Tag Archives: Paranoia

Borderline Personality Disorder Awareness: BPD Explained

May is mental health month in the United States. It is also borderline personality disorder awareness mnth. BPD is my current diagnosis. I have written a few posts on this condition already, but most required some previous knowledge of BPD or mental illness in general. In honor of mental health month and BPD awareness month, I am going to write about my experiences with mental illness in this post and will share facts along the way.

I have always struggled with rapidly shifting emotions and mood swings. If it had been popular at the time and my parents had sought help for me, I might’ve been diagnosed with a childhood-onset mood disorder. I do not have bipolar disorder or major depression now, but these conditions are thought to affect children differently. In the current edition of the psychiatrist’s manual, the DSM-5, there is a diagnosis for children with severe mood swings, dysphoric (sad or angry) moods and extreme temper tantrums. This disorder is called disruptive mood dysregulation disorder. It is thought not to be lifelong, as it can only be diagnosed in children under age eleven.

I remember as a child of about nine already experiencing suicidal thoughts and making suicidal threats, particularly during meltdowns or tantrums. This is not necessairly a sign that the child is going to attemtp suicide – I never did -, but this is also not just “attention-seeking”. It is, in fact, a sign that a child is in serious distress.

Making repeated suicidal threats or attempting suicide is one of the core symptoms of borderline personality disorder. It is commonly thought that most people with BPD only threaten suicide and “aren’t serious about it”. In fact, however, about ten percent of people with this diagnosis die of suicide.

As a teen, I started self-injuring. Self-injury is also a core feature of BPD. This may have many functions other than “attention-seeking”. Of course, some people with BPD do not know how to ask for attention and instead use self-harm as a way to get it. Even then, attention is a human need and withholding it altogether will not usually solve the problem. Other functions of self-injury may include to express pain, to numb out feelings or conversely to feel something when one is feeling empty or numb.

Chronic feelings of emptiness are another symptom of BPD. Generally, a person with BPD is somewhat depressed or numb. This feeling of numbness is also common with major depression, post-traumatic stress disorder and dissociative disorders, all of which commonly co-occur with BPD.

Dissociation is the feeling of being disconnected from oneself, one’s thoughts or feelings or one’s surroudnings. Symptoms of dissociation, particularly depersonalization (feeling “unreal”), are common in many mental illnesses. The most well-known specific dissociative disorder is dissociative identity disorder, also known as multiple personality disorder. My former therapist, who diagnosed me with BPD, believed that BPD and DID/MPD are on the same spectrum.

Paranoia is also common in people with BPD. However, as opposed to people with schizophrenia or related disorders, people with borderline personality disorder experience paranoia only briefly when under stress. For example, when I am overwhelmed with eotions, I tend to mistrust people and situations, while I am not usually paranoid.

Lastly, people with BPD have difficulties in relationships. Firstly, they often have an intense fear of abandonment and go to great lengths to prevent people from leaving them. Some may push people away (“I abandon you before you can abandon me”). Others, like me, are excessively clingy. People with BPD may also alternate between idolizing and devaluing the people who are important to them.

No two people with BPD or any other mental illness are alike. For a diagnosis of borderline personality disorder, you only need to meet five out of nine criteria. I meet between six and eight depending on how you look at it.

Borderline personality disorder bears similarities to post-traumatic stress disorder, dissociatve disorders and mood disorders, particularly bipolar. However, the difference between bipolar and borderline personality disorder is that people with bipolar disorder experience long-lasting mood episodes, whereas people with BPD have rapidly-shifting moods. BPD cannot be diagnosed in children, although of course they can have mood swings. They may then be diagnosed with disruptive mood dysregulation disorder. Psychiatrists are beginning to diagnose BPD in adolescents starting at arund age fifteen. This is good, because, the earlier someone gets treated, the more likely they are to reach recovery.

BPD Criteria and Me

Yesterday, I came across someone going through the BPD criteria and describing how he met them. I thought I would do the same, so here goes. My diagnosis was based on DSM-IV-TR criiteria because the Netherlands has not yet implemented DSM5. You need to meet at least five criteria out of nine. I meet at least six and most likely two more.

  1. Frantic efforts to avoid real or imagined abandonment. Well, I have a huge fear of abandonment, but my attempts at coping with it tend to lead to actually being abandoned. I often can predict when someone is going to abandon me, but am not sure whether this is a self-fulfilling prophecy, good empathy, or magical thinking.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is the one criterion I mostly don’t recognize. Oh well, I do on occasion push my husband away by saying I don’t love him anymore. In this sense, I am the stereotypical “I hate you, don’t leave me” type. My husband says his presumption about borderlines is that people fight tooth and nail then five minutes later are cuddling.. I don’t do that.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self. This is definitely me. As I pointed out in a previous post, I have no sense of self at all beyond the labels I carry, and in fact am just learning to use my own labels rather than those stuck on me. I tend to have my identity depend on how others see me.
  4. Impulsivity in at least two areas that are potentially self-damaging (eg. spending, sex, substance abuse, reckless driving, binge eating). Binge eating an running off into dangerous situations for me (ie. going for walks without watching for traffic). This is not suicidal behavior. Spending when in a hyperactive mood.
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Well, I self-harm and often make suicidal threats. when talking on the phone with my sister about my new BPD diagnosis, she said that mild self-injury like I do does not really count and that I make suicidal threats for attention. Well, I disagree with the “for attention” bit but really it doesn’t matter.
  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 so true for me. I have rapidly shifting moods from irritable to anxious to hyper etc. My sister got talking of manic depression, but then moods have to last for a couple of days to weeks. Mine don’t. I return to “normal” (ie. slightly depressed and irritable) or another mood episode within a day or so.
  7. Chronic feelings of emptiness. I’m not really sure about this one as I have good reason to feel empty, ie. no job or extensive day activities. Then again, the feeling of emptiness can come for no reason and go with another perseveration or impulsive action.
  8. Inappropriate, intense anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights). I don’t physically fight but I do have recurrent temper outbursts. For me, I’m not too sure whether they’re meltdowns or outbursts, but I do have them in situations other than when overloaded too.
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms. Well, duh. I have both actually. I get terribly paranoid when under stress and obviously have dissociative symptoms, ie. feelings of not being myself, chronic depersonalization and derealization, occasional amnesia.

I have been trying to find DSM5 criteria, but can’t. I know a new model for diagnosising personality disorders has been proposed, which bases the diagnosis on a combination of impairments in personality functioning and personality traits, but this model is used for research purposes only.