arena of mental illness.
I look forward to more of your posts.
…Pamela
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Eric, I really do appreciate your “Like” of my recent post. You seem like a very insightful, as well as educated professional. I have read some of your posts and confess that I don’t have multi-personalities or other psychosis , but have suffered through deep depression. It is difficult to get rid of. I will will stop trying, though! Your blog is encouraging.
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Thank you so much Michael✨
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I have BPD, and love Marsha Linehan’s DBT program that covers the four modules of Mindfulness, Interpersonal Relationships, Distress Tolerance, and Emotional Regulation. These are all key concepts to everyone’s daily life that a majority of people have no idea how to begin doing. I wish her program was implemented in high school curriculum along with basic life lessons such as balancing a checkbook, how to pay taxes, how to build credit, and other life hacks that most don’t learn until it’s too late. This is a great article, and I am glad BPD is something that is being discussed. Thank you.
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Hi, in order to be diagnosed with any mental disorder doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a technical and detailed description of bipolar disorder as well as BPD. You must meet certain number of criteria to be officially diagnosed.
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Great post.. I think it is wonderful that people can join here, I hope it brings comfort to them..
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I work with a person who exhibits signs BPD. I’ve seen this person explode into inappropriate and explosive emotional outbreaks. I avoid this person as much as possible which seems to work well for me.
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WOW, that was incredible. But I got scared that I might be BPD when I read the section on fear of abandonment. Then I realized, I was abandoned – at 4 years old by my mother and then my dad emotionally abandoned me. I was diagnosed with having severe abandonment issues and I experience separation anxiety when any loved one leaves for a period of time. But, I actually love my alone time, I prefer to live alone – now after all I have been though, and I don’t mind even taking myself out to eat. On topic 6 I can at times gamble when I feel too lonely or if I am planning a trip to see my grand-kids I will always overspend. But I don;t have the other BPD you mentioned here, however, I keep finding men who do not show these traits early on in the relationship but always end up surfacing later on. 😦
I am desperately looking for answers right now.
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This is very informative thank you. I once dated a guy who displayed all the above signs in the most extreme ways. It was exhausting😲😲
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I always suspected my mother suffered from something like this, and now I’m even more sure. Thank you for the insights!
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I am glad this was illuminating. Thank you for your comment Janey! ✨
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I have suffered three major traumatic events in my life. Each one triggering the memory of the last. Lately I have been struggling severely from everything in this article and it has been an ongoing issue that has taken a decade to reach the point it is at now. This post has shined a lot of light on something that has been of great confusion to me thank you.
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Reblogged this on MIU Hacks.
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i found this very insightful, my 28 yr old daughter has just been told she has a personality disorder we don’t know which cluster she will be in yet but she does tick a lot of the boxes and to be honest for me its scary as hell , i was hoping for bi polar i was hoping they could see what i do now i see its much more …… thank you
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I am glad you found this post helpful ✨
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Summed it up well.
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Thank you for not painting us as monsters. I recently completed MBT and my therapist reckons I no longer meet the criteria however the stigma attached to this disorder is real and it is frankly heartbreaking.
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It does seem to be a curse. Once you’re labeled with it, that’s it. That’s all anybody sees. You could have 30 good years and still, all they see is BPD. I no longer fit the label either but it still follows me around everywhere. I have even considered getting new doctors who don’t know about my previous diagnosis just so I can be treated like a human again. So I know what you mean!
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Wonderful post! And thorough. I was diagnosed with BPD when my symptoms peaked at 24; I’m 25 now and on the right medications but my 24th year was horrible, and the relationship I was in was incredibly unstable. One thing I find about the abandonment: I fear emotional abandonment. If someone likes me, well they’ll eventually hate me. It’s really tricky to get rid of thoughts like that though >.<
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This was so much more informative than anything else I’ve read on BPD. I’ve been diagnosed with major depressive disorder since I was 12 years old. I’m in my mid-twenties now. For the last year or two, I haven’t really felt that I fit the MDD diagnosis as much anymore. As I was reading your article, it made me smile. I felt like I had gotten an answer, or at least a lead, to a diagnosis that fits with my behavior. I haven’t brought it up to my psychiatrist out of fear. Fear of what exactly? I don’t really know. I probably don’t want her to think that I’m ridiculous or crazy for diagnosing myself when she’s the one with the PhD.
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This is such a great informative post. These traits are also inherent and cross over in so many other mental health issues, so it can be difficult to decipher.. which I suspect is why people go un-diagnosed for a long time or get the wrong diagnosis. I used to work in environments with a lot of people with BPD and I really feel for anybody suffering from this 😦
Thanks for the info!
Lianne
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An interesting post which explains this aspect of mental illness clearly for non-experts such as myself. In my job I often am called to help people with a range of mental illness and our training is sketchy at best. Articles like yours help give me the background info which help me relate better as I arrange expert professional help for my patients. Thanks 😊. Regards, Rusty.
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Thank you for this post, which is the most comprehensive on the subject I’ve read in a long time. Going by my own experience, stress only aggravates the condition further, which is so blatantly obvious, it shouldn’t even need saying. But it’s also good to read that some readers have managed to kick BPD to the curb so to speak. So there is hope for some of us.
It seems to me though that with BPD you tend to lash out at and / or fear abandonment by those you were taught to revere / respect / fear / cherish the most in childhood, parents, partners, God.
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I’ve read many articles on BPD and this is one of the best descriptions. Very informative!
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My girlfriend has this. Something i learned one week after she moved in with me (that’s how quickly it became manifest). It’s been very difficult and i’m not sure how much more of it I can take. I love her deeply, but it seems no matter how much love i give her, she never misses a chance to toss it all aside, vilify me and treat me like a monster. She recently came across Jordan Peterson’s work and has found renewed hope there. But every up so far has been followed by an even greater down so i’ve become too apathetic to risk having any hope left of my own. I’m continuing to give her as much support as i can. I’ve written on my blog what i’ve learned so far about borderline and as best i can tell it stems from an underdeveloped part of the brain. Possibly due to malnutrition or lack of love and attention as an infant.
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Thank you Dr Perry. About 7 years ago I was diagnosed with BPD. Recently I have been in therapy again for Depression and together with my own research and my therapist’s conclusions the diagnosis was revised to Complex PTSD. I began to question my original diagnosis because over time I found information that contradicted it. When you join BPD support groups and find you don’t fit in, it begs the question “why don’t I fit in”. I understand the field of Psychiatry and Psychology is always changing and we are all learning. I never identified with my mental health issues and still don’t. I am just grateful my new therapist was able to get to the real issue at hand. I love your blog as it is always informative and inciteful. Glenda
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Oh. My. God. My ex-friend fits virtually all of your description – especially “It does not take a huge trigger for a BPD to ping-pong between extreme emotions”!! I used to say she was giving me emotional whiplash! I thought she was (undiagnosed) bi-polar, but I know better now. I *so* wish I had known about BPD back when we were friends. Sigh. At least now I understand her, albeit retroactively. I severed the relationship to save my own sanity, and do not regret it. At least now I feel less guilty. (I used to fall for her manipulations, like “You’re so cold!” and “You don’t care about me!” etc. Now I’m free!) Thanks for writing this excellent article.
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