DIAGNOSIS: BPD. What is it? How can I tell?

[BPDFamily.com]

It is a significant challenge to determine if someone in your life has Borderline Personality Disorder or any personality disorder. We often do not have a formal diagnosis to rely upon.  

The American Psychiatric Association cautions us against using the DSM criteria for making amateur "cookbook" diagnoses as they are often inaccurate. For our own sake and for the sake of others,  we want to be responsible and constructive in assessing the mental health of others in our life.  First and foremost, these designations were created to help people and families, not label and blame.

When we encounter high conflict and destructive relationship behaviors in others, our first priority could be to triage our situation. Write down the difficult behaviors that we have observed.

• If any are dangerous (e.g., domestic violence, suicidal ideation, or criminal) or fatal to the relationship (e.g., serial adultery, ruinousness spending), it makes sense to immediately start planning for safety.

• For all the others, we should do everything we can to reduce the conflict in the immediate term. This may not be not easy for us.  It usually involves giving in to the other person and providing them space and listening to/validating them. At the same time, we should force ourselves to step back from the conflict and process the hurt or resentment that we are feeling.  This requires a great deal of maturity.  We have tools for neutralizing the situation (stop the bleeding) and we have tools for taking a step backward (rebalancing ourselves). As difficult as it may be, starting here is usually in the best interest of ourselves and our children.

Once the situation is defused as best it can be, we can then start investigating what is going on so that we can make informed decisions.  When we encounter high conflict people with destructive relationship behaviors it is important for us to know that the problems can be caused by a large range of things from immaturity,  short term mental illness (e.g. depression), substance induced illness (e.g. alcoholism), a mood disorder (e.g., bipolar), an anxiety disorder (e.g. PTSD), a personality disorder (e.g., BPD, NPD), or even a learning disability (e.g. Aspergers) and "any combination of the above" (i.e., co-morbidity). It will likely take some digging to sort it out.

The behaviors exhibited during a relationship for all of these afflictions can look somewhat alike but the driving forces and the implications can be very different.  For example, was that lying predatory (as in ASPD), ego driven (as in NPD), defensive (as in BPD), a result of being out of control (as in alcoholism), or ineptitude (as in Aspergers).  Was it situational, episodic (bipolar), or has it been chronic. Yes, all lying is bad, but the prognosis for the future is not that same in all situations. For example, depression and bipolar disorder (mood disorders) are very responsive to drug therapy -- substance abuse often requires intervention and inpatient detoxification -- personality disorders require multi-year re-learning therapies (e.g. DBT, Schema) --  Aspergers is often considered a long term disability.  Chronic bad behavior and situational bad behavior are very different.

It is probably best to resist the temptation to immediately latch onto one of the personality disorder symptoms lists as the magic formula. Doing this may make the situation appear more hopeless and more one-sided than it actually is, and it may send us in a wrong or unhealthy direction.  

Getting back to the subject in the title "What is BPD?" -- personality disorders, per se', are lifelong afflictions -- anyone can act "borderline" in a particular situation. To be a PD, symptoms must have been present for an extended period of time, be inflexible and pervasive, and not a result of alcohol or drugs or another psychiatric disorder -- the history of symptoms should be traceable back to adolescence or at least early adulthood -- the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control.

"Present for an extended period of time" doesn't mean constantly and obviously present.  Many people with this disorder, especially as they get older, learn to adapt and control or isolate the worst of the disordered actions except when stress pushes them past their ability to control and manage.  This is why the disorder is more visible to the family and close friends. "Present for an extended period of time" means that there have been indications of the disorder at different times dating all the way back to the teen years.

It is also worth noting that personality disorders are spectrum disorders - meaning that there is a broad range of severity.  At the lower end, it is not necessarily a personality disorder at all - people can have a personality style like BPD or NPD.  Surely you know someone that is pretty narcissistic, but not mentally ill.  People with BPD can range all the way from "very sensitive with somewhat nonconstructive ways of coping and avoiding hurt" (BPD personality style) all the way to social dysfunction (e.g., unable to hold a job) and potentially life threatening behavior (e.g. severe BPD).

Whether it is BPD or BPD personalty style, Bipolar Disorder, or simple depression, etc, you are welcomed and encouraged to work with the members here at bpdfamily.

A high conflict, emotionally abusive parent, child, relationship partner or spouse, regardless of the causation, is a challenge and we need to take appropriate steps for our own wellbeing and that of our family.  And hopefully you want to learn how to rise above and manage your interface with the difficult person in a constructive, mature and healthy way.  It's our very next step to a constructive, mature and healthy future for ourselves.

Tall order, I know.  I had a loved one with this disorder, too.  

Skippy

[Skip]

It is a significant challenge to determine if someone in your life has Borderline Personality Disorder or any personality disorder. We often do not have a formal diagnosis to rely upon.  

The American Psychiatric Association cautions us against using the DSM criteria for making amateur "cookbook" diagnoses as they are often inaccurate. For our own sake and for the sake of others,  we want to be responsible and constructive in assessing the mental health of others in our life.  First and foremost, these designations were created to help people and families, not label and blame.

When we encounter high conflict and destructive relationship behaviors in others, our first priority could be to triage our situation. Write down the difficult behaviors that we have observed.

• If any are dangerous (e.g., domestic violence, suicidal ideation, or criminal) or fatal to the relationship (e.g., serial adultery, ruinousness spending), it makes sense to immediately start planning for safety.

• For all the others, we should do everything we can to reduce the conflict in the immediate term. This may not be not easy for us.  It usually involves giving in to the other person and providing them space and listening to/validating them. At the same time, we should force ourselves to step back from the conflict and process the hurt or resentment that we are feeling.  This requires a great deal of maturity.  We have tools for neutralizing the situation (stop the bleeding) and we have tools for taking a step backward (rebalancing ourselves). As difficult as it may be, starting here is usually in the best interest of ourselves and our children.

Once the situation is defused as best it can be, we can then start investigating what is going on so that we can make informed decisions.  When we encounter high conflict people with destructive relationship behaviors it is important for us to know that the problems can be caused by a large range of things from immaturity,  short term mental illness (e.g. depression), substance induced illness (e.g. alcoholism), a mood disorder (e.g., bipolar), an anxiety disorder (e.g. PTSD), a personality disorder (e.g., BPD, NPD), or even a learning disability (e.g. Aspergers) and "any combination of the above" (i.e., co-morbidity). It will likely take some digging to sort it out.

