Dsm 5 Borderline Personality disorder (A Comprehensive Guide)

In this guide, DSM 5 Borderline Personality disorder, symptoms of Borderline Personality disorder along with the diagnostic criteria, causes, and treatment options will be discussed.

What is Borderline Personality disorder according to the DSM- V?

Borderline personality disorder, that is part of the Cluster B of personality disorders in the DSM 5,  is a mental disorder that is characterised by a pattern of episodes where a person experiences intense fluctuating moods, distorted self-image, and maladaptive behaviour. 

People with this personality disorder may experience intense anger, depression, and anxiety that can last from a few hours to days- episodic shifts.

A person with this disorder can experience maladaptive symptoms that impact their work, relationships,and sense of self. 

These symptoms according to the DSM-V include:

  • An intense fear of abandonment leading to  extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships
  • Rapid changes in self-identity and self-image that include shifting goals and values.
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, or sabotaging success.
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Intense mood swings lasting from a few hours to a few days
  • Feelings of emptiness
  • Inappropriate, intense anger, frequently losing your temper,or having physical fights

These symptoms can cause this particular condition to be dangerous and often warrants treatment. 

What is the DSM criteria for Borderline Personality disorder diagnosis?

The Diagnostic and statistical manual of Mental Disorders (5th ed) DSM-V outlines the following criterion to make a diagnosis of Borderline Personality disorder. 

Borderline personality disorder usually involves a pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity in all aspects of their lives.

These patterns usually begin by early adulthood and can involve at least 5 (or more) of the following:

  • Individuals often make desperate or panicked efforts to avoid real or imagined abandonment. For example, they might get irrationally angry when someone is late for an appointed meeting. 

This fear is often related to this inability or intolerance of being alone as well as their own self-evaluation that being abandonment will mean that they are inherently bad. 

  • A pattern of unstable and intense interpersonal relationships that alternate between extremes of idealisation and devaluation.

They might start out idealising their partners, demanding more time with them and then suddenly devaluing them because they think that this person does not care enough. 

This shift, according to the DSM 5, could be because they become disillusioned from their own idealisation of their partners leading them to expect abandonment.

  • Identity disturbance where they have an unstable self-image or sense of self. This often manifests in the form of shifting goals, values, as well as vocational goals. 

They might change their sexual identity, their social groups, their aspirations, and their goals suddenly. Especially when they notice that there is a lack of meaningful supportive relationships.

  • There is Impulsivity in at least 2 areas that are potentially self-damaging. They may gamble, binge, use substances, engage in unsafe and reckless sexual behaviors, and be finaiacially risky. 

These impulsive and destructive behaviours are usually caused by perceived rejection, abandonment so that the other individual assumes responsibility. 

  • Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour often for the same reasons as mentioned above.
  • Affective reactivity and instability of mood where they might experience intense episodic dysphoria, irritability or anxiety lasting less than a few days be to interpersonal distress. They also have a hard time dealing with their anger or regulating their anger. 
  • Chronic feelings of emptiness and boredom which leads them to do things that might be dangerous or destructive at times such as substance use or unsafe sex etc. 
  • Inappropriate, intense anger or difficulty controlling anger where any interpersonal stress or conflict tend to result in frequent displays of temper, constant anger, recurrent physical fights.
  • They may also experience stress-related paranoid or psychotic as well as dissociative symptoms such as hallucinations, delusions as well as body image distortions amongst other things, 

What are the prevalence rates of Borderline Personality disorder according to the DSM-V?

According to the DSM 5, the average prevalence rates of Borderline personality disorder belong to a range between 1.6% to 5.9%. 

The manual also estimates that it is as high as 20 percent in the psychiatric population, 10 percent in outpatient mental health clinics, and an average of 6 percent in primary care settings. 

It is more prevalent in younger individuals as opposed to the older population and women are more likely to be diagnosed with Borderline personality disorder as opposed to men. However, it is speculated it this disparity could be because men tend to be misdiagnosed (NAMI)

What are the Risk factors and comorbidity risks?

According to the DSM, the factors that influence prognosis include:

Genetics research has found that Borderline personality disorder is five times more likely in first degree relatives than the general populations. 

Some research also finds that Brain abnormalities- structural and neurochemical- have shown that there are issues related to symptoms of borderline personality disorder such as emotion regulation, impulsivity and aggression. 

It is also possible that stressful life experiences during childhood such as sexually or physically abused or neglected during childhood, loss, or parental substance use and misuse- leading to hostile or unstable family enivomeojntment also increases the likelihood of this disorder (Mayo Clinic)

How does Borderline Personality disorder impact an individual’s life?

The major impact borderline personality disorder has on an individual’s life is on their relationships, their sense of self, and their expense of their emotions. 

