Borderline Personality Disorder WHAT IS IT & WHAT CAN HELP? BY ALEXANDRA WILSON (AMHSW; CSW; MAASW; BSW USYD)
Borderline Personality Disorder (BPD) is an often misunderstood and highly stigmatised mental health disorder. However it is not a rare condition, approximately 1–4% of the population are thought to have BPD, which is more than bipolar disorder and schizophrenia combined. BPD unfortunately has one of the highest rates of death of any mental health condition, with an estimated 10% of sufferers ending their own lives. This is an unacceptable statistic and shows we need to do more to provide those with BPD support and effective treatment. Diagnosis and Symptoms A personality disorder is defined in DSM 5 (Diagnostic & Statistical Manual of Mental Disorders, 2013), as, ‘...an enduring pattern of inner experience and behaviours that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.’ (DSM 5, 2013; pp. 645). In other words, it’s part of somebody’s personality. In basic terms, BPD leads to difficulties regulating one’s emotions and emotional responses, and these difficulties have a significant impact on the person’s life and relationships.
A diagnosis of BPD can only be made in adults, however traits of the disorder can be seen emerging in adolescence. The diagnosis criteria for BPD requires 5 or more of the following apply for the person over time: Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationships, characterised by alternating between extremes of idealisation and devaluation Identity disturbance: markedly and persistently unstable self–image or sense of self Impulsivity in at least 2 areas that are potentially damaging (e.g. substance abuse, reckless driving etc) Recurrent suicidal behaviour, gestures, threats or self–mutilating behaviour Affective instability due to marked
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reactivity of mood Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress–related paranoid ideation or severe dissociative symptoms. (DSM 5, 2013; pp. 663) As you can see, BPD may have many different combinations of these symptoms. Therefore, there is not one standard form of BPD, there are many variations. A diagnosis of BPD is often a diagnosis of exclusion. That means it is made when other diagnosis have been dismissed. It is common for people diagnosed with BPD to have had previous diagnoses of depression, anxiety, or other mental health conditions. People with BPD can also have co–existing mental health issues as well as BPD. For example, it
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