Julie Miller's Mental Health Blog

Borderline #2

Posted on: February 24, 2010

Borderline personality disorder can be .  very complicated to define.  Like with any personality disorder, the specific behavioral and emotional criteria are pervasive and chronic.

Five or more of the following criteria are required for an official diagnosis of borderline personality disorder.  An individual can also have borderline “traits” or “features” and this would require only one or more of these criteria.

A personal with borderline personality might:

  • Avoid real or imagined abandonment at almost any cost
  • Experience a pattern of alternating between intense admiration and hatred of others
  • Experience an unstable self-image or even uncertainty about his or her own identity
  • Behave impulsively in ways that hurt themselves, including spending, frequent or  unprotected sex with many partners, substance abuse, disordered eating, reckless driving, etc.
  • Think about suicide often, make repeated suicide attempts, or self-injure through cutting or burning himself or herself
  • Experience frequent emotional overreactions or intense mood swings, including feeling depressed, irritable, or anxious, lasting for only a few hours at a time or a day or two
  • Feel a sense of emptiness on a long-term basis
  • Experience inappropriate, fierce anger or problems controlling anger
  • Experience temporary episodes of feeling suspicious of others without reason (paranoia) or losing a sense of reality

You may relate to several things listed above, or maybe just one or two.  Many individuals, who do not meet the full criteria for a borderline personality diagnosis, experience one or two of these criteria in their personality.

There may be several possible reasons an individual may experience these conditions.  Sometimes, as discussed in the previous post, other issues may seem to be like a borderline personality feature, but if considered more carefully by the mental health professional, that particular symptom may really be part of some other condition.

I have met a client more than once who came with a label of “borderline” but who was not borderline; instead, perhaps they had PTSD (post-traumatic stress disorder; see “‘P’ is for PTSD” in upcoming posts), or bipolar disorder/manic or hypermanic phase, or even a different personality disorder such as histrionic or dependent.

It’s also helpful to think of borderline personality, along with any other personality, traits or features, as relating to problems with attachment, sometimes called “attachment trauma.”

Consider the first criteria listed above:  “avoid real or imagined abandonment at almost any cost.”  This is a fairly common symptom experienced by individuals from dysfunctional families in which they were abandoned (physically, emotionally, etc.) by important caregivers.  The degree to which a person is abandoned as an infant or child is very likely the degree to which they will avoid a recreation of that experience as an adult.

Given this perspective, one can perhaps understand the chronic, long-term, pervasive nature of a personality disorder like borderline personality.  The more chaotic the attachment experience as an infant or child, the more chaotic the attachment style will be as an adult, leading to frantic attempts to avoid abandonment, a highly volatile relationship style (“I hate you/don’t leave me”), difficulty regulating one’s own emotions (including attempts to do so in self-destructive ways), and difficulty with a solid sense of self.

Other symptoms often co-occur with borderline personality issues, including depression, anxiety, dissociation, addictions (chemical or “process” like spending, sex, gambling, relationships, etc.), eating disorders, etc. This is no simple problem, and treatment can be slow and complicated.

Next time, I’ll talk about treatment options.

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