Borderline Personality Disorder
29.9.12
Borderline personality disorder (BPD) (according to the ICD-10 World Health Organization disease classification, emotionally unstable personality disorder, borderline type) is a personality disorder marked by a prolonged disturbance of personality function, characterized by unusual variability and depth of moods. These moods may secondarily affect cognition and interpersonal relations.[n 1]
The disorder typically involves an unusual degree of instability in mood and black-and-white thinking, or splitting. BPD often manifests itself in idealization and devaluation episodes and chaotic and unstable interpersonal relationships, issues with self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods ofdissociation.[1] It is only recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in individuals over the age of 18; however, symptoms necessary to establish the disorder can also be found in adolescents.
Splitting in BPD includes a switch between idealizing and demonizing others (absolute good/love vs absolute evil/hate with no "grey area"). This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. BPD disturbances may also include harm to oneself.[2] Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.[n 2]
There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline,[3] and some have suggested that this disorder should be renamed.[4] The ICD-10 manual has an alternative definition and terminology to this disorder, calledEmotionally unstable personality disorder. There is related concern that the diagnosis of BPD stigmatizes people and supports discriminatory practices.[5]
Diagnostic and Statistical Manual
The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR), a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as:[1][15]
- A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
- Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
- 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).
- Chronic feelings of emptiness
- Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms
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