THE DIAGNOSIS

DISCLAIMER

Borderline Personality Disorder is highly dependent on the patient. There are 256 possible combinations of the main symptoms which means 256 different possible ways of manifesting. On top of that, the causes will vary, the schemas will vary and how you, or your loved one, cope with the symptoms will vary.

I highly recommend seeking professional help and getting a professional diagnosis if you don't already have one.

I've benefitted from a specialist therapist and, through professionals, have been diagnosed as, at least, borderline genius. Alongside hyperawareness of both my own thoughts and emotions, as well as the emotions of others, I view the world in a largely unique way. Navigating help that's readily available can be beneficial but a therapist that knows both you and the condition can help tailor much more efficient treatment.

What's In a Name?

Borderline Personality Disorder, a.k.a. Emotionally Unstable Personality Disorder, or less commonly, Emotional Intensity Disorder, is considered to be one of the most debilitating, severe, psychologically painful, stigmatised and misunderstood of all the mental health conditions.

Its name doesn't help. The term "disorder", particularly combined with "personality", conjures up all manner of preconceptions. It implies there's something fundamentally wrong with the sufferers personality but this is an issue with the naming conventions and not the sufferer. Indeed, when discussing disorders of any type, the "disorder" aspect is more to demonstrate that whatever precedes it is something that impacts normal functioning. For example, post-traumatic stress disorder is stress caused by previous trauma that impacts the sufferers ability to function normally. As such, while "personality disorder" is perfectly apt as a descriptor of a subset of mental health conditions, it is more beneficial to ignore the "disorder" part of the name.

"Borderline", in this instance, comes from the fact that those with the illness don't fall in either the psychotic or the psychoneurotic camps by which most mental health conditions were categorised at the time. There is a lot of contention with this as the term "borderline" has evolved to refer to different things within the psychological community and its use in BPD is therefore now misleading.

"Personality", in psychology, is the enduring sets of behaviours and traits that distinguish each of us as individuals. As BPD diagnosis relies on recognising these enduring behaviours as symptoms, it is much more appropriate in its use and doesn't need to be considered with "disorder".

There have been and currently are many discussions about renaming the condition based on the symptoms outlined further below. These names include:

Emotionally Unstable Personality Disorder

Emotional Intensity Disorder

Emotional Dysregulation Disorder
Impulse Disorder
Interpersonal Regulatory Disorder
Post-Traumatic Personality Disorganisation

Personally, I prefer Cognitive Affective Instability Disorder (CAID) as it reflects the instability in thinking (cognitive) and emotion (affective) but this isn't as common an alternative.

Symptoms

Borderline Personality Disorder (BPD) is diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) though more simplified in the DSM-IV. It requires that at least five of the nine symptoms are met for a diagnosis to be made. There are some issues with this as many of the symptoms overlap with other conditions but they are (from the DSM-IV for ease of comprehension with additions below from myself):

1. Frantic efforts to avoid real or imagined abandonment.

These may include, but aren't limited to: abandoning relationships first for fear that they'll abandon you; getting into emotionally or physically intimate relationships quickly; paying excessive attention to their needs often to your own detriment, i.e. financially or physically.

2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

You may have come across the term "splitting". It's considered to be a defense mechanism defined by an inability to hold opposing thoughts or feelings. I find the "black and white thinking" descriptor more fitting as you effectively don't see the world in the shades of grey that it is. The positives and negatives are no longer weighed appropriately; a situation is either entirely bad or entirely good and the opposing evidence no longer matters. You may find you idealise someone and they become your "favourite person" who, despite all their obvious flaws, can do no wrong. Until they do something wrong to you or against your values and, no matter how you felt about them before, the reverse becomes true and positives no longer matter. This can be reversed and the pattern repeat.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

Personally, I find this is a double-edged sword. I am able to adapt myself to all manner of people to fit in chameleon-like with whomever I'm interacting with (with limits). This can, however, be exhausting for some and may shape the personalities of others entirely. It may manifest in changing who you are completely evidenced by changing opinions/beliefs, career, friendships, aspirations, etc. Of course, research is now showing personality is an ever-changing aspect but, in those of us with BPD, the changes are much more profound whether between situations or over a longer period. Having a strong sense of identity gives us the ability to adapt to changes around us and to develop self-esteem. As a result, an unstable self-image can often lead to deep feelings of guilt, shame and self-loathing or seeing ourselves as "bad".

