Well if you are into the cold, harsh, clinical definitions check out the official diagnostic criteria for Borderline Personality Disorder below. Doesn’t really sound that great from a lay person’s perspective, does it? And trust me, as a sufferer it’s horrible to recognise yourself in this. The diagnostic criteria are so dehumanising, and as someone who feels wholly disordered and depersonalised, I found this quite confronting. Family and friends or the curious masses look at this, but it doesn’t help them understand. Being understood is vital for people with BPD.
So, I am going to break these criteria down into my own experience of the disorder on individual posts. If you suffer from BPD, you may identify with some of what I’ll share, and hopefully feel a little less alone. Living with BPD is a crippling, isolating, and deeply misunderstood illness. For family and friends, hopefully, this helps you understand your loved one better.
On a super important note, if you or your loved one has been diagnosed with this – for goodness sake don’t google it! It is one of the most stigmatised and misrepresented disorders out there – the world is full of haters, and if you go down that path, it will hurt. I recommend educating yourself further through official, recognised channels, e.g. BPD Foundation, Beyond Blue, SANE, Headspace and other official mental health sites.
The good news folks is that there is a way out of this – recovery is possible, but I’ll deal with that in a later post.
First the boring official bit which I picked up from the BPD Foundation https://bpdfoundation.org.au/diagnostic-criteria.php.
BPD is usually diagnosed using American Psychiatric Association Diagnostic and statistical manual of mental disorders 4th edition – text revision (DSM-IV-TR) criteria (see table below).
World Health Organization International statistical classification of diseases and related health problems 10th Revision (ICD-10) also includes diagnostic criteria for unstable personality disorder, borderline type (see table below).
DSM-IV-TR diagnostic criteria for BPD*
A pervasive pattern of instability of interpersonal relationships, self-image and affects, (also here) and marked
impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five
(or more) or the following (in addition to general diagnostic criteria for a personality disorder):
1. Frantic efforts to avoid real or imagined abandonment
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
(here, and here and here)
4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance
abuse, reckless driving, binge eating)
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour here and here
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) here and here
7. Chronic feelings of emptiness
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
So what causes BPD?
Is it just another “mental illness”? Is there a physiological aspect to it? Is it genetic or hereditary? Biological or biosocial? Is it contagious? (Nope – definitely not the latter – you can rest easy on that one!) However, there are different theories, and research is still ongoing, as I’m not an expert I’ll just stick with what my doctor has told me – a much-simplified version.
In general, there is thought to be a genetic component, i.e. some people are just naturally sensitive. Beautiful, caring, vulnerable and sensitive people. We are simply born that way, but being raised in an abusive, or even disruptive or invalidating environment traumatises us. When I say traumatises us, I do mean actually, physically alters our brain. Different neurochemicals affect the physical structure and if we get too much of the wrong ones … we become damaged.
Two parts of the brain are affected – the prefrontal cortex and the amygdala. The prefrontal cortex is like a control centre; how to behave, whether the decisions you make are sensible; the difference between right and wrong – it is rational. The amygdala, on the other hand, is not rational. It is your emotional centre. Emotions are experienced and processed here it is also your survival centre, i.e. fight or flight.
So in most people, these two parts of the brain work hand in hand. You experience an emotion through your amygdala and your prefrontal cortex analyses it, rationalises it and tells you how to behave. But with BPD, the prefrontal cortex doesn’t function correctly. Theories include improperly formed from birth, trauma damage, e.g. erosion due to the brain producing too much cortisol. Which leaves an over-active amygdala running the show. Effectively we are controlled purely by our emotions, and the ability to regulate and rationalise is missing.
Bu purely controlled by our emotions I simple mean we feel more. Non-BPD sufferers apparantly feel emotions on a scale of 0-20% and emotions last 5-20 seconds. BPD sufferers have an emotional baseline of around 80% and our emotions last hours to days. So they are extreme, intense and prolongued. For me there is no in between state of emotions – I am locked in one emotion until triggered to the next. It is exhausting!!
Is there a cure?
YES! If you have BPD, your brain can be “rewired” as it were. It’s not an easy road, it is hard work, you will take two steps forward and sometimes fall into a heap, but it does get easier. There is hope, so hang in there and don’t die eh?
You can get better!