Individuals with this disorder tend to struggle with the fear of separation or abandonment which affects their thoughts, their experience of their emotions, and their behaviours which involves a push and pull between closeness and emotional distance. 

They also struggle with their identity leading to many changes and shifts that people might find irrational such as suddenly changing their career, relationships or their goals especially right before they reach a milestone. For example, graduation, or marriage. 

In severe cases, individuals with this disorder also experience hallucinations and delusions as well as other psychotic symptoms especially when they are stressed that affects their ability to live independently and live healthy lives.

Their tendency to ebnegae in impulsive behavirps also maeke their risk of suicide and death high, often times indidvaiusl also struggle with disabilities and ehalth issues caused by their impulsiveluy and selfhard behaviors.

Borderline personality disorder also makes it likely that these individuals struggle with emotional regulation leading to anger issues, deep despair that might struggle with maintaining healthy relationships with others and might also struggle with other disorders like depression, eating disorders and substance use disorders all of which impacts their quality of life and well-being. . 

What are the treatments for Borderline Personality disorder?

The various treatments for Borderline Personality disorder include:

Psychotherapy

For Borderline personality disorder, psychotherapy is the main treatment particularly cognitive behavioural therapy (CBT) and  dialectical behaviour therapy (DBT). 

These therapies have been lauded for their positive outcomes in treating individuals with borderline personality disorder. 

CBT helps clients identify and change unhealthy beliefs, replace behaviours, learn how to deal with their thoughts that tend to affect and influence their emotions. 

DBT, a form of CBT that was created specifically to help individuals with BOrderline Personality Disorder, is designed to help individuals develop acceptance of their struggle and develop healthier lives by learning various skills related to Interpersonal effectiveness, emotional regulation, mindfulness, and distress tolerance.

Medication

As of right now there is not designated medication for Borderline Personality disorder however doctors might prescribe a pharmacological treatment for individuals with BPD who has a comorbid mental disorder such as:

  • antidepressants to treat depression
  • antipsychotics to treat aggressive symptoms
  • antianxiety medications to treat anxiety

Conclusion

In this guide, DSM 5 Borderline Personality disorder, symptoms of Borderline Personality disorder along with the diagnostic criteria, causes, and treatment options for depression has been discussed.

Frequently asked questions related to “DSM 5 Borderline Personality disorder”

What is a borderline personality like?

Individuals with Borderline Personality usually struggle with  intense, unstable emotions and relationships that tend to arise due to their  insecurity and self-doubt. 

They might be seen as angry, overly emotional, and at times manipulative in the way they tend to engage in self-destructive behaviours to fight their fears of abandonment and rejection. 

What are the symptoms of borderline personality disorder?

These symptoms according to the DSM-V include:

  • An intense fear of abandonment leading to  extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships
  • Rapid changes in self-identity and self-image that include shifting goals and values.
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, or sabotaging success.
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Intense mood swings lasting from a few hours to a few days
  • Feelings of emptiness
  • Inappropriate, intense anger, frequently losing your temper,or having physical fights

Is BPD worse than bipolar?

It is not possible to say that one disorder is worse than another because one cannot compare the pain of one individual with another individual. 

According to Verywellmind, People with bipolar disorder tend to experience mania and depression while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness. 

Each individual struggles with either of the disorders, faces their own struggle and experiences their own personal pain.

Can borderlines have friends?

Yes it is possible for people who have borderline personality disorder to have and maintain healthy relationships with their friends by developing healthy boundaries, a healthy way of regulating their emotions, developing assertive communication, and overall taking care of their mental well-being.

What can be mistaken for BPD?

Some disorders can be mistaken for BPD because someone of the symptoms of BPD can be very similar to other mental health problems, such as:

  • bipolar disorder.
  • depression.
  • psychosis.
  • antisocial personality disorder (ASPD)

What does a borderline person think?

People with BPD have a tendency to engage in various cognitive distortion patterns like thinking in extremes, a phenomenon called “dichotomous” or “black-or-white” thinking. 

This form of thinking causes them immense distress and disrupts their world view, their view of others and themselves leading to relationship problems with other people. 

Is BPD the same as bipolar?

BPD and bipolar disorder are not the same. They have some similar symptoms, but they are very different conditions. BPD is a personality disorder, and bipolar disorder is a mood disorder.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

Borderline Personality disorder. NAMI. Retrieved on 31st January 2022. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder

Borderline Personality disorder. Mayo Clinic. Retrieved on 31st January 2022. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237#:~:text=Borderline%20 personality%20disorder%20is%20a,a%20pattern%20of%20unstable%20relationships.

Kivi. R. Borderline Personality Disorder. Healthline. Retrieved 31st january 2022. https://www.healthline.com/health/borderline-personality-disorder#complications

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