BPD diagnosis and traits
Personality is the characteristic patterns of thinking, feeling, and behaving that makes us distinctive as people. Not all patterns are the same all the time, but the way we interact and engage with the world is quite consistent across situations and over time. Therefore, people are often described as “bubbly”, “shy”, “meticulous”, etc. These derivatives of personality traits are so intrinsically connected to an individual’s identity that the term “personality disorder” may leave one feeling that something is fundamentally wrong with his/her identity and therefore the term can be stigmatising or unhelpful.
However, when clinicians use the term “personality disorder” it does not mean there is something wrong with an individual’s character, rather it describes longstanding difficulties in how individuals think and feel about themselves and others, and consequently of situations where they may struggle to cope or function healthily. BPD is one of ten personality disorders recognised in the Diagnostic Statistic Manual of Mental Disorders (DSM-5).
“Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.” ― James A. Chu
For someone to have a personality disorder, their thoughts, feelings and behaviours are problematic, persistent and pervasive in their daily life.
EMOTIONS MATTERS, INC. – Spreading awareness about BPD
Having a BPD diagnosis or trait is associated with specific problems in interpersonal relationships, identity, emotions, behaviours, and thinking.
- Relationships: BPD is associated with intense relationships characterised by instability, conflict, and breakups. Relationships with loved ones may be idealised or devalued due to black-or-white thinking. There may be demand to spend a lot of time with a loved one and share a lot of intimate details early in the relationship, then flip quickly to hatred. The fear of abandonment whether real or imagined can lead to intense anxiety, fear or anger. A push-pull dynamic can occur of which individuals will make frantic efforts to prevent the perceived abandonment from loved ones by begging, fighting or threatening self-harm.
- Identity: Individuals with BPD have difficulties grasping a stable sense of their careers, sexuality, values and types of friends. They may report rapid extreme changes and have no sense of who they are or their life directions. This can result in distorted self-image and disturbed relationships.
- Emotions: Emotional instability due to high sensitivity and difficulty with regulating emotions, even to minor events, is a key feature of BPD. Individuals with BPD can report frequent mood changes from feeling happy to extremely down or inappropriate anger within a few minutes. Once triggered, it can take a long time to return to a more stable mood. Regulating these unpredictable emotional surges can be overwhelming and can leave individuals with BPD feeling empty and out of control. People with BPD may deliberately harm themselves or have suicidal behaviour as a distraction or relief from emotional distress, punishment towards themselves or as an expression of their inner pain.
- Behaviours: Disinhibition as a way of easing distress in individuals with BPD is characterised with the tendency to engage in risky and impulsive behaviours such as shopping sprees, binge eating, under eating, reckless driving, shoplifting, unsafe sex, drug and alcohol misuse, and deliberate self-harm. Dissociation is the feeling of being “checked out” and is a way of coping with distress. Sometime is can be helpful however, it can be dangerous when doing things while dissociated.
- Thinking: Ongoing feelings of emptiness can be perceived physically in the chest or abdomen, like a hole that needs to be filled. These feelings can occur from a few reasons, such as, being let down, expecting to be let down by others, a lack of close relationships or shutting out to stop emotional surges. During times of stress, people with BPD may have paranoia of threats or dangers that don’t exist. They may worry about judgement from others and either withdraw from social groups or show aggression to perceived threats. People with a history of trauma may be hypersensitive to their surroundings as a defense mechanism from perceived dangers.
How common is BPD?
Between 1-4% of the population is estimated to have BPD diagnosis. Around 10% of people in outpatient mental health treatment are thought to have BPD, and around 20% of patients admitted to psychiatric hospitals have BPD. Symptoms usually first appear in late adolescence and seem to peak in early adulthood before getting better with age.
Who can make a diagnostic assessment?
Only psychiatrists or psychologists can make a diagnosis. A general practitioner (GP) can assist with referral to a mental health professional with experience in the assessment and treatment of psychiatric disorders and other specialist mental health services (such as private group treatment programs). Services such as the Australian Psychological Society referral service can also provide information with regard to experienced practitioners. GPs can also facilitate a referral for the one-off psychiatric assessment and treatment recommendations that come under Medicare.
See Recovery Point – Mental Health Professionals to understand the difference among mental health clinicians.