4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).

Self-explanatory really. While it specifies "reckless" specifically in terms of driving, it applies to all. Risky sex, spending money you don't have, etc.

5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.

Again, self-explanatory. I feel when you're inundated with intense, severely painful emotions that you can cycle through very quickly and have no control over, it is utterly exhausting, it feels like the only escape is death. Combine these emotions with an extended time period as BPD is a chronic condition and impulsivity and you can see the potential for this behaviour...

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.)

This is the emotional dysregulation or instability that some of the other names for BPD comes from and is usually a core feature. The instability may be triggered by events, situations, etc, but it can also be spontaneous. It means that we suffer with greater variability in moods and emotions, most often negative such as panic and despair, but also these emotions tend to be extremely volatile and overwhelming. It's a difficult one to describe for me as I was diagnosed on the cusp of 37 so I've not really known or remember any different and so my emotions are, simply, my emotions. I still feel love, hurt, joy, sorrow, etc, but I feel them much, much more intensely.

7. Chronic feelings of emptiness.

A case of "if you know, you know". How does someone describe such a harrowing feeling to someone who isn't familiar with it? It's feeling numb, swallowed up, alienated, vague, disconnected from the world and those around you, isolated. It's sometimes physical like a hole in the chest. It's always psychological like feeling inhuman. It's distinguishable from hopelessness and loneliness but it is also indistinguishable. It's distressing.

8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).

One thing to take into account is the "inappropriate". Is the anger you feel regularly or irregularly proportionate to the situation? Is your angry response, physical or verbal, proportionate to the situation? This is key. The frequency is also a major factor.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

When stressed, the BPD sufferer may experience temporary paranoia and paranoid thoughts or dissociate. Dissociation is feeling a complete disconnect from your body or even reality. Both of these scenarios are particularly distressing and may well create a feedback loop supporting itself for longer periods than the initial stress.

Causes - UNFINISHED

Genetic

Childhood Trauma

Stigma

As I've mentioned, Borderline Personality Disorder is one of the most stigmatised mental health conditions if not the most.

This mostly comes from misunderstanding behaviours and not knowing the causes. This stigma leads to kindly healthcare professionals not wanting to give you the diagnosis to prevent the stigma and to ignorant healthcare professionals not willing to treat you because of the stigma. This negative response can drag up negative responses from childhood which led to the disorder itself thus making it even harder for someone with BPD.

I am not familiar with much of it as I've been quite fortunate but I have seen some of it online which I will address here:

Lying

The Wikipedia page on the condition says the following: Some theorists argue that patients with BPD often lie. However, others write that they have rarely seen lying among patients with BPD in clinical practice.

I vehemently disagree with the premise that BPD involves some sort of predisposition to lying. We tend to have a set of rigid "rules for life" in place to protect ourselves. Rules both to live by and to perceive "danger" when others break them. One of mine is to always be truthful and honest. I can't hide the truth and I'm an appalling liar. I tell the truth and expect others to do the same. While this doesn't mean it's true for all those with BPD, it also doesn't mean I have BPD any less than anyone else and so to paint this idea that "patients with BPD often lie" is false.

That being said, one major aspect of BPD outlined in the symptoms is fear of abandonment. While it is somewhat paradoxical, there may be situations in which some people with BPD may lie to make themselves look better or because they perceive truth may lead to this abandonment. This does not make lying an integral part of BPD. It is simply a coping mechanism that some may use as a result of one of the main symptoms. Fear is a powerful emotion and we humans enter a "Fight or Flight" response to it that results in often irrational, split-second reactions. I don't believe it is fair to hold anyone accountable for these reactions as I'd hope no one would when I freeze and develop superhuman strength when gripping something nearby at extreme heights.

BPD is also about learned, maladaptive coping behaviours. To some, they may have had to lie in the past or had particularly devastating reactions to the truth that they now try and avoid with falsehoods. A mental health professional should know better than to judge someone for these behaviours as they are often ingrained and become natural. They should, instead, be helping the individual to break the habit.

None of this is to excuse lying; I despise liars and relationships built on false notions that lies create. I merely wish to demonstrate how it is unfair to hold this against anyone with BPD as it is most likely beyond their control and so the stigma shouldn't exist.

