"For everything you can say about BPD, the reverse is also true." Janice Cauwels.
"Psychiatry's struggle to define borderline personality disorder is similar to that of the Supreme Court justice with the definition of pornography: ‘I know it when I see it.'" John V. Wylie, M.D.
In the last 15 years, I've done countless interviews with the media. And the question I dread the most always comes first: "What is borderline personality disorder?"
Given that the the average attention span is 60 seconds and borderline disorder may be the most complex mental disorder in the DSM-IV-TR, this is always a challenge. In this post, I'll attempt to give you a short, sweet--but broad-based picture of BPD in a real-life environment. This information comes from a combination of:
1) The psychiatric and mental health community
2) People with BPD (BPs) discussing themselves
3) the observations of several thousand friends and family members (non-BPs) over a 15-year period.
This chart illustrates the way The American Psychiatric Association defines the disorder in the Diagnostic and Statistical Manual. It lists nine traits, five of which a person needs to have to be eligible for the BPD diagnosis. I've renumbered them, however, and split them into mostly three categories: those that involve thoughts, feelings, and actions.
Now let's take a closer look at same thoughts, feelings, and actions that are typical of people with BPD in general (not all will apply to your particular situation). These are all, of course, also common in people who don't have BPD.
A person with BPD might:
* Alternate between seeing others as completely for them or against them.
* Have a hard time recalling someone's love for them when they're not around.
* Change their opinions depending upon who they're with.
* Alternate between idealizing people and devaluing them.
* Remember situations very differently than other people, or find themselves unable to recall them at all.
* Believe that others are responsible for their actions-or take too much responsibility for the actions of others.
* Seem unwilling to admit to a mistake-or feel that everything that they do is a mistake.
* Base their beliefs on feelings rather than facts.
* Not realize the effects of their behavior on others.
A person with BPD might:
* Feel abandoned at the slightest provocation.
* Have extreme moodiness that cycles very quickly (in minutes or hours).
* Have difficulty managing their emotions.
* Feel emotions so intensely that it's difficult to put others' needs-even those of their own children-ahead of their own.
* Feel distrustful and suspicious a great deal of the time.
* Feel anxious or irritable a great deal of the time.
* Feel empty or like they have no self a great deal of the time.
* Feel ignored when they are not the focus of attention.
* Express anger inappropriately or have difficulty expressing anger at all.
* Feel that they never can get enough love, affection, or attention.
* Frequently feel spacey, unreal, or out of it.
A person with BPD might:
* Have trouble observing their own and others' personal limits.
* Rush into relationships based on idealized fantasies of what they would like the other person or the relationship to be.
* Change their expectations in such a way that the other person feels they can never do anything right.
* Have frightening, unpredictable rages that make no logical sense-or have trouble expressing anger at all.
* Physically abuse others, such as slapping, kicking, and scratching them.
* Needlessly create crises or live a chaotic lifestyle.
* Act inconsistently or unpredictably.
* Alternately want to be close to others, then distance themselves.
* Cut people out of their life over issues that seem trivial or overblown.
* Act competent and controlled in some situations but extremely out of control in others.
* Verbally abuse others, criticizing and blaming them to a point where it undermines the other person's confidence in themselves.
* Act in what seems like extreme or controlling ways to get their own needs met.
* Accuse others of doing things they did not do, having feelings they do not feel, or believing things they do not believe.
Researchers have been struggling to describe the different ways BPD manifests itself for decades. So far, though, there seems to be no official consensus . The quotes at the beginning of this post reflect this struggle.
It's like of the oft-told tale about the blind men seeking to describe an elephant by touching just one part. According to the story, The blind man who feels a leg says the elephant is like a pillar. The one who feels the tail says the elephant is like a rope; the one who feels the trunk says the elephant is like a tree branch; and the one who feels the ear says the elephant is like a hand fan.
The story is used to indicate that reality may be viewed differently depending upon one's perspective. In a way, they are all right. And in a way, they are all wrong.
You can see how this applies to borderline disorder in my comments to my blog post, "Yes, Virginia, People with Borderline Disoder DO have empathy.
One person says, "Those of us who have suffered at the hands of someone with BPD know first hand if there is a fraction of empathy in someone with BPD that it is at a level so small that it can't be measured."
Someone who disagrees counters, "In my experience, the person I know with BP has TOO MUCH empathy and reflects too much about how others are feeling and can not deal with the overpowering emotions it brings out in her."
Professionals, too, are touching elephants. A clinician in an emergency department caring for suicidal and self-harming BPs is convinced that all BPs are looking for help. A man divorcing his borderline wife turns to folks in similar circumstances in online communities and is just as convinced that all BPs lie in court.
Borderline Disorder From High Altitudes
In the 15 years I've spent writing about BPD, I have had a unique viewpoint as a passenger in a helicopter high enough to see not only the entire elephant, but the short-sighted people with their hand on just one part sharing their findings to others. The people fall mostly into two group: those in the mental health field who interact with BPs part time under specific conditions, and family members who live with the borderline loved ones 24/7.
My own real-life observations shows that there are three types, which I describe in my post recent book, "The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Working on Eggshells"
This view, of course, is merely my own and I am sure I will revise it over time as I learn more. There are lots of elephants, and each one is different. There's always more to learn.
Thanks to the blog Merry Making for the picture used in this blog post, which was drawn by a five year old.