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While a patient with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of depression, anxiety, or anger that may last only minutes, hours, or at most a day.[11]
These may be associated with episodes of self-injury (including cutting), impulsive aggression, and drug or alcohol abuse. Difficulties in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, gender identity, sexual orientation, friendships, and values.
Dissociative episodes, where the person may experience visual or auditory hallucinations, or become disoriented or experience depersonalization, occur generally in the context of hyperarousal, either through extreme emotion or anxiety. These generally last no more than a few minutes but may occasionally occur over hours or days. Aggressive, self harming or potentially dangerous behaviors may occur during these episodes.
Individuals with BPD can be highly sensitive to rejection -- for example, reacting with distress or anger to separations. This can occur with family members, health professionals and friends, as well as partners. These fears of abandonment may be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide attempts or self-injury may occur along with anger at perceived abandonment and disappointments. Ironically, the desperate clinging to other people can serve as the catalyst for conflict that drives others away.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and trust for the other person, but when a separation or conflict occurs that others may see as slight (e.g., a minor argument), they can lose their sense of attachment and trust and may become withdrawn or angry.
As a consequence of difficulties with emotional regulation (i.e., emotional dysregulation) and maintaining some social boundaries, people with BPD can sometimes make rapid and seemingly deep connections with others, marked by unrealistically high levels of mutual admiration. When very open and in need of reassurance and love, they can sometimes overwhelm others with praise, attention and intimacy.
They can also feel overwhelmed by others, or be taken advantage of. Due to the inherent instability of such relationships, and unresolved issues for the person with BPD (particularly in matters of trust and self-worth), they are prone to react strongly to apparent slights and reverse their over-positive view. This can be experienced by others as unexpected hostility or betrayal, and can also be confusing and painful for the person with BPD.
People with BPD exhibit other impulsive behaviors, such as excessive spending, gambling, binge eating, and risky sex.
Usually, people who suffer from this have an inability to control themselves whilst doing certain things. As well as the above, this can include (but is not limited to):
Sufferers are also usually unable to control their sexualities. Rather than deciding whether they are hetrosexual, homosexual or bisexual, they often change their minds between the three, resulting in ignored feelings, confused emotions and an overactive imagination which usually makes the situation worse for them.
BPDs are disproportionately represented in prison populations: 23 per cent of incarcerated men and 20 per cent of incarcerated women are diagnosed with BPD. Singleton, N., Meltzer, H. & Gatward, R. 1997, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London. many more here - [2]
Self-destructive behavior can cover a wide range of activities. The most well-known and most recognizable symptom of a borderline patient is automutilation (self-cutting), usually of the arms, but often other areas such as the legs, chest, belly, and face. Cutting may or may not be carried out with suicidal intent, even though both entail an increased chance of suicide and self-injury attempts are highly common among patients. [12] [13]
Self-destructive behavior is also considered to be wider activities that are damaging to one's self, carried out with a motivation to harm oneself or with a lack of desire to consider one's own well being. This can include eating disorders, excessive exercise, remaining in an abusive relationship and deliberate sleeping pattern irregularities.
Suicidal or self-harming behaviour is one of the core diagnostic criteria in DSM IV-TR, and management of this can be a complex and challenging issue.
The suicide rate is approximately eight-to-ten percent.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the widely-used American Psychiatric Association guide for clinicians seeking to diagnose mental disorders, defines Borderline Personality Disorder ("B.P.D." or BPD) as: a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts.[1]. BPD is classed on "Axis II", as an underlying pervasive or personality condition, rather than "Axis 1" for more circumscribed mental disorders. A diagnosis of BPD requires, according to the DSM, five or more of the following to be present for a significant period of time:
--- from the DSM-IV-TR, 301.83.
The World Health Organization's ICD-10 has an equivalent diagnosis called Emotionally Unstable Personality Disorder - Borderline type (F60.31). This requires, in addition to the general criteria for personality disorder: disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual); liability to become involved in intense and unstable relationships, often leading to emotional crisis; excessive efforts to avoid abandonment; recurrent threats or acts of self-harm; chronic feelings of emptiness.
A commonly used mnemonic to remember some features of borderline personality disorder is PRAISE:
Borderline personality disorder (BPD) is defined within psychiatry and related psychological fields as a disorder characterized primarily by emotional dysregulation, extreme "black and white" thinking, or "splitting" (believing that something is one of only two possible things, and ignoring any possible "in-betweens"), and turbulent relationships. It can also be described by mental health professionals as a serious mental illness characterized by pervasive instability in mood, interpersonal relationships, self-image, identity, and behavior, and a disturbance in the individual's sense of self.
The disturbances suffered by those with borderline personality disorder have a wide-ranging and pervasive negative impact on many or all of the psychosocial facets of life -- including employability and relationships in work, home and social settings. Furthermore, BPDs may be marginalized by society due to their moods and behaviors.
