Symptoms of Borderline Personality Disorder

Borderline personality disorder (BPD) is defined by the Diagnostic and Statistical Manual of Mental Disorders-IV as a pattern of instability in interpersonal relationships in an individual’s life, along with an unstable self-image, affect, and increased impulsivity starting in early adulthood. In order for a mental health professional to diagnose BPD, five or more patterns of behavior must be present.

Individuals with BPD may experience unstable relationships that cycle between idealization and devaluation. These individuals may make frenetic efforts to avoid abandonment, whether it is real or imagined. Another sign of borderline personality disorder is impulsivity in two or more areas of life such as reckless sex, spending, driving, binge eating or substance abuse. These may be self-damaging or self-mutilating behaviors.

Some individuals display recurring suicidal behaviors which may include gestures and threats. This disorder is the most lethal of all psychiatric disorders. Up to 10 percent of patients with BPD commit suicide, which is 50 times higher than the rate of the general population. This makes borderline personality disorder of intense interest to researchers and policymakers alike, because in the United States BPD affects 5.9 percent of the general population.

Individuals with BPD suffer from chronic feelings of emptiness. Some who suffer from BPD have feelings of extreme anger that they rarely express to family or loved ones. Others may be physically aggressive. The amount and form of anger expressed vary; some may display a temper while others will frequently get into physical fights.

Paranoia may arise in situations of stress. Distress causes these individuals to feel intense emotional pain, which may be an adaptive response to repetitive childhood trauma. Distress for these individuals is discomforting and arises from a specific stressor. The loss of a parent, parental mental illness, exposure to violence, and emotional, physical or sexual abuse are reported in 90 percent of those with BPD. Due to emotional and physical trauma, dissociation may occur. Dissociation is a state of consciousness disruption that impairs perception, memory and identity.

There are particular patterns of behavior that family and loved ones may observe in the individual’s life. Instability is one of the only constants in the lives of those with BPD. This instability is pervasive and exists in a range of contexts. Because this individual fears that separation or rejection may be inevitable, they are sensitive to changes in their circumstances. For example, if plans suddenly change or appointments are canceled, these individuals may react inappropriately with anger or panic.

Individuals with BPD may fear abandonment even when an appropriate length of separation must be faced. They may experience irrational beliefs; for example, a cancellation or plan change may be taken as a sign that they are being wholly rejected. In general these fears are connected to their discomfort with being alone and a need to be with others.

Potential caregivers are put on a pedestal very quickly but this typically does not last, as naturally the caregiver will eventually disappoint. Those with BPD tend to view people as either all good or wholly bad, without a gray area. The reason for this is that they oscillate between idealization and devaluation in their relationships.

The symptoms, experiences and progression for each individual with BPD will be unique. Recent studies focused on the personality dimensions of BPD found that the disorder is characterized by high neuroticism and low agreeableness coupled with low conscientiousness. These findings are in line with the BPD symptoms of identity issues and abandonment fears.

In general, the symptoms are maladaptive behaviors used to manage the perceived negative messages received from others. Although they crave love and support, their fear of abandonment leads to instability. But the core feature of this disorder is chronic interpersonal dysfunction. Their relationships are frequently damaged because of their expectations of rejection.

Typically mental health professionals and health care workers who encounter BPD mistakenly believe that the individual can control their own behavior. Those who are close to an individual with BPD may feel less empathy and support due to this lack of understanding. Encounters with a person with BPD may be confrontational or aggressive. They may be needy or dependent, and often use manipulation to meet a perceived need.

It is important to keep in mind that those suffering with BPD have difficulties with emotion regulation. They are sensitive to rejection, and may resort to self-harm due to overwhelming emotions such as anxiety, distress, guilt and shame. Even after other BPD symptoms have remitted, their interpersonal problems persist and tend to be the primary focus during treatment. Calmness, empathy, flexibility and honesty are vital for interacting with those who have BPD.