Notes on Borderline Personality Disorder (BPD)

Originally written on March 8, 2019

*Information from Wikipedia

Borderline personality disorder is characterized by the following signs and symptoms:

- Markedly disturbed sense of identity
- Frantic efforts to avoid real or imagined abandonment and extreme reactions
- Splitting ("black-and-white" thinking)
- Impulsivity and impulsive or dangerous behaviors (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation
- Unstable and chaotic interpersonal relationships
- Self-damaging behavior
- Distorted self-image
- Dissociation
- Frequently accompanied by depression, anxiety, anger, substance abuse, or rage

The most distinguishing symptoms of BPD are marked sensitivity to rejection or criticism, and intense fear of possible abandonment. Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Fear of abandonment may lead to overlapping dating relationships as a new relationship is developed to protect against abandonment in the existing relationship. Other symptoms may include feeling unsure of one's personal identity, morals, and values; having paranoid thoughts when feeling stressed; depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.

People with BPD may feel emotions with greater ease, depth and for a longer time than others do. A core characteristic of BPD is affective instability, which generally manifests as unusually intense emotional responses to environmental triggers, with a slower return to a baseline emotional state. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them. According to Dr. Marsha Linehan, the sensitivity, intensity, and duration with which people with BPD feel emotions have both positive and negative effects. People with BPD are often exceptionally enthusiastic, idealistic, joyful, and loving. However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.

People with BPD are also especially sensitive to feelings of rejection, criticism, isolation, and perceived failure. Before learning other coping mechanisms, their efforts to manage or escape from their very negative emotions may lead to emotional isolation, self-injury or suicidal behavior. They are often aware of the intensity of their negative emotional reactions and, since they cannot regulate them, shut them down entirely since awareness would only cause further distress. This can be harmful to people with BPD, since in normal functioning negative emotions alert people to the presence of a problematic situation and move them to address it. People with BPD may feel emotional relief after cutting themselves.

While people with BPD feel euphoria (ephemeral or occasional intense joy), they are especially prone to dysphoria (a profound state of unease or dissatisfaction), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognized four categories of dysphoria that are typical of this condition: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity, and feelings of victimization. Within these categories, a BPD diagnosis is strongly associated with a combination of three specific states: feeling betrayed, feeling out of control, and "feeling like hurting myself." Since there is great variety in the types of dysphoria experienced by people with BPD, the amplitude of the distress is a helpful indicator of borderline personality disorder.

In addition to intense emotions, people with BPD experience emotional "lability" (changeability, or fluctuation). Although that term suggests rapid changes between depression and elation, the mood swings in people with this condition more frequently involve anxiety, with mood fluctuating between anger and anxiety and between depression and anxiety.