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Borderline Personality Disorder ~ Part 4 of 5 ~ DSM Criteria

Posted Oct 12 2008 6:19pm
According to the DSM the criteria to meet borderline personality disorder the five of the following features must be present:

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. identity disturbance: markedly and persistently unstable self-image or sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms

There are many other issues which I will discuss in another post for this series. It is time again where I want you to make your comments before I disclose my own experience of my mother being untreated and having severe symptoms and my own diagnosis. I’ll pay someone to go first…I’ll even give up my chocolate chip cookies. (No response) Okay, but how about the weather these days…Anyway, the following information is adapted from Stop Walking on Eggshells and Surviving a Borderline Parent

1. Frantic attempts to prevent feelings of actual or preceived abandonment or rejection. People with BPD rely on others for their feelings of worth and emotional caretaking. The fearfulness can be so strong that they often act in ways that bring about the abandonment and rejection they are trying to avoid (and which therefore validates and reinforces their fears). They panic and may have burst of rage or beg the person to stay.

With my mother, she would panic and become angry even rageful if my step-father or I were not home when she expected or was going to be home alone. She also could not leave a marriage that was clearly dangerous to herself and I. As a result of her not wanting to be alone, I would usually not participate in regular events with my friends if I knew that she was going to be home alone. I didn’t do this consciously, but looking back I new on some level that there was going to be a cost if I didn’t stay home.

For me, I still have difficulty anytime my therapist goes on vacation or there is a holiday. I think that he is never going to come back and, at one time, thought that he was intentionally trying to hurt me. The feelings of abandonment, panic and self-worth would send me into a tail spin and to calm down I would self-injure.

2. Patterns of relationships that are intense and unstable; repeated tendencies to shift between extremes of loving and hating another person. This is referred to as splitting, people with BPD have difficulty experiencing two feeling states at one time. An example would be that some is all bad and ungiving versus all good and idealized. It may happen without any provocation or even any interaction. They look to others to provide self-esteem, approval, and a sense of identity. They look out for any cues that someone doesn’t like or love them. When fears seem confirmed, they may fly into rages, make accusations, become hysterical, seek revenge, mutilate themselves, have an affair or any number of destructive things.

Being an only child, my mother would shift me constantly form the all good child (“I never have to worry about you”) to the all bad (“you are the reason for all my problems”) It was very confusing and resulted in unprovocated rages. I ended up feeling responsible for her happiness, keeping the peace, felt worthless and helpless to change things. She could be fine one moment and the next raging at me. I would also listen to her do that with my step-father and her boss all the time.

For me, I would do that in my head with friends, co-workers and especially my supervisors. I was always looking and finding some reason to feel rejected and then hate them. With my husband, it was not as bad, but we got into quite a few arguments over nothing…I just hated myself so much that I’d try to make him hate me or feel all bad because I got him angry.

3. Difficulty describing the self, interests, or aspirations; frequent shifts in self-perception. Depending on who they are with, they may change their opinion, thoughts and even values to please the other person. There is a chronic feeling of emptiness. Roles played could be the over-achiever, the victim, the helper or caretaker. They need someone else to tell them who they are.

For my mother, I saw her play this dance all the time. She was like a chameleon because she was a different person with different people. Different stated interests and values. It was very confusing. I didn’t know where she really stood. She was also the victim and I was her caretaker.

For me, I became the victim for survival. The target for her rages and constantly changing to adapt to her mood or what she wanted to do. I was her caretaker and until recently, I still did this. Now, I am slowly moving away from that role, but it is very difficult because she experiences it as abandonment and then, I’m the all bad object. In school, work and home, I was the over-achiever and without those things, I didn’t know who I was.

4. Impulsive, often reckless, self-harming behaviors in areas such as substance abuse, binge eating, overspending, promiscuous sex, reckless driving, shoplifting, etc. All of these are addictive behaviors and temporarily fill the emptiness. There is a very high connection between BPD and substance abuse.

I don’t think my mother falls into this category. My therapist said that BPD is about rage. My mother’s was directed outward and mine was inward. So, let’s see eating disorder and overspending fit.

