Author: Dr. Christopher Deussing

Personality disorders are entrenched patterns of inner experiences & behaviors that deviate from an individual’s cultural norms.

These patterns manifest in 2 or more realms: (a) emotions, (b) cognitions, (c) impulse control, & (d) interpersonal relationships. These patterns are ubiquitous across multiple spheres of functioning (Bhui, 2018).

Borderline Personality Disorder (BPD) usually emerges by adolescence. A person with BPD will have experienced unstable relationships for years. This interpersonal chaos often connects to the individual’s self-representation & early family interactions. This relational dissonance infiltrates multiple settings & regularly pairs with an analogous emotional lability that can rapidly cycle (Linehan, 1993).

Individuals with BPD are highly sensitive, increasing vulnerability to environmental conditions (Kernberg et al., 2009). The perception of separation, rejection or loss of structure can create radical shifts in emotions, self-image, thoughts, & behaviors. Considering this, BPD can be viewed primarily as a disorder of emotional dysregulation (Gunderson, 2008).

Individuals with BPD may experience abandonment terror when faced with separation. For example, a client with BPD may feel despair when a therapist announces a vacation. This fear of abandonment may lead them to believe they are a bad person and impair one’s ability to be alone, resulting in a need to engage with people in destructive dynamics (Kreisman et al., 2021).

The American Psychiatric Association (APA) delineates 9 criteria for BPD; at least 5 of these criteria are needed to diagnose BPD (2013):

• (a) chronic feelings of emptiness;

• (b) emotional instability toward daily events (e.g., episodic sadness or irritability lasting a few hours);

• (c) frantic efforts to avoid real or imagined abandonment;

• (d) identity disturbance with unstable sense of self;

• (e) impulsive behavior in 2 or more areas that are self-destructive (e.g., sex, drugs, disordered eating)

• (f) difficulty controlling anger (e.g., rage outbursts);

• (g) highly entropic relationships characterized by splitting between deification & demonization;

• (h) recurrent suicidality or self-harm (e.g. cutting); and

• (i) transient, stress-related paranoia or severe dissociation.

However, this is only one way to view BPD. We must remember the DSM-V is not the end-all-be-all. We need innovative & contrarian ways to conceptualize BPD to further evolve our understanding of this complex disorder (Deussing, 2023).

References:

APA. (2013). Diagnostic & statistical manual of mental disorders: DSM-V.

Bhui, K. (2018). Complex personality disorders.

Deussing, C. (2023). Advanced dialectical behavior therapy mechanisms of change.

Gunderson, J. (2008). Borderline personality disorder: A clinical guide.

Kernberg, O. & Michels, R. (2009). Borderline perosnality disorder.

Kreisman, J. & Straus, H. (2021). I hate you — don’t leave me.

Linehan, M. (1993). Cognitive behavior therapy of borderline personality disorder.