Recently, we encountered a case of borderline personality disorder in the clinic, and the following is given in the clinic to sort out.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, borderline personality disorder requires at least five of the following eight characteristics.
1. the possibility of impulsively causing self-harm, such as squandering money, gambling, or self-injury
2. unstable or overly strained interpersonal relationships, demeaning others, and often taking advantage of others for selfish reasons
3. inappropriate outbursts of anger or lack of control over anger
4.Identity disorders, as manifested by variability in gender identity, self-identity, choice of occupation, etc.
5. emotional instability, such as sudden depression and anxiety, irritability for hours or days, followed by a change to normal.
6. intolerable loneliness, depression when alone.
7, self-injurious physical behavior, such as self-destruction of shape, repeated accidents or fights.
8, feeling empty and bored for a long time.
Test whether to switch to BPD
The following psychological test can help assess whether you have certain factors that may lead to BPD. Answering the following questions honestly will help you determine if you need to consult a psychologist.
1. I often feel abandoned because of what my parents (loved ones, children, friends) say or do.
2.Striving not to be abandoned by others, even to the extent of going crazy (such as crying, self-abuse, etc.).
3.The friends I met at the beginning were very innocent, but after a long time they felt that they could not accept me.
4, often feel unbearably lonely.
5.Emotions fluctuate extremely easily, and stable emotions do not last for hours.
6.Incapable of controlling outbursts of anger and easily get into verbal or physical conflicts with people.
7, repeatedly using self-harming behavior to obtain relief or pleasure.
8, frequently threatening or asking for help in a suicidal posture.
9. unclear definitions of at least two of self-image, gender orientation, long-term goals or career choices, preferred types of friends to associate with, and value preferences.
10. chronic feelings of emptiness and boredom
11. low self-esteem and frequent feelings of disappointment, helplessness and powerlessness.
12, tend to be resistant and pessimistic about new things.
13, stubbornness.
14.No one in sight.
15, difficulty in interacting with authority figures.
16.Over-sensitive to criticism, easily feeling belittled and ignored.
17, a history of pleasing others.
18, self-blame.
19, hypervigilance and hypersensitivity to surrounding insecurities.
20, prone to unjustified fear and confusion.
Assessment criteria.
The above 20 questions, 1 to 10 questions are general characteristics of borderline personality disorder.
11 to 15 questions are subtype characteristics of capricious borderline personality disorder.
16-20 are subtypes of self-destructive borderline personality disorder.
If you answered “yes” to an item, you should be worried about yourself. If you answered “yes” to two of them, it is recommended to consult a psychologist immediately.
Clinical presentation and diagnosis
Borderline personality disorder is a common psychiatric personality disorder characterized by instability in mood, interpersonal relationships, self-image, and a variety of impulsive behaviors, and is a complex and serious mental disorder. The typical characteristics of borderline personality disorder have been described as “stable instability”, which often manifests as treatment noncompliance and is difficult to treat.
The diagnostic entity for borderline personality disorder was introduced into psychiatric diagnosis in 1948 with the DSM-I, then called Emotionally Unstable personality disorder, and was dropped in 1968 with the DSM-II. The DSM-III was introduced in 1980 and has been retained in the DSM-IV-TR since then, replacing the diagnosis of cyclothymic personality disorder.
This disorder of borderline personality disorder has a long history from its discovery to its identification as a clinical diagnosis. In 1837, Prichard suggested that many people who were thought to be “unreasonably insane” were in fact mentally ill, but that this mental illness was mainly manifested by differences in mood, habits, and temperament. The differences in mood, habits, and temperament are the main manifestations of these disorders. In 1890, Rosse, an American, first used the term “borderline” to describe a group of patients between neurosis and psychosis. In 1909-1919, Pelman and Clark also discussed the relationship between borderline mental states, borderline neurosis and psychosis, respectively. 1921, Kraepelin suggested that the borderline type was a broad but unmarked field, a state between insanity and the various bizarre manifestations of normal people. In 1930, Partridge studied the sociopathic personality in “somatic pathological personality inferiority” and proposed to exclude this diagnosis. In the same year, the American Oberndorf noticed that many American psychiatrists were using psychoanalytic theory to treat borderline psychiatric patients, a tendency that was different from the international mainstream at the time. In 1942, psychoanalyst Deutsch described the “as-if personality,” which is in fact what is known today as the borderline personality. In 1949, Hoch and Polatin used the term “pseudo-neurotic schizophrenia” to describe a group of patients whom Schmideberg later named “borderline” individuals.
In 1954, Knight combined psychoanalytic self-psychology and object relations to describe, analyze, and treat borderline patients, and in 1955, Glover proposed that personality disorders were a borderline state. By this time, American psychiatrists were at the forefront of studying borderline patients worldwide, and they were largely embracing a psychoanalytic perspective on these cases. From the late 1950s until the mid-1970s, research on borderline states began to unfold on a large scale and many cases were accumulated. The psychoanalyst Kernberg summarized the findings of the psychoanalytic community, introduced the term “borderline personality organization” and clarified its diagnostic elements. The diagnostic criteria of the DSM-III essentially follow the framework of their work.
