Do I Have Borderline Personality Disorder? The Signs and Symptoms of BPD

Monday, September 22, 2014 by Meg   •   Filed under Sexuality/Relationships

When people talk about codependent relationships, they often refer to traits seen in Borderline Personality Disorder (or BPD). Borderline Personality Disorder usually emerges in adolescence or early adulthood, though some symptoms may emerge sooner. It can be a difficult condition to treat due to the intense emotions inherent in the personality and the depression, anxiety and panic that tend to crop up at any hint of abandonment. For additional reading, Borderline Personality Disorder Demystified, Mindfulness for Borderline Personality Disorder, The Borderline Personality Disorder Survival Guide and Get Me Out of Here: My Recovery from Borderline Personality Disorder are all great resources. 

But you're here because you want more information RIGHT THE HECK NOW. So  I invited a friend to give you a run down of what Borderline Personality Disorder looks like from inside couples counseling sessions. Because despite the name calling often endured by those with this issue, having Borderline Personality Disorder does not make you “crazy”.  But overcoming it usually requires professional assistance in order to strengthen adult attachment patterns and provide a base of safety upon which individuals can build healthier relationships.

Help is available. Don't go it alone.

I Am Not “Crazy.” I Have Borderline Personality Disorder.    

By: Dr. Samantha Rodman

Many men come to couples counseling saying in no uncertain terms that their wives are crazy.  When I ask what they mean, they say that their wife is extremely volatile, her moods are all over the place and she either loves him or hates him. They might tell me that she acts impulsively (i.e., reckless driving, overspending, drinking too much), that she tends to feel depressed and empty a lot, that she can’t stand to be on her own. But the key feature is that she tends to “freak out” when she feels abandoned.  And she feels abandoned at the slightest reason, even if he just has to go to work.

Well this certainly does sound "crazy."  What could be going on?  Generally, this pattern of behavior indicates that an individual may fit the diagnosis for Borderline Personality Disorder (BPD).

What is Borderline Personality Disorder (BPD)?

According to the Diagnostic and Statistical Manual (DSM-V), to meet a diagnosis of Borderline Personality Disorder, you must show “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following”2:

  1. Frantic efforts to avoid real or imagined abandonment (e.g., they become very upset when they think you’re going to leave them)
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (i.e., they love you or hate you, everything is black or white. One classic book about BPD is called I Hate You, Don't Leave Me)
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self (e.g.,  careers, religions, appearance, and even sexual orientation can be fluid)
  4. Impulsivity in at least two areas that are potentially self-damaging, e.g., substance abuse, binge eating, and reckless driving (This may also include overspending, frequent casual sex or starting fights.)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behaviors (such as cutting)
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria (bad mood), irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness (which leads to intolerance of being alone)
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms (under stress, those with BPD may think everyone is out to get them or they detach from the present reality)

Who Gets Borderline Personality Disorder and WHY ME?

Men are diagnosed with BPD as well, but 75% of individuals diagnosed with BPD are women, possibly because men are more frequently diagnosed with narcissism and antisocial personality disorder when presenting with the same symptoms1.

BPD, like many psychological issues, is thought to stem from both nature and nurture.  In this case it’s an innately sensitive temperament coupled with an invalidating environment.  An invalidating environment is one where a child’s sense of reality is denied, or when parents systematically state or imply that the child’s viewpoint is unworthy of respect. Invalidation occurs any time a child is told not to feel what they feel.  This occurs frequently in homes with abusive, alcoholic, narcissistic, or borderline parents.  Abuse is a severe form of invalidation; after physical, sexual, or emotional abuse, the child is often told that it didn’t happen and/or not to tell anyone.  This makes the child doubt whether abuse really did occur or whether they are crazy.

As adults, individuals with BPD find it very hard to be in successful intimate relationships.  At first they can come off as the ideal partner, because they are seductive, charming, and bend their personalities to be whatever their new partner wants. (This is easy because they usually had to mold themselves into what a parent wanted in order to gain favor or avoid abuse.)  But, over time, people with BPD start to act clingy, jealous, and don’t usually like partners to be away from them at all.  They may become very upset when their partner prioritizes anything over the relationship, and will often threaten to leave, or to hurt themselves.  Relationships where one partner has BPD are often very volatile, with blowout fights and dramatic and passionate reconciliations.  

It makes a lot of sense that a child who grew up unable to trust her parents to provide consistent love and support would develop a debilitating fear of being abandoned in later intimate life.  The concept of attachment panic is that mammals need to be attached to a caregiver to survive, and when the caregiver is detached, or distant, this triggers an evolutionarily adaptive panic response.  Thus, in relationships, when a partner acts distant or cold, most people experience anxiety.  For someone with BPD, there is a very low threshold for feeling this anxiety, because they grew up being so uncertain of the love of their caregivers.  So even when a partner says he has to go to the store, something in the back of the BPD individual’s mind will think he’s leaving forever, and she will become uncomfortable and clingy.

Often, women with BPD pair with men who tend toward narcissism.  Narcissists don’t find the immediate devotion shown by their BPD partner to be strange, and often enjoy someone who is so “obsessed” with them, even though they will deny this and say they “hate drama.”  The BPD partner finds it subconsciously familiar to be with a partner who is self-absorbed and invalidating of their needs, as this is what they likely grew up feeling.  So this is a common pairing that is seen in couples counseling, and is an extreme version of what I call the “Mr. Perfect and His Crazy Wife” dynamic.

Although therapists used to think that BPD was untreatable, great strides have been made and many individuals with BPD show tremendous and long-lasting improvement post therapy.  If the symptoms of BPD resonate with you, therapy is often very helpful for this disorder, so don’t be afraid to seek counseling.  You’re not crazy, and there is likely a very good reason why you behave the way you do.  

Dr. Samantha Rodman is a clinical psychologist in private practice in Maryland and a happily married mom of three kids under 5.  She blogs on Dr. Psych Mom, and has been featured in The Washington Post, The Huffington Post, The New York Times and Scary Mommy. Like her on Facebook, and tweet to her @DrPsychMom.

 

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Citations
  1. http://www.ncbi.nlm.nih.gov/pubmed/14686459
  2. http://www.amazon.com/Diagnostic-Statistical-Manual-Disorders-Edition/dp/0890425558



Topic-Relevant Resources

Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD
All the basics on Borderline Personality Disorder including helpful techniques to cope with symptoms.

Get Me Out of Here: My Recovery from Borderline Personality Disorder
This one of a kind book takes you inside the mind of someone with BPD and details a personal recovery from the disorder.

The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD
The title says it all. Great run down of what BPD is and how to live with it.

Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy
How to use mindfulness tactics and Dialectical Behavioral Therapy (DBT) in the treatment of Borderline Personality Disorder.

I Hate You--Don't Leave Me: Understanding the Borderline Personality
A look inside Borderline Personality Disorders and effective treatments.