The behaviors exhibited during a relationship for all of these afflictions can look somewhat alike but the driving forces and the implications can be very different.  For example, was that lying predatory (as in ASPD), ego driven (as in NPD), defensive (as in BPD), a result of being out of control (as in alcoholism), or ineptitude (as in Aspergers).  Was it situational, episodic (bipolar), or has it been chronic. Yes, all lying is bad, but the prognosis for the future is not that same in all situations. For example, depression and bipolar disorder (mood disorders) are very responsive to drug therapy -- substance abuse often requires intervention and inpatient detoxification -- personality disorders require multi-year re-learning therapies (e.g. DBT, Schema) --  Aspergers is often considered a long term disability.  Chronic bad behavior and situational bad behavior are very different.

It is probably best to resist the temptation to immediately latch onto one of the personality disorder symptoms lists as the magic formula. Doing this may make the situation appear more hopeless and more one-sided than it actually is, and it may send us in a wrong or unhealthy direction.  

Getting back to the subject in the title "What is BPD?" -- personality disorders, per se', are lifelong afflictions -- anyone can act "borderline" in a particular situation. To be a PD, symptoms must have been present for an extended period of time, be inflexible and pervasive, and not a result of alcohol or drugs or another psychiatric disorder -- the history of symptoms should be traceable back to adolescence or at least early adulthood -- the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control.

"Present for an extended period of time" doesn't mean constantly and obviously present.  Many people with this disorder, especially as they get older, learn to adapt and control or isolate the worst of the disordered actions except when stress pushes them past their ability to control and manage.  This is why the disorder is more visible to the family and close friends. "Present for an extended period of time" means that there have been indications of the disorder at different times dating all the way back to the teen years.

It is also worth noting that personality disorders are spectrum disorders - meaning that there is a broad range of severity.  At the lower end, it is not necessarily a personality disorder at all - people can have a personality style like BPD or NPD.  Surely you know someone that is pretty narcissistic, but not mentally ill.  People with BPD can range all the way from "very sensitive with somewhat nonconstructive ways of coping and avoiding hurt" (BPD personality style) all the way to social dysfunction (e.g., unable to hold a job) and potentially life threatening behavior (e.g. severe BPD).

Whether it is BPD or BPD personalty style, Bipolar Disorder, or simple depression, etc, you are welcomed and encouraged to work with the members here at bpdfamily.

A high conflict, emotionally abusive parent, child, relationship partner or spouse, regardless of the causation, is a challenge and we need to take appropriate steps for our own wellbeing and that of our family.  And hopefully you want to learn how to rise above and manage your interface with the difficult person in a constructive, mature and healthy way.  It's our very next step to a constructive, mature and healthy future for ourselves.

Tall order, I know.  I had a loved one with this disorder, too.  

Skippy

[Skip]

Below are characterization of the disorder by the American Psychiatric Association, the National Institute of Health, and The Mayo Clinic.

The American Psychiatric Association



Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A very important part if that is they must have impaired functionality.  Without that, we are pretty much talking about a borderline personality style - a difficult but not pathological condition that is more responsive to therapy than than a "personality disorder".

A topline summary of the DSM 5 definition (due to be published in March 2013)  is:

1. Impairments* Impairments in self functioning AND impairments in interpersonal functioning (*important)

2. Negative Affectivity, characterized by:

• Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

• Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

• Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

• Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

3. Disinhibition, characterized by:

• Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

• Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

4. Hostility:  Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

The complete DSM-5 definition is located here: DSM 5


National Institute of Health

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The Mayo Clinic

People with BPD often have an unstable sense of who they are. That is, their self-image or sense of self often rapidly changes. They typically view themselves as evil or bad, and sometimes they may feel as if they don't exist at all. This unstable self-image can lead to frequent changes in jobs, friendships, goals, values and gender identity.

Relationships are usually in turmoil. People with BPD often experience a love-hate relationship with others. They may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even misunderstandings. This is because people with the disorder have difficulty accepting gray areas — things are either black or white. For instance, in the eyes of a person with BPD, someone is either good or evil. And that same person may be good one day and evil the next.

In addition, people with BPD often engage in impulsive and risky behavior. This behavior often winds up hurting them, whether emotionally, financially or physically. For instance, they may drive recklessly, engage in unsafe sex, take illicit drugs or go on spending or gambling sprees. People with BPD also often engage in suicidal behavior or deliberately injure themselves for emotional relief.

Other signs and symptoms of borderline personality disorder may include:

* Strong emotions that wax and wane frequently

* Intense but short episodes of anxiety or depression

* Inappropriate anger, sometimes escalating into physical confrontations

* Difficulty controlling emotions or impulses

* Fear of being alone

[Randi Kreger]

These are concepts from my most recent book, The Essential Family Guide.  These are not clinical concepts reported in any study or professional organization, rather my take on things.Types of pwBPDs: ~Lower Functioning~Higher Functioning (Invisible)Lower-Functioning These are the classic border¬line patients who result in the statistics you read about in chapter 1. Here are some characteristics of lower-¬functioning conventional BPs: 1.   They cope with pain mostly through self-¬destructive behaviors such as self-¬injury and suicidality. The term for this is acting in. 2.   They acknowledge they have problems and seek help from the mental health system, often desperately. Some are hospitalized for their own safety.3.   They have a difficult time with daily functioning and may even be on government disability. This is called low functioning.4.   If they have overlapping, or co-¬occurring, disorders, such as an eating disorder or substance abuse, the disorder is severe enough to require professional treatment.5.   Family members’ greatest challenges include finding appropriate treatment, handling crises (especially suicide attempts), feelings of guilt, and the financial burden of treatment. Parents fear their child won’t be able to live independently. Because lower-¬functioning conventional BPs seek mental health services, unlike the higher-¬functioning invisible BPs we’ll talk about next, they are subjects of research studies about BPD, including those about treatment. Higher Functioning Invisible BPs1.   They strongly disavow having any problems, even tiny ones. Relationship difficulties, they say, are everyone else’s fault. If family members suggest they may have BPD, they almost always accuse the other person of having it instead. 2.   They refuse to seek help unless someone threatens to end the relationship. If they do go to counseling, they usually don’t intend to work on their own issues. In couples therapy, their goal is often to convince the therapist that they are being victimized.3.   They cope with their pain by raging outward, blaming and accusing family members for real or imagined problems. 4.   They hide their low self-¬esteem behind a brash, confident pose that masks their inner turmoil. They usually function quite well at work and only display aggressive behavior toward those close to them. Family members say these people bring to mind Dr. Jekyll and Mr. Hyde. 5.   If they also have other mental disorders, they’re ones that also allow for high functioning, such as narcissistic personality disorder (NPD).6.   Family members’ greatest challenges include coping with verbal, emotional, and sometimes physical abuse; trying to convince the BP to get treatment; worrying about the effects of BPD behaviors on their other children; quietly losing their confidence and self-¬esteem; and trying—¬and failing—¬to set limits. BPDs with Overlapping CharacteristicsMany BPs possess characteristics of both lower-¬functioning conventional BPs and higher--functioning invisible BPs. Author Rachel Reiland is typical of a BP with overlapping characteristics. When she insinuated she was going to shoot herself, her psychiatrist admitted her to a psychiatric hospital. Yet she held a job as a full-¬time mother and was active in church. Although she acted out toward her husband and psychiatrist, she was able to appear nondisordered toward most people outside her family.