The post-1980s period to the present has been a period of rapid growth in the study of borderline personality disorder. Research on the epidemiology, etiology, diagnosis, and treatment of borderline personality disorder has become one of the mainstream research topics in the international psychiatric community, alongside schizophrenia, mood disorders, and posttraumatic stress disorder.
The clinical manifestations of borderline personality disorder
First, disorder of self-identity (Self-identity). Lack of self-goal and self-worth, low self-esteem, and a lack of understanding of issues such as “who am I?” Who am I?”, “What kind of person am I?” and “Where do I want to go?” There is a lack of reflection and answers to such questions. While this disruption of self-identity often begins during adolescence, patients with borderline personality disorder clearly experience a lag in self-identity, remaining in a confused stage with discontinuous and conflicting self-images. This is reflected in various contradictions and conflicts in their lives.
Second, an unstable and rapidly changing state of mind. Patients often have intense anxiety and easily oscillate between anger, sadness, shame, panic, fear, and feelings of euphoria and omnipotence. There is often a chronic, pervasive sense of emptiness and loneliness that surrounds them. The state of mind is characterized by rapid and variable changes. Especially when exposed to stressful events, patients are highly susceptible to brief episodes of tension and anxiety, irritability, panic, despair, and anger. However, their mood often lacks the persistent sadness, guilt and infectiousness characteristic of depression, and they do not have biologically characteristic symptoms such as early awakening and weight loss.
Third, there is significant separation anxiety. They are described as “coming into life with an umbilical cord in their hands, always looking for a place to attach it”. There is a great fear of being alone and abandoned. They are extremely sensitive to abandonment and separation and try to avoid separation scenarios by all means, such as begging or even threats of suicide. Very afraid of loneliness, lack of self-soothing ability, often need to discharge the empty loneliness through a variety of stimulating behaviors and substances such as drinking, promiscuity, drugs, etc.
Fourth, conflict in intimate relationships. They will swing between two extremes in intimate relationships. On the one hand, they are very dependent on each other, and on the other hand, they are always arguing with people close to them. One will feel that the other party is the best, and then the other party said worthless. Repeated relationship breakdowns, interpersonal relationships in constant conflict. People who get along with them often feel very tired, but can not get out.
Fifth, impulsivity (impulsivity). Impulsive behaviors such as alcoholism, extravagance, gambling, stealing, substance abuse, gluttony, and promiscuity are common. 50% to 70% of patients have impulsive self-destructive and suicidal behaviors, and 8-10% of patients succeed in committing suicide. It is a disease with a high suicide rate. Sudden outbursts of anger, destruction, brawling, and cursing are also common impulsive behaviors.
Sixth, the psychotic symptoms of stress. In stressful situations, depersonalization (depersonalization), implicated concepts such as transient or situational delusions or hallucinations that seem to have a basis in reality, etc. are likely to occur. Generally, these symptoms are mild, brief in duration, and can be relieved quickly after the mental stress is lifted, and antipsychotic medications are effective.
The most authoritative diagnostic criteria for borderline personality disorder is the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). This diagnostic criterion first originated in 1967 when Kernberg introduced the concept of borderline personality organization (BPO) based on the work of psychoanalysts Stern and Knight.
The borderline personality organization has the following characteristics.
1. identity diffusion;
2. primitive defense mechanisms, such as splitting, idealization, denial, projection, acting out, and projective identification.
3. The ability to test reality is generally good, but it is difficult to withstand change and failure.
On this basis, in 1975, Gunderson & Singer reviewed previous research on clinical observations of borderline personality and proposed several descriptive criteria, including emotional irritability, impulsive behavior, poor interpersonal relationships, psychotic-like perceptions, and social maladjustment. A semi-structured research instrument, the Diagnostic Interview for Borderlines (DIB), was also developed.
The DSM-5 describes borderline personality disorder as a generalized pattern of behavior that is less severe than psychosis but more severe than neurosis and affects all aspects of the person’s life, including interpersonal, self-perception, and emotional instability, with marked impulsivity. This pattern of behavior usually begins to emerge in early adulthood, or even earlier, and is characterized by the following.
1. strained and unstable interpersonal relationships, either very good or very poor
2. identity disorders, self-perception and self-image, who is one? What is the meaning of life? Lack of stable internal value standards, sometimes feeling perfect and sometimes feeling worthless, and difficulty in forming a stable self-esteem. They are also extremely distressed by this, and sometimes resort to desperate measures to re-establish their inner balance.
3. their behavior seems to be an effort to escape some kind of real or imagined abandonment
4. the impulsiveness of apparent self-destruction (e.g., excessive consumption, sexual desire, addictive behavior, overeating, reckless driving, etc.), which can have adverse consequences for themselves
5. suicidal or self-injurious behavior, making suicidal gestures, or threatening to commit suicide.
6, emotional instability due to an overly reactive state of mind (e.g., short-term distress, depression, anxiety, or irritability)
7, chronic feelings of emptiness.
8, inappropriately strong anger or difficulty controlling anger (e.g., frequent tantrums, fits of anger, repeated fights)
9. transient, context-related paranoid perceptions, victimization, or severe dissociative symptoms.