DSM-IV Definition of BPD

1.A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

2.Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).

3.A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."

Following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10:

The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area....people are idolized one day; totally devalued and dismissed the next.

Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely unaware of one feeling state while in the other.

When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in other to preserve the all-good image of the other person.

Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.

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

5.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).

6.Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

7.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).

8.Chronic feelings of emptiness.

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

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

Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.

There is no "pure" BPD; it coexists with other illnesses. These are the most common. BPD may coexist with:

*Post traumatic stress disorder
*Mood disorders
*Panic/anxiety disorders
*Substance abuse (54% of BPs also have a problem with substance abuse)
*Gender identity disorder
*Attention deficit disorder
*Eating disorders
*Multiple personality disorder
*Obsessive-compulsive disorder

Statistics about BPD

BPs comprise:

*2% of the general population
*10% of all mental health outpatients
*20% of psychiatric inpatients
*75% of those diagnosed are women
*75% have been physically, sexually, or emotionally abused