[Abigail]

Skip, very good overview and perspective.  Randi, I generally agree with your analysis of high functioning, however, the concept of a severity scale that Skip writes about makes more sense than just high functioning/low functioning.

I agree that this disorder is less likely to be diagnosed when it is on the lower end of the severity scale.  My husband had seen 5 psychiatrists and yet he was never diagnosed.  He also wasn't likely to provide any therapist or professional with an accurate life history in one or two sessions. And due to privacy laws, its easy to block interviews with family members who could shed some light on the "reality" on the home front. The closest they came was a diagnosis of depression and some "anger management problems".  There's a difference between having a temper problem and raging over insignificant events.  

I often wonder what the statistics would be if these less severe pwBPD's were included in the statistics.  I know way too many people who have signs of having the disorder from the descriptions I've heard and the behavior I've observed.   I know at least 10 who are diagnosed (several of whom I had a part in getting them to the right professional who diagnosed them) and another 15 who fit some of the criteria, and another 12 who I suspect but I don't know enough about them or their situation.  And I am not in the mental health field.

We were fortunate to find a doctor, Leland Heller, who truly understood the disorder and was able to diagnose it in a lot of high functioning individuals.  He has developed a treatment plan that works and he is truly unique.  My husband's BPD is controlled with the proper combination of medication and through following his doctor's instructions.  :)r. Heller is a family practitioner, not a mental health professional.

Therapists need to be better trained to recognize BPD traits in less severe individuals.  Unfortunately, they are looking for textbook examples of a female who self-injures and is low-functioning.  And wherever possible, talk to those closest to the patient to get a better understanding of what is going on.

 

Abigail

[Mollyd]

How do you tell if someone has the disorder?

I think you first must consider your own tendencies.  For example, are you someone who thinks they see people with personality disorders EVERYWHERE  (If so, maybe you'll want to be careful to be sure that you aren't interpreting one bad situation as a pervasive condition) ?  Or, are you someone who tends to allow many people into your life that are struggling to function at a basic level (Maybe you struggle to see the difference between normal and abnormal behaviors - you might tend to overlook giant red flags)?  If you know your own vulnerabilities, you have a better shot at asking the right kinds of questions, mitigating your own thinking.

When I was a kid, I was surrounded by people who had thoughts and behaviors that would be considered "personality-disordered".  The way the adults in my life thought about, experienced, and reacted to the world was markedly different than one might expect from the culture and environment.  Thus, as I approached adulthood, my "normal meter" was broken.  I simply couldn't tell what thoughts and behaviors would fall into or out of the range of normal.  So, for me, I had to learn to be MORE discerning about abhorrent behaviors/thinking/emotional reactivity.  I had to re-guage my normal meter.  I learned to tell by reading criteria, and talking about it with others, and reading more and more and more, and watching people outside my family, and asking more questions to people I trusted as mentors.  I learned to understand what it really looked like to have an unstable sense of self, to have mood lability, to conceptualize what splitting was.  I had seen it my whole life - but reading the words didn't connect to the experience I'd had.  I had to make the connection.

Another thought relates to discerning reactive behaviors to the syndrome of BPD.  Most people have, at one time or another in their life, had behaviors that were emotionally reactive, impulsive, self degrading, lacking stability in thought of self.  To see this behavior in another does not indicate BPD.  What indicates BPD is to see the criteria pervasively in that person's life, across many circumstances, and over a significant period of time.

To view another person as having a personality disorder is to see a serious and persistent mental health condition; it seems to make sense to bounce questions and thoughts off those who are experienced, knowing from where you come.  It seems asking a lot of questions (like - what else could this be?) is an important part of the process, and having objective, educated mentors to help is advisable.

Molly

[Unreal]

I think it is very challenging. I'm seeing many people with undiagnosed spouses/exs/parents on this site.  I'm one of those (my ex is not officially diagnosed).  The important thing to realize with mental illness is that the DSM is not a cookbook.  At any given time, someone may have many or all of the symptoms of an active disorder, or several disorders but really be suffering from another syndrome, another etiology, or nothing.  Many disorders can look like BPD.  BPD, itself, is a controversial diagnosis in the field.  Many of the leading personality researchers have rec'd it be excluded from the next DSM.  I look at the DSM as a descriptive system.  The core features of a disorder can be found and understood far better in reading journal articles than they can be in a surfacey examination of DSM symptoms.  The situation is far more complicated, diagnostically, than checking off five symptoms.  It is a fairly common opinion to argue for a dimensional approach to personality disorder diagnosis.  Most of these behaviors occur on a continuum.  They are not generally dichotomous.   

I think that the presence of personality traits such as splitting and raging are enough (for example) that it is really not of concern what you may call the problem.  It needs to be dealt with and understood.

[Skip]

Getting a basic understanding of personality disorders (and mood disorders, and anxiety disorders) greatly helped me understand the difficult relationship I was in.  It sent me on a journey that helped me see that our problems had roots in issues that long preceded our relationship.  I discovered her life-long patterns after talking to a family member and asking the right questions. I made important decisions based on them.  

