About BPD

An Introduction to BPD

Borderline personality disorder is a serious mental illness that has been estimated to affect as much as 5.9% of the population (1). BPD can hinder an individual's attempt to function at even the most basic levels, while also negatively impacting friends and family members of the person suffering from it. Despite its prevalence, BPD has historically been marginalized and misunderstood, used even among clinicians as a catch-all diagnosis for patients who are considered "difficult" and resistant to treatment.

One of the core features of BPD is an impaired ability to regulate emotions (2). Consequently, the emotional life of someone with BPD is frequently volatile, with even minor events leading to a disproportionate, usually very negative response. This could manifest as rage in response to a perceived insult from a close friend or as a bout of intense despair, marked by a global sense of hopelessness and profound sadness after a small setback. Though these emotional states rarely last more than several hours, the frequency of these changes can have a very destabilizing effect on the individual.

A Clinician's Perspective

Although borderline personality disorder is usually identified by impulsive behaviors and highly emotional outbursts, current thinking suggests that the condition primarily reflects a profound sensitivity to relationships. Individuals with BPD have an unstable sense of self and others, and this instability is played out in how they experience the people in their lives. Problem behaviors can be dangerous and must be addressed before underlying issues can be worked on meaningfully, yet it is easy to get caught up with putting out brush fires and overlook the fear of rejection or abandonment which are at the heart of the illness.

Criteria for BPD

In the most recent edition of the American Psychiatric Associations' Diagnostic and Statistical Manual (DSM-IV-TR)*, the following explanation and diagnostic criteria are provided for borderline personality disorder:

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: