DSM IV Criteria

Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:  

  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour 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 behaviour covered in Criterion 5. 

  5. recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour 

  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

The DSM IV goes on to say:

The prevalence of Borderline Personality Disorder is estimated to be about 2% of the general population, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients. In ranges from 30% to 60% among clinical populations with Personality Disorders.

Course

There is considerable variability in the course of Borderline Personality Disorder. The most common pattern is one of chronic instability in early adulthood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources. The impairment from the disorder and the risk of suicide are greatest in the young-adult years and gradually wane with advancing age. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and vocational functioning.

 Living with a BPD child:

If you have read the above medical criteria, you can maybe get a vague idea of what BPD is all about. However hard I try to empathise, I can't imagine what it's like to feel "empty" inside, I feel too full of life. But I am living with someone who has shown BPD symptoms for the last three years, and I know that it's not easy for us, the people who love him and care about him, and it hurts so much to know that whatever we feel he is probably feeling ten times more acutely.

Sometimes the future looks so glum, we seem to go from one crisis to another, in the last year he has made 7 parasuicide attempts and one very serious one, he has been in and out of psychiatric hospitals at an average of a stay a month, over the last year. Where we live, the mental health services do not have the resources to help BPD sufferers, so they won't keep him in hospital for more than 7 to 10 days at a time. They say, and deep down inside I know that it's true, that a psychiatric hospital isn't the place for someone with BPD, in fact it can make their situation worse and lead to a dependency on being institutionalised. BPDs  have to learn to face the world, to live with their families and to adapt to what is around them It has taken me two years to realise this.

The beginning was the worse, suddenly, apparently out of the blue, he cut his wrists.. not enough to really hurt himself but certainly enough to scare us all and to get help. He was sent to an adolescent crisis unit for 5 weeks, where he was diagnosed with major depression and finally sent home on anti-depressants. I knew that he had smoked the odd joint before then and was in fact already taking him to a drug clinic, but soon after this first crisis his smoking got way out of control. For the last two years he has been smoking about 15 to 20 joints a day, claiming that by being out of things, he doesn't "hurt" inside his head. So far, nobody has been able to persuade him otherwise. Then came the most terrible, frightening bouts of aggression, that came quite out of the blue. We would be eating a meal and suddenly he would fly into a rage and start breaking plates, turning over chairs and even the table. He has broken down the front door and the back door and broken several windows in his fits of rage, as well as throwing heavy items at his twin brother and younger sister. At the same time, he was losing weight in an alarming manner and the psychologist at the drug centre was weighing him at every visit. He went to a psychiatrist but stormed out on the first visit as he didn't like the way the doctor talked to him, and he refused to go back. Then he started self-injuring himself, cuts on his arms and wrists, tiny little scabs from bites or whatever that he would work on until they were large nasty wounds. He was admitted to a dual pathology unit for mental problems mixed with drug abuse, where he was diagnosed with Borderline Personality Disorder. I started to search the Internet for all the information I could find, and sure enough... this person they described on all the pages was my son. From that moment on, things became easier for me, I suddenly knew the face of the beast we are fighting, and decided that, for my part, the beast won't win. Obviously I don't have the final word to say on the matter. Tom must learn to take his own decision and to realise he is ultimately responsible for them. It isn't going to be easy for any of us, but with the medications he is being given (he's currently on Lithium, Sinogan, Rivotril, Zypreza, Paroxetine and Akinetron Retard) and the therapy he gets, and everything I can read on the subject, we WILL win this battle. The therapy that seems to be having great results in many cases I've read about is called Dialectical Behaviour Therapy, and I'm currently trying to find out how and where this therapy is available on Spain, where we live.

I said earlier that sometimes the future looks so glum, and there are still many days when that's how I feel. Tom is still sometimes aggressive, but not anything like as much as he used to be. He still takes any money he finds in the house, he still “borrows” my car without permission and damages it trying to be a racing driver. He has been arrested twice, for getting nervous when stopped by the police for totally insignificant reasons, like not wearing a crash helmet when riding a moped, and being unable to handle the situation he struck out at the policemen. He still has moments, many of them, when he is unable to do anything but spend the day half asleep hiding under a blanket. He still spends hours lying on the floor in the entrance to the house, whispering into the dog’s ear.  He still gets so stoned that he doesn’t even know where he is. He still has no projects at all for the future, most of the time. But he is still here and on good days, he still laughs and tells us that he loves us and that if it weren’t for us he doesn’t know what he’d do, he still sometimes dreams about living and working in a remote farmhouse, and I know that inside that tortured mind there is a wonderful, sensitive person who just doesn’t know how to cope.

I also look at the positive aspects that have come as a result of this disorder. I have learnt to put things in perspective in life and to let the trivial things occupy the trivial place they deserve. I think/hope I have learnt to listen to people with more attention, not just Tom, but his sister who feels terribly left out of it all. I have made some magnificent friends who have offered me their unconditional support. I have learnt who I can't count on, too. I have learnt to enjoy today and what today brings. To savour the small things in life that bring happiness and joy. To tell my kids regularly how much I love them. To have hope. This page is a way of sharing my hope with other people.

Back to the Top