Later, I came to realize that some of the situational stuff was more a contributing factor than I had thought.  That was a learning experience for me.  

And, still later I realized that I too, had some baggage to work on.  I now have, hopefully, greater self-awareness and a more mature understanding of relationships.

It all took time to understand. A lot of time. And what I initially thought was Borderline Personality Disorder was probably more like borderline personality style - not the clinical manifestation of the disorder (BPD) but the traits on a sub-clinical basis.  There is a difference between having borderline tendencies (borderline personality style)  or narcissistic tendencies (narcissistic personality style) and actually having the disorder.

This all paired up disastrously with a situation we eventually found ourselves in (a suicide in her family) and my own weaknesses.

Why was it so hard to understand if some one has this disorder?

1) The diagnostic process is complex. First the person has to qualify as have sufficient impairment to be considered a personality disorder (there are 5 point scales for this).  They they have to qualify for a type (there are 5 point scales for this, too.)

2) Many of the symptoms for BPD and other personality disorders are the also seen in depression, bipolar disorder and other mood disorders, anxiety disorders (e.g., PSTD), substance abuse, and even Aspergers syndrome.

3) To be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life.

4) Analyzing a relationship conflict when you are one of the involved parties is tough. Everything you see is through the eyes your own biases (and lack of professional training is challenging). It's much easier to see dysfunction in others and harder to see our own or how we are contributing to the overall dynamics.  If the relationship conflict is driving us to do things we don't normally do - how much of that is happening of the other side.

5) Many of us are dealing with people tendencies, the so called high functioning or invisible BPD, rather than the disorder so it is not as obvious.  There is little consolation with "tendencies" as pw BPD tendencies  can be very hurtful and very destructive.  The one upside is that they are likely to be more responsive to therapy than someone with a full disorder.

It's a journey of discovery... .every answer tends to open another door to more questions.

Skippy

[JoannaK]

I do have to second Skip's comments above... . 

It isn't cut and dried, and transient symptoms can make it difficult to determine if your loved one suffers from a borderline personality disorder.  But, if you or your children are being abused, picked on, subject to fairly continuous criticisms or complaints, if life with the person is either a roller coaster (highs and lows) or increasingly unpleasant, you need to look carefully at personality disorders as a possible cause.

Here is a video that Skip developed with the staff that may help in understanding BPD:

[Sadanty]

Does anyone have any information on the Personality Disorder Belief Questionnaire and how it works?

Thanks in advance

Sadantyhqt

[Skip]

The Personality Disorder Beliefs Questionnaire (PDBQ)

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors, 1999

A. Arntz, R. Dietzel and L. Dreessen in

This questionnaire provides 6 sets of 20 "Assumptions" held by those suffering from the various personality disorders.

The following 20 "beliefs" have been the most commonly associated with those diagnosed with BPD:

1. I will always be alone.

2. There is no one who really cares about me, who will be available to help me, and whom I can fall back on.

3. If others really get to know me, they will find me rejectable and will not be able to love me; and they will leave me.

4. I can't manage by myself, I need someone I can fall back on.

5. I have to adapt my needs to other people's wishes, otherwise they will leave me or attack me.

6. I have no control of myself.

7. I can't discipline myself.

8. I don't really know what I want.

9. I need to have complete control of my feelings otherwise things go completely wrong.

10. I am an evil person and I need to be punished for it.

11. If someone fails to keep a promise, that person can no longer be trusted.

12. I will never get what I want.

13. If I trust someone, I run a great risk of getting hurt or disappointed.

14. My feelings and opinions are unfounded.

15. If you comply with someone's request, you run the risk of losing yourself.

16. If you refuse someone's request, you run the risk of losing that person.

17. Other people are evil and abuse you.

18. I'm powerless and vulnerable and I can't protect myself.

19. If other people really get to know me they will find me rejectable.

20. Other people are not willing or helpful.

[Sadanty]

 

I ran into the following description :

Arntz and colleagues developed a list of 20 BPD assumptions based on the writings of Beck et al. (1990) combined with their own clinical experience with this population (Arntz, Dietzel & Dreessen, 1999). Similar to the themes proposed by Young and colleagues, the BPD assumptions Arntz, Dietzel and Dreessen (1999) proposed reflected themes of aloneness (e.g., “I will always be alone”), dependency (e.g., “I can’t manage it by myself, I need someone I can fall back on”), unlovability (e.g., “If others get to know me, they will find me rejectable and will not be able to love me”), emptiness (e.g., “I don’t really know what I want”), lack of personal control (e.g., “I can’t discipline myself”), badness (e.g., “I am an evil person and I need to be punished for it”), interpersonal distrust (e.g., “Other people are evil and abuse you”) and vulnerability (e.g., “I’m powerless and vulnerable and I can’t protect myself”). Many of the assumptions included in the Personality Disorder Belief Questionnaire (PDBQ) by Arntz et al. (1999) were drawn with permission directly from the list of beliefs in the appendix of Beck et al. (1990). However, they also included some additional assumptions that they observed in BPD patients. Arntz et al. (1999) found that patients with BPD scored higher on the PDBQ than patients with cluster-C personality disorders or normal controls.



Reference: A.C. Butler et al. / Behaviour Research and Therapy 40 (2002) 1231–1240

From the same paper:

The PBQ (Personality Disorder Questionnaire) was developed as a clinical measure of the beliefs associated with personality disorders, as proposed by Beck et al. (1990). The PBQ is composed of 126 items and nine scales (with 14 items per scale) that assess the following personality disorders: Avoidant, Dependent, Obsessive Compulsive, Histrionic, Passive–Aggressive, Narcissistic, Paranoid, Schizoid and Antisocial. Beck et al. (2001) found that patients diagnosed with Avoidant, Dependent, Obsessive Compulsive, Narcissistic or Paranoid Personality Disorder scored higher on their respective PBQ scales than on PBQ scales designed to assess the beliefs of other personality disorders. In addition, patients with Avoidant, Dependent, Narcissistic and Paranoid personality disorders scored higher on their corresponding PBQ scale than patients with other diagnoses scored on those scales.



and

Several of the beliefs associated with BPD patients appear to be not only dysfunctional, but contradictory as well. This internal dissonance may further contribute to the maladaptive behavior and distressed affective state exhibited by many BPD patients. For example, a patient with BPD may feel extremely helpless, resulting in a variety of dependent behaviors, while simultaneously experiencing distrust, particularly in close or intimate relationships.