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. The suicide rate is high for this disorder at 8%-10% of those diagnosed with BPD. People with BPD have many, many, many periods of overwhelming uncontrollable emotional pain. Self-mutilation is a coping mechanism used to release or manage these emotions. Usually they are feelings of shame, anger, sadness and abandonment. Self-mutilation may release the body’s own opiates, known as beta-endorphins. These chemicals lead to a general feeling of well being. Self-mutilation may include, but is not limited to cutting, burning, breaking bones, head banging, needle poking, skin scratching, pulling out hairs, and ripping off scabs – all without suicidal intent. I will cover self-injury and the reasons for it in a separate post series.

Again, my mother does not fall into this category. Her rage is all about taking it out on others and mine is all about destroying myself. So, I fit this category with cutting, bruising, and burning.

6. Frequent mood swings and intense emotional reactions, irritability or anxiety of changing duration – anywhere from a few hours to a few days. A Dr. Jekyll-Mr. Hyde situation with switching from happy and loving to furious, fearful, or depressed within hours or less. Often, the person himself doesn’t remember–or claims not to remember-what was said or done during this state. When most people feel bad, they can take steps to feel better. They can also control, to some extent, how much their moods affect their relationships with others. People with BPD have difficulty doing this.

Oh, did I ever experience this with my mother. It was literally like walking on eggshells all the time or like walking through a minefield and the mines keep changing position with every step you take. No predictability and there is nothing that can be done to prevent this. I learned to be hypervigilant. I never knew if I was going to be teased, ignored, physically attacked, verbally attacked, demanded upon, discounted, minimized or if everything would be normal which was rarely the case. I became so afraid of asking or saying anything. There were many times that I questioned my sense of reality because she wouldn’t remember or deny something she said or a ragefest.

I personally experience it now, but I am aware of it and try to take steps not to act upon my feelings. After I was married, I start doing this with my husband, but it was not frequent enough to be too problematic and I was getting better. Then, when the memories started, it got really bad, but therapy really helped. I’ll catch myself and apologize and he just hugs me and says that he loves me. He is so supportive and understanding. At work and school, I was able to keep it together unless I was under tremendous stress like during the last year before I stopped working. Toward the end, I was having quite a bit of difficulty.

7. Ongoing or frequent feelings of being hollow, empty or fake; chronic feelings of emptiness. People with BPD commonly report a deep sense of boredom or a profound emptiness, which is why they may turn to drugs or alcohol, become obsessed with money and possession, or harm themselves. Lacking a strong core, a sense of self they can trust, they feel out of control and dependent upon others, forever victimized. Despite their sometimes larger than life, hard to ignore exterior, those with BPD are sometimes described by loved ones and clinicians as seeming hollow and as putting up a façade.

I am sorry. My mother fits this, but I don’t want to think or write about it at this time. I keep going away everytime I try, so I’m not going to try anymore. I really wish I could. For me, I often feel fake like I’m fooling others. I rarely have a sense of trusting myself; however, that is growing. When really stressed, I feel like a little kid helpless and dependent on specific people.

8. Either underexpressed or overexpressed feelings of anger, seen in frequent displays of temper, rage, recurrent physical fights, or extreme sarcasm or withdrawl. Rages. Many adult children know them all too well, whether the trigger is a coat hung askew in the closet, a spilled drink, a loud TV, sickness, the suggestion that the person with BPD doesn’t remember something the way others do, or a request for divorce. Whether precipitated by something seemingly trivial or serious, the storm-not uncommonly comprised of verbal assaults or physical abuse-can subside just as quickly as it rolled in.
Hmmm…which one of these describe my mother…ALL of them overexpressed. (Now, was I a bit sarcastic…naw!!) Mine all underexpressed. It seems like I was the only one in the family that was not allowed to express my anger, but was the receptacle of everyone elses.

9. Brief extreme periods of mistrust, paranoia, of feelings of unreality (numbness, disconnection, dissociation).
I was recently discussing with my therapist whether or not my mother had any psychosis, which would be beyond dissociation. His response was to begin saying the things that my mother used to and still says to me.  In case you missed it, he was implying that she was psychotic at times. For me, I often go through periods of mistrust, but especially of numbness, disconnection and dissociation).

This post of the series was much, much more difficult than I thought it would be. I found myself becoming numb or dissociating quite a bit. It is such a fresh area that I am looking at that it is too raw to process right now. I hope, even though, I was unable to give you more personal examples that you were able to understand the information. I feel like I need a PRN and a long nap now. Goodnight!!
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