borderline personality disorder

borderline personality disorder is a psychological condition marked by a prolonged disturbance of personality function, characterised by unusual variability and depth of moods. these moods may secondarily affect cognition and interpersonal relations. the disorder typically involves an unusual degree of instability in mood and black-and-white thinking, or splitting. BPD often manifests itself in idealisation and devaluation episodes and chaotic and unstable interpersonal relationships, issues with self-image, identity, and behaviour; as well as a disturbance in the individual’s sense of self. in extreme cases, this disturbance in the sense of self can lead to periods of dissociation.

SYMPTOMS - 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 behaviour covered in criterion (5);
2. a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation 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, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). note:do not include suicidal or self-injuring behaviour covered in criterion (5);
5. recurrent suicidal behaviour, gestures, threats, or self-injuring behaviour 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-relation paranoid ideation, delusions, or severe dissociative symptoms.

DIFFERENTIAL DIAGNOSES - comorbid (co-occurring) conditions are common in BPD. when comparing individuals diagnosed with BPD to those diagnosed with other personality disorders, the former showed a higher rate of also meeting criteria for:

• anxiety disorders
• mood disorders (including clinical depression and bipolar disorder)
• eating disorders (including anorexia nervosa and bulimia nervosa)
• and, to a lesser extent, somatoform or factitious disorders
• dissociative disorders
• substance abuse is a common problem in BPD, whether due to impulsivity or as a coping mechanism, and 50 percent or 70 percent of psychiatric inpatients with BPD have been found to meet criteria for a substance use disorder, especially alcohol dependence or abuse which is often combined with the abuse of other drugs.