According to the cognitive theory of BPD, these diametrically opposing beliefs are latent until they are activated by an external event. The patient then processes information in a dichotomous way, which creates anxiety, frustration, depression, or shame. In order to relieve this internal tension temporarily, the patient may behave in an extreme and self-destructive manner such as attempting suicide, binge eating, self-mutilating, or engaging in substance abuse. BPD patients also may act out against others in an attempt to punish them for perceived betrayal or withholding of what is needed. Self-punitive and other-punitive behaviors may occur in close temporal proximity in BPD. Schema formulations of BPD refer to this erratic alternating behavior as schema flipping (Young, 2002).

[Marney]

Wow!  Thanks for this information - the contradictary stuff always did my head in.  eg. Blaming others but also blaming himself at the same time.  The word 'punitive' got to me as well.  I always felt like any arguements we had wouldn't be solved until he felt either that I'd been punished or that he'd punished himself. ?

[Desert]

The Personality Disorder Beliefs Questionnaire (PDBQ)

The following 20 "beliefs" have been the most commonly associated with those diagnosed with BPD:

11. If someone fails to keep a promise, that person can no longer be trusted.

How ironic.  The one thing about my ex that was completely predictable was she was virtually certain to renege on her word. 

[Skip]

This is from our web site... .and may be helpful for those trying to understand BPD or if someone has the disorder.



https://bpdfamily.com/bpdresources/nk_a102.htm

Diagnostic Tests

Commonly used assessment tests that may help you identify "BPD thinking" include the Structured Clinical Interview (SCID-II), and the Personality Disorder Beliefs Questionnaire (PDBQ). There are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

In addition there are some free, informal tests available - some bpdfamily.com members have found that these tests are helpful.

Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionnaire is available from the American Psychiatric Publishing ($60.00).

Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. We have included a list of questions most often answered as "yes" by people with Borderline Personality Disorder .

[lbjnltx]

hello friends,

2 months ago i gave this list to our t.  out of the blue on thurs. he pulled it out and had my d answer each one.  then he began to discuss and verify her written responses.  he only got to about #8 when time ran out. 

at the earliest date possible i will get a copy of her responses and see where we are in her beliefs to date.  we are experiencing alot of progress/change at this time 33 days without a rage. yea!

i will suggest to t that we revisit questions at intervals so that we can see what we need to work on and where we have been victorious.

keep believing in miracles,

lbjnltx

[Skip]

Commonly used assessment tests that may help you identify "BPD thinking" include the Structured Clinical Interview (SCID-II), and the Personality Disorder Beliefs Questionnaire (PDBQ). There are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

In addition there are some free, informal tests available - some bpdfamily.com members have found that these tests are helpful.



Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionnaire is available from the American Psychiatric Publishing ($60.00).

Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. We have included a list of questions most often answered as "yes" by people with Borderline Personality Disorder .

More... .

[l bo]

My exBDPgf is very high functioning and I didn't know what was going on or reasons for some of the odd behavior I experienced. Luckily someone pointed out it could be BDP, never heard of it and as I read the criteria most of it fit. Then I could recognize all the red flags I saw but didn't recognize at the time. I was still unsure, at times, if she really suffered from this or if I was the one going crazy. Thankfully we were only together for 10 months and haven't suffered like many on here have, I was able to get out rather quick. After a long silent treatment I mentioned BDP to her which essentially put the nail in the coffin I was looking for, haven't heard from her since and that was over a month ago.

Everyone has probably seen the 9 criteria for helping to determine BDP, I stumbled across a BDP "Personality" test and wow oh wow oh my, my ex fits MOST of these. Thought I would share if anyone else is wondering about their SO.

Does criticism from other people, even in small measure, make you feel horrible inside?

While being successful in your work life, do you feel as though a happy, successful relationship has been the one thing that's alluded you?

Would you say your emotional life has been characterized by anguish?

Have you found it hard to have close friends for very long?

Do you feel like you have less friends than those around you?

Do you tend to, at first, over idealize people and later often feel let down by them?

Have you ever been accused of behaving in ways that are all or nothing with nothing in between?

Have you taken on the values, habits and preferences of people, institutions, religions or philosophies, only to regret this decision later?

Have you experienced intense episodes of sadness, irritability, and anxiety or panic attacks?

Have you often felt raw? exhausted? in despair?

Do you have trouble sleeping?

Have you experienced chronic feelings of emptiness? Have you experienced a physical manifestation of this in your stomach or chest?

Do you have trouble being alone?

Have you experienced intense relationships?

Do you feel like other people's emotional needs are too great?

Have you felt depleted from giving it your all to relationships?

Have you felt like since you've given it all to relationships and they haven't worked, that your only choice for sanity and balance is to not be in a relationship?

Do you often feel lonely even when you are in a relationship?

Do you consciously or unconsciously fear being abandoned?

Do you seem to require more time with your partner than those you observe around you?

Does your partner accuse you of having a double standard about the relationship?

Have you said you feel "unsafe" in your relationship?

Do you feel like your partner isn't telling you everything?

Have you ever experienced an overpowering feeling that your partner was keeping things from you? Has your partner expressed feeling falsely accused of doing or saying things?

Do social engagements and vacations often end up in turmoil?

Do you feel a strong need for control?

Are you often afraid that the world is going to cave in on you... .that your life is going to collapse if you aren't in control of everything?

Have you demonstrated outbursts in your most intimate relationships that seemed very appropriate at the time but you regretted later?

Have you suffered from intense bouts of anger that last for hours, maybe even a few days?

Are your expressions of anger sometimes followed by shame and guilt?

Do you ever feel shameful?

After a relationship has ended, have you felt like you're experiencing Post Traumatic Stress Syndrome?

Do you feel like any contact with that person causes you too much stress?

Have you ever cut someone off and refused to speak to them?

Have you continued to refuse contact no matter how hard they try to reach you?

Do you use alcohol or drugs to soothe your emotional pain?

Do you have, or has anyone suggested you have, an eating disorder?

