I Hate You, Don't Leave Me

Inside the mind of a borderline.

by Jerold Kreisman, M.D.

The Borderline Chameleon: Changing Identities, Changing Diagnoses

Am I Borderline or just sometimes I act crazy?

Published on January 9, 2011 by Dr. Jerold J. Kreisman, M.D. in I Hate You, Don't Leave Me

With the New Year come pledges to alter your life. Resolutions are made to start, stop, change--start dieting, stop smoking, change jobs. For someone with Borderline Personality Disorder (BPD), change is less consciously determined. Transformation for such a person is more reflexive, less rehearsed. The borderline chameleon changes depending on the environment and who is present, constantly struggling to fit in. A Republican among republicans, a Democrat among democrats, the borderline lacks a stable, consistent collection of beliefs and principals. This fluctuating identity makes it difficult to establish a firm sense of self.

Just as someone with BPD struggles to stabilize a coherent, reliable identity, the clinician contends with establishing a diagnosis which may be as elusive. The chameleon disguises of BPD implicate various illnesses. Could mood swings suggest Major Depression or Bipolar Disorder? Does destructive impulsivity infer Attention Deficit Disorder or cover over drug abuse? A series of impaired relationships?--Maybe that implies Anxiety Disorder or Post-traumatic Stress? What about feelings of paranoia or unreality?--Is it Schizophrenia? Am I Borderline, or is it just sometimes I act crazy?

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BPD is so difficult to accurately diagnose because it intersects with other disorders in several ways. Most often, it may coexist, but be submerged, in the wake of a more prominent disorder, such as Depression. Borderline symptoms may not become discernable until after treatment of the other illness is mobilized. Secondly, BPD's chameleon disguise may mimic another syndrome and induce an incorrect assessment. In such a way, a cursory evaluation of "mood swings" may initiate a misapplied label of Bipolar Disorder. Alternatively, BPD may camouflage another illness, and be installed inaccurately as the primary diagnosis.

Just as the borderline individual is a chameleon, constantly altering identity, so is the BPD diagnosis. Differentiating the syndrome from other maladies can be almost as challenging a task as the struggle to conquer the illness.