Manipulation

Extremely similar to lying as what is lying but manipulating someone's perception of events or something through falsehood in order to gain a favourable response?

"Manipulation" implies malice aforethought but the behaviour itself is, more likely than not, a response to fear and therefore spontaneous or a maladaptive coping behaviour. People with BPD may have been victims of manipulation themselves and thus will take every effort to avoid doing it to others. It is a condition in which the sufferer takes great unconscious pains to avoid the pain of their past and are familiar with that pain and will never inflict it on others because of this.

The "manipulative" behaviour in question is usually expressing intense emotional pain, self-harming or suicidal behaviour. People will react to this by trying to provide comfort and feel manipulated into doing so by the behaviours. However, self-harming or suicidal behaviour is a reaction to internal, intense emotional pain that others may verbalise and should be considered as more of a "self-soothing" reaction as opposed to an attention-seeking one. If those with self-harming behaviour like anorexia nervosa can rightly be seen as self-harming due to internal struggles, why is it someone with BPD is viewed as "manipulative" for actively self-harming due to internal struggles?

Violence

This stigma is particularly exacerbated by media portrayals. It assumes that those with BPD are more prone to violence towards others. However, those who study the condition mostly agree it is very unlikely that someone with BPD will physically harm anyone else.

Anger can be a significant symptom and its intensity can be amplified by the emotional dysregulation aspect of the condition. Again, much like manipulation and lying, it can often be something those with BPD have experienced in the past and will do everything they can to avoid expressing this anger at others. We often turn it inwards instead which may result in self-harming behaviours.

There is, unfortunately, a correlation between intimate partner violence and BPD but this is usually because of an interplay of several specific symptoms and their intensity that not everyone with the condition has. Indeed, many people with BPD don't struggle with anger which is a key part in IPV.

Superpowers

Much like Spiderman's negative experience of being bitten by a radioactive spider, the bite of borderline personality disorder can bring its own "superpowers".

These aren't necessarily present in every person with the condition but tend to come with it as a result of symptoms and causes.

High Cognitive and Affective Empathy and Compassion

Being subject to emotional storms, intense emotions, a fear of abandonment and both internal and external struggles, can lead to a highly empathic individual. This includes not only the ability to feel another's emotions quite strongly but also to know how and what they feel and think and recognize their beliefs and intentions. The latter is known as Theory of Mind and, while research shows this may be impaired in those with BPD, I'd argue that if we were being honest with ourselves the research would demonstrate otherwise. I have a high degree of empathic accuracy that manifests as a "gut feeling" but my mind requires something more "substantial" than that and plays Devil's Advocate against myself; I want to listen to and act on the gut feeling but my head, the disordered thinking aspect of BPD, tells me "no" and my anxiety tends to be born from that conflict of my head seeking the negatives against what I feel intuitively.

Alongside empathy, knowing the pain of intense emotions and what it's like to be hurt means BPD individuals can often be some of the most compassionate people out there.

Affective empathy and compassion is part of why many recommend teaching or healthcare career paths for those with BPD.

High Perceptiveness and Intuitiveness

As a result of the same causes behind empathy, the BPD individual can be very sensitive and especially intuitive which means they'll tend to pick up on very subtle cues or emotional changes in others. An increased need to be aware of one's own surroundings and the emotions of others learned from childhood makes those of us with the condition extremely aware of what's going on. This perceptiveness can lead to unique insights and, indeed, perspectives.

High Creativity

"There is no great genius without some touch of madness." - Aristotle

Art, of any discipline, tries to capture the human experience to invoke a reaction from the observer. There is nothing more human than the spectrum of emotions we all experience. People with BPD who can successfully translate their intense emotions and their unique experiences into art and have a high degree of creativity.

Highly Passionate

Again, as a result of things inflicted on them in childhood or due to injustices felt in adulthood, the BPD individual can be very passionate in pursuit of social justice. This passion can also manifest in hobbies too where the hobby serves as an outlet or a distraction.

And, yes, in the bedroom too... We're chronic people-pleasers after all.

Fierce Loyalty

Highly Resilient

Spontaneous

High Intelligence/Self-Awareness

Usually Gifted

Highly Curious

Very Protective

Heightened Sensitivity

Love Deeply