Have you been known to spend too much, eat too much, be sexually promiscuous, or drive too fast?

Have others commented or complained you work too much?

Has anyone ever accused you of being paranoid?

Have you ever cut yourself?

Have you ever experienced so much emotional pain that you felt like you wanted to die?

Have you ever attempted suicide?

[JoannaK]

Do you remember where you read this, lbo?

[atwittsend]

Do you remember where you read this, lbo?

www.borderlinepersonalitysupport.com/borderline-personality-disorder.html

[JoannaK]

This list comes with a very important cavaet:

**Please note affirmative answers to the questions do not indicate a fixed conclusion. They may, however, provide you with the realization that there's a possibility you or a loved one may be a Borderline Disorder Personality. A definitive diagnosis can only be made through an evaluation by a psychiatrist or mental health care clinician who specializes in Borderline Personality Disorder. We can help you find the right professional in your area.

The only "true" test of whether or not someone has BPD is a careful examination of the person's behaviors and feelings against the nine diagnostic criteria by a trained therapist.  Almost everybody can answer "yes" to one or more of the questions in this screening device at some point in his/her life. 

[Skip]

Do you consciously or unconsciously fear being abandoned?

Would we know if we "unconsciously feared being abandoned"?      No slight to the author - all of these tests have value - if only to raise your awareness and encourage you to look further.

There are some professional questionnaires that might be helpful for a more indepth look.

Diagnostic Tests - Diagnostic Interview for Borderline Patients (DIB-R)

The Diagnostic Interview for Borderline Patients (DIB-R) is the best-known "test" for diagnosing BPD. The DIB is a semi structured clinical interview that takes about 50-90 minutes to administer. The test consist of 132 questions and observation using 329 summary statements. The test looks at areas of functioning associated with borderline personality disorder. The four areas of functioning include Affect (chronic/major depression, helplessness, hopelessness, worthlessness, guilt, anger, anxiety, loneliness, boredom, emptiness), Cognition (odd thinking, unusual perceptions, nondelusional paranoia, quasipsychosis), Impulse action patterns (substance abuse/dependence, sexual deviance, manipulative suicide gestures, other impulsive behaviors), and Interpersonal relationships (intolerance of aloneness, abandonment, engulfment, annihilation fears, counterdependency, stormy relationships, manipulativeness, dependency, devaluation, masochism/sadism, demandingness, entitlement). The test was developed to be administered by skilled clinicians, but can also be given by a non professional.

Diagnostic Tests - Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionnaire is available from the American Psychiatric Publishing ($60.00).

Diagnostic Tests - Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. We have included a list of questions most often answered as "yes" by people with Borderline Personality Disorder.



Diagnostic Tests - Other

Other commonly used assessment tests are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

In all cases, if any of these tests lead you to believe that you or someone else in your life has a possible disorder - the best thing is to see a trained professional.

[justwantout]

My BDP husband and I are divorcing, since the separation I've worked really hard to repair family and friend relationships that had been damaged over the years due to the BPD issues of my spouse.  Now that I have my family back in my life they want to help but I am finding it really difficult to explain BPD to people who have never heard of it and aren't used to mental health issues.  When they ask exactly what it is I find I end up feeling really petty when I try and explain all of it. I'm sure thats due to some emotional fallout of all the years of everything being "my" fault.  But, can anyone suggest any articles that are written to that audience, people that have frankly never heard of it let alone imagine living with it.  

[havana]

It is very difficult to explain this to someone that hasn't been there. It will sound petty to most people. If you could think of a way for them to here the thousands of petty things plus the major issues you might have a chance.

[lbjnltx]

consider this article.  simple and to the point.  BPD for beginners!

www.articlesbase.com/mental-health-articles/a-child-like-mind-borderline-personality-disorder-2784170.html

hope this helps.

lbjnltx



Anthony Centore, PhD
Jul 07, 2010

I have sometimes thought that my three-year-old daughter seems borderline
. One minute she is saying, I love you Mommy, and the next minute she is shouting, Go away Mommy! One minute she laughs, the next she cries hysterically.

Time with my daughter helps me understand the world through her eyes. Her world is exciting, yet frightening. Her behaviors and emotions fluctuate to express this. For me, and undoubtedly for her, it sometimes feels like a roller coaster. Thank God, she has me to hold onto.

Adults with BPD often experience emotions much like my three-year-old child. As such, their behavior seems reasonable to them. The problem or pathology arises because these individuals are not childrenthey are adults. In terms of emotion regulation, interpersonal and some cognitive skills, they are at times functioning like children. Growth in each of these areas can occur independently, which results in an adult with the emotional composure of a two-year-old.

The life of those with BPD is a roller coasterchaotic, erratic, and distressed. They frequently feel as though they have no one to hold onto and the ride is getting faster and more treacherous. It involves twists and turns of venting anger, numbing pain, and engaging in self-deprecation. Often this leads to isolation, with ever more shame, anger, and pain.

Although their behaviors may seem game-like, it is not always so. Their behaviors are complex defenses that serve to protect them from what they may perceive as harm, rejection, and inevitable abandonment. These behaviors can be traced back to those of a distressed child, searching desperately for an anchor.

 

If I feel it, it must be true

Just the other day, my daughter said, I feel sad Mommy. It must be a sad day. In general, emotionally healthy people can distinguish between feelings and facts. If you fail a test (fact), you may feel inadequate (feeling). But this does not mean that you are inadequate. It may be just one failed test out of many successes.

Individuals with BPD have difficulty separating feelings from facts. In their economy, if they feel it, it is true. As such, when these individuals feel bad, their self-destructive behavior seems completely reasonable to them. These individuals repeatedly need to revise facts to fit their feelings. This is why their perceptions and beliefs may seem distorted and unstable.

Polarization

As my daughter cognitively matures, she is moving toward an understanding that just because I am angry does not mean I dont love her. However, for the most part at this stage of development, life remains polarized for her into good and bad. Like children, adults with BPD are unable to integrate situations and feelings that involve opposition. This leads to black-or-white thinking, overvaluation oscillating with devaluation, and a process known as splitting.

These cognitive mechanisms are efforts to protect themselves and make sense of the world. Life does not often come in black or white, but instead either black-and-white or many shades of gray. People are both kind and cruel, warm and cold, available and unavailable, depending on situations, needs and various factors. Because a person with BPD cannot cognize a world with complexity of this kind, it is necessary to separate people into black-or-white categories based on their most recent behaviors.

Projection/Blame

Recently my daughter blamed her oneyear- old brother when she tripped over her own toys. This was quite a feat, since her brother was sound asleep at the time! Projection and blaming are powerful weapons of denying ownership and avoiding responsibility. Projection is the process of attributing ones own unpleasant traits, behaviors, and/ or feelings to someone else. This primitive defense allows people with BPD to feel relief from self-condemnation. It also helps them avoid the fear of rejection and abandonment that would be stirred if they directly confronted their brokenness.

Core Issues

Emotion dysregulation is believed to be the core issue of BPD. Therefore, those with BPD manifest relational, behavioral and cognitive disturbances in an effort to achieve emotional modulation. They push others away for emotional protection; they inflict self-injury to numb emotional pain; they dissociate to avoid thinking about trauma; they create fantasies to ease the pain of reality.

Many of these people are intelligent and successful and seem to have everything going for them. However, inside they feel empty and incomplete. Their behaviorswhich may appear to be manipulation and game-playing to those who are targetedare usually done to self-soothe emotionally.

But in the midst of trying to achieve love and remain safe, individuals with BPD can inflict great pain, distress, grief, and anguish on those around them. Individuals with BPD can be frankly abusive. Parents, spouses, children, friends, and professionals involved with a person with this disorder are all vulnerable, not to mention the suffering individuals themselves.

As such, professionals who work with BPD patients or clients risk countertransference and burnout. Professionals and loved ones can spend years trying to understand the patients behaviors and validate feelings. However, this can prove exhausting and self-defeating. As with any dysfunctional behavior that involves abuse, the perpetratorno matter what the reason for his/her behavior must start taking responsibility.

So as a professional committed to working with these patients, it is necessary to bridge the gap between the adult person and the psyche of the disturbed child by not only validating, but also teaching self-capability enhancement. How do we do this?

Grace, Grace and More Grace

During the past ten years, advances in treatment of BPD have occurred in many areas, including biological underpinnings, psychotherapy and pharmacological treatment. One of the most innovative and effective psychotherapeutic approaches to BPD is Dialectical Behavior Therapy, developed by Dr. Marsha Linehan.1 This treatment addresses the extreme dichotomous thinking, for instance, by helping patients find a balance between overvaluing and condemning. It also focuses on developing skills, such as problem solving, selfsoothing, assertiveness, kindness, emotion regulation, and distress tolerance. These approaches, if integrated with Biblical principles, are quite effective.

Whatever treatment is used, Christian professionals know that the approach must offer Gods grace, kindness, and mercy. In an interview regarding his new book, Grace-Based Parenting,2 Dr. Tim Kimmel described grace as loving and honoring them when they are not loving back and loving your child when they dont deserve it. This attitude is necessary in working with BPD patients. In fact, such work can be thought of as grace-based therapy. As Christians, we are taught to love others (Matthew 22:39). Exemplifying Gods love is the only way to truly demonstrate validation, convey acceptance, and show understanding of these individuals.

However, like Christ, we do not accept unacceptable behaviors. Christ accepts and loves us as his children, but also wants us to become like him: go and sin no more (John 8:11). In treatment, then, in addition to validation, we must teach life skills and tools, not unlike what I am currently doing with my child. I teach her to self-soothe, how to deal with disappointment, and how to express and regulate her emotions. My prayer is that as she develops and individuates, she will mature into an independent and godly woman. That is the hope for patients suffering with BPD. One hopes that the gap between child and adult will narrow as they progress through treatment. Take help from telephone counselor.

Clearly, because of their profound skills deficits and intense emotional pain, working with BPD patients requires an emotional, physical and spiritual commitment from the therapist. It is, in a sense, raising and parenting children. What a way to honor God!

 
Retrieved from "www.articlesbase.com/mental-health-articles/a-child-like-mind-borderline-personality-disorder-2784170.html"

[RefugeeFromOz]

I know that this doesn't help to explain it to other people, but for myself one of the reasons it is so difficult to explain to other people is that we were forced - by experience, by pain, and by the simple need to survive - to open our minds to a realm of dysfunctional behavior that others cannot imagine.  When I talk to others about this, I often say it's like learning that the monsters of our childhood dreams actually do exist.  I definitely divide my life into "before" and "after" the BPD experience.  I truly think it's transitional in our develop as people, and we now see into rooms and spaces in our minds, and allow for realities, that others can't imagine.  The scope of the experience goes way beyond words, and that's the fundamental problem.  Unless you can also convey the confusion, frustration, fear, and despair, you can't explain it.

Every time I see one of these posts about how to explain the experience I feel great sympathy for the poster.  We've all been there and I think it will always remain a difficult topic.  We're similar to combat veterans who can only truly communicate and share experiences with other combat veterans.

[sosadandone]

I read alot of others posts here and many seem to focus only on the on/off or irrasible qualities of their partners. I'm not minimizing anyone else's suffering here but I wonder if some are just too quick to label their partner who may just be somewhat quick tempered. IMHO BPD- as I experienced it with my ex was a severe disorder which had many many facets beyond just someone who gets easily upset. In fact mine seldom got angry. However he did have almost all of the other criteria seen in BPDs. In fact when I once sent him Dr Gunderson's criteria and asked how many of them he had; he answered; "all of them". So I am going to list Gunderson's criteria and ask if you would look at them and see how many your partner really exhibits.

I guess what I am suggesting is that we not be too quick to label someone, especially those we claim to love. Here is the list. How many does your partner really have. Mine had almost all

Gunderson and his colleague, Jonathan Kolb, tried to make the diagnosis of BPD by constructing a clinical interview to assess borderline characteristics in patients. The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:

Affect

chronic/major depression

helplessness

hopelessness

worthlessness

guilt

anger (including frequent expressions of anger)

anxiety

loneliness

boredom

emptiness

Cognition

odd thinking

unusual perceptions

nondelusional paranoia

quasipsychosis

Impulse action patterns

substance abuse/dependence

sexual deviance

manipulative suicide gestures

other impulsive behaviors

Interpersonal relationships

intolerance of aloneness

abandonment, engulfment, annihilation fears

counterdependency

stormy relationships

manipulativeness

dependency

devaluation

masochism/sadism

demandingness

entitlement

[Jemima]

Dear sosadandone,

I agree that the problems with some people are much more severe than those of others. I am not familiar with Gunderson's criteria, but the DSM-IV-TR gives nine criteria, not the much more extensive list you gave here. You can be diagnosed by a professional with five. Some of the criteria are more about the pwBPD's inner experience, so if they have not received an official diagnosis, it is their SO, relative, or friend's guess that they are BPD. That's why many people (including myself) designate their problematic person as "uBPD" (undiagnosed BPD).

The way the profession currently defines disorders is using a "categorical" model. Therefore, you can fall into the "category" of a PD or of BPD in particular, yet this says nothing about how severe your problems are. A method of defining disorder according to the severity of dysfunction would be a more "dimensional" model.

It appears that the Gunderson that you reference is attempting to get at the depth and severity of dysfunction in the structured interview you describe.

Depression may be simpler to wrap our heads around when we are talking about categorical vs. dimensional ways of looking at problems. You can meet the criteria for depression with five of the nine criteria for depression --- say, excessive guilt, fatigue, weight loss, insomnia, and depressed mood --- and be SEVERELY impaired (guilt is crippling, you can't get out of bed, you're skin and bones, haven't slept in three weeks, etc.) or MILDLY impaired (unrealistic guilt is uncomfortable, you get to work but aren't as productive, you've lost 10 lbs without trying, sleep 4-5 hours a night, etc.).

I think here at bpdfamily.com we try to support everybody regardless of the level of BPD or even BPD traits in people we are in relationship with.

[Blossom]

We're used to the DSM criteria for BPD, but i was looking at BPD resources and came across the ICD criteria which i hadn't seen in some time; i felt the differences were interesting and in turn, thought they may be interesting here. My search was sparked by the increase in discussion of the diagnosis itself on the boards (at least, that i've seen) and despite my H not presenting in perhaps the same volatile way as others, he is most definitely BPD. Anyway, i digress, i've lifted this from Wiki but the differences were, i thought, very interesting:

www.en.wikipedia.org/wiki/Borderline_personality_disorder

Diagnostic and Statistical Manual

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[1][14]    A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

       1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

       2. A pattern of unstable and intense interpersonal relationships characterized by alternating 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., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

       5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

       6. 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).

       7. Chronic feelings of emptiness

       8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

       9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

International Classification of Disease

The World Health Organization's ICD-10 defines a conceptually similar disorder to borderline personality disorder called (F60.3) Emotionally unstable personality disorder. It has two subtypes described below.[26]F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

   1. marked tendency to act unexpectedly and without consideration of the consequences;

   2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;

   3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;

   4. difficulty in maintaining any course of action that offers no immediate reward;

   5. unstable and capricious mood.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

   1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);

   2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;

   3. excessive efforts to avoid abandonment;

   4. recurrent threats or acts of self-harm;

   5. chronic feelings of emptiness.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

[Skip]

DSM-5 sheds some light... .

The DSM-5, due out in 2013, will bring a number of changes to the definition of the personality disorders.  The working group is trying to do away with the complex multiaxial diagnostic approach and to make the personality disorders more discrete (less overlap) - basically the Axes I, II, III will be consolidated to one -- the 10 personality disorders will be reduced to 5 or 6.

But maybe the greatest change for non-professionals like ourselves, is that they are attempting to clearly define the lne between personality disorder and personality style.

Have a look... .



The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

Self (impairment in at least 1):

Identity: Experience of oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity for, and ability to regulate, a range of emotional experience.  To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Self-direction: Pursuit of coherent and meaningful short-term and life goals; utilization of constructive and prosocial internal standards of behavior; ability to self-reflect productively.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Interpersonal (impairment in at least 1):

Empathy*: Comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding of the effects of own behavior on others.    To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).

Intimacy*: Depth and duration of positive connections with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior.   To be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).





Below is the scale for "empathy".  There are four scales in total.

Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing.  Is aware of the effect of own actions on others.

Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.

Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.

Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering.  Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.

Extreme Impairment (4)  Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance).  Social interactions can be confusing and disorienting.



Here is the scale for intimacy.  There are four scales in total

Healthy (0) -Maintains multiple satisfying and enduring relationships in personal and community life. Desires and engages in a number of caring, close and reciprocal relationships. Strives for cooperation and mutual benefit and flexibly responds to a range of others’ ideas, emotions and behaviors.

Mild impairment (1) -Able to establish enduring relationships in personal and community life, with some limitations on degree of depth and satisfaction.Capacity and desire to form intimate and reciprocal relationships, but may be inhibited in meaningful expression and sometimes constrained if intense emotions or conflicts arise. Cooperation may be inhibited by unrealistic standards; somewhat limited in ability to respect or respond to others’ ideas, emotions and behaviors.

Impaired (2) Capacity and desire to form relationships in personal and community life, but connections may be largely superficial. Intimate relationships are largely based on meeting self-regulatory and self-esteem needs, with an unrealistic expectation of being perfectly understood by others. Tends not to view relationships in reciprocal terms, and cooperates predominantly for personal gain.

Very Impaired (3) Some desire to form relationships in community and personal life is present, but capacity for positive and enduring connection is significantly impaired. Relationships are based on a strong belief in the absolute need for the intimate other(s), and/or expectations of abandonment or abuse.  Feelings about intimate involvement with others alternate between fear/rejection and desperate desire for connection. Little mutuality: others are conceptualized primarily in terms of how they affect the self (negatively or positively); cooperative efforts are often disrupted due to the perception of slights from others.

Extreme Impairment (4)  :)esire for affiliation is limited because of profound disinterest or expectation of harm.  Engagement with others is detached, disorganized or consistently negative. Relationships are conceptualized almost exclusively in terms of their ability to provide comfort or inflict pain and suffering. Social/interpersonal behavior is not reciprocal; rather, it seeks fulfillment of basic needs or escape from pain.



The remaining scales are listed here:  dsm5.org/ProposedRevisions.aspx?rid=468

[rich5a]

Are people with BPD psychotic as well as neurotic... .Can someone explain that a little better. I know there are varying degrees of the disorder... .does the BPD individul who suffers more psychotic episodes make them extremely disordered?

Thanks