The Behavioral Dimensions of Borderline Disorder

 

The Behavioral Dimensions of Borderline Disorder

 

The Black Sheep Project has chosen to use the the four Behavioral Dimensions of Borderline Disorder described below to help people like you better understand the Disorder in the context of your life. These dimensions are an extension of the nine diagnostic criteria defined by the professional mental health community in the DSM-5 (listed for reference at the bottom of this page).

You are likely to recognize some of the things described in the behavioral dimensions and diagnostic criteria described below in parts of your life. Be careful not to rush to any conclusions as you read - instead, look at this as a place to start a conversation from, whether with someone close to you or with a clinician.

 

Group 1: Poorly regulated emotions

Poorly regulated emotions is often cited as the driving force behind many of the symptoms of Borderline Disorder. If you are affected by Borderline Disorder, your emotions may change quickly from one end of the spectrum to the other. You may also find it difficult to perceive others’ emotional responses in an accurate way, especially around unpleasant events. At times, you may overreact emotionally to events or situations, or have bland responses. Your mood swings may be marked and unstable.

Symptoms of severe anxiety are also common with Borderline Disorder, which can manifest itself in physical symptoms including headaches, backaches, stomach pains, rapid heartbeat, irritable bowels and panic attacks. Intense anger is also a common challenge for those affected by Borderline Disorder. You may have difficulty controlling your anger, justified or not, and the slightest event may result in a destructive outburst. You may even realize that your you are overreacting but find yourself unable to control the emotions that you feel.

Another feeling reported by those suffering with Borderline Disorder is a chronic feeling of emptiness. This feeling is followed sometimes by boredom, loneliness or dissatisfaction with life. Learning to understand the feelings and life situations that trigger such behaviors through therapy will help you to gain control over your life and find more effective responses and better more effective ways to be in relationship.


Group 2: Impulsivity

Self-damaging behavior is so common within people with Borderline Disorder that some experts in the field consider it the most important issue facing those with the Disorder. Impulsivity is present to some degree in almost all people with Borderline Disorder. Research shows that this impulsivity is the result of an imbalance between the neural systems that regulate emotions, impulse control and reasoning. Understanding the degree to which impulsivity affects your behavior is important to helping you understand how to determine the approaches you take on your treatment path.

Impulsive behavior is behavior that harms you. You may behave impulsively by recklessly spending money or binge eating. Or you may engage in more serious acts like excessive drinking, drug abuse, uncontrolled gambling, violent aggressive acts, or sexual promiscuity. You may commit illegal acts like shoplifting and speeding.

Some people with Borderline Disorder engage in behaviors that include Recurrent Suicidal Behavior, Gestures, Threats or Self-Mutilating Behavior. These acts can range in severity from behaviors that seek help, are attempts to gain attention, to gain control or can be life threatening.

If you are a person with Borderline Disorder who engages in these behaviors you may harm yourself physically by scratching or cutting your wrists, arms or other parts of your body, burning yourself with cigarettes, or overdosing with medications. This may be done in an  attempt to have others take care of you, or to “get even” with someone or to get your way. More often, you may hurt yourself to relieve the emotional pain that you feel and to make life more tolerable when it has reached a level you can no longer tolerate.

These symptoms are very distressing for those who are in relationship to you, your families and all those who love you. If you engage in such behaviors, we at the Black Sheep Project recommend that you see a psychiatrist who is experienced and trained in Borderline Disorder to determine if you have the Disorder. Remember, we are with you.

Munchausen’s Syndrome is another form of self-injurious behavior that may occur in people with Borderline Disorder. People with Munchausen's Syndrome intentionally hurt themselves in ways that look like verified medical conditions. Through this they receive a great deal of attention and medical care. Often those with Munchausen’s have familiarity with the medical field.

Munchausen by Proxy is a subtype of the same disorder where the parent of a child will inflict a medical condition upon a child to seek medical care and attention for the child. Sometimes these cases tragically end in death before they are diagnosed. If the underlying problem of Borderline Disorder is not diagnosed, the behaviors will likely continue regardless of legal, medical and personal consequences.

Suicide is the most extreme of the self-injuring behaviors. It is imperative to know that some people with Borderline have the intent to commit suicide.

You need to know the difference between hurting yourself for the reasons already discussed and the presence of a significant suicide risk. You can learn to understand the progression to suicide and determine your risk early.

The first stage is having thoughts that life is not worth living. The second stage is thinking about suicide itself, at first occasionally, and then more and more often. You may then progress to finding yourself planning how you would do this. This is a dangerous step in the progression towards suicide, as the next step is the final one, suicide itself.  

Some circumstances put you at greater risk. It is important for you to be aware of them and to take the necessary steps to take good care of yourself. If you have Borderline Disorder and engage in highly impulsive acts, such as the use of drugs and alcohol, your risk of suicide is between 4 and 9 percent according to historical data. Whether or not you fall into a high-risk category, if you feel yourself at risk for the symptoms of suicide, or you do not feel safe for any reason, you need to get help quickly. Major depressive disorder and bipolar disorder are common co-occurrences in people with Borderline Disorder that put you at greater risk for suicide. Those who use drugs, alcohol, or engage in self-harming behaviors or who were physically or sexually abused as children or teenagers are more likely to complete suicide than those with Borderline Disorder who have not been exposed to these events. The fact is, those who are most impulsive are the most at risk.

Please know that repeated parasuicidal acts, or suicidal gestures, may result in your family and friends mistaking your reports of real suicide situations for parasuicidal behavior. It is essential that you learn to stop parasuicidal behaviors. A treatment plan and a clinical professional can help you with this. It is also essential for families and clinicians of those with Borderline Disorder to learn the risk factors for suicide in Borderline Disorder and remain alert to the risk of suicide in patients with the Disorder.

There is a community of support here for you with the Black Sheep Project, a community of others who have a common story, who have faced similar challenges and emerged to build happy and successful lives. We are with you, here to help you find a therapist who is just the right fit and create a way forward with the ones you love.

If you believe you are at risk for attempting suicide, you should contact your physician if you have one. If not, or if you cannot get through, call a suicide prevention line, the closest hospital emergency room, or dial your local emergency services number.


Group 3: Impaired Perception and Reasoning

People with Borderline Disorder often say they have difficulty with memory, particularly under stress. If you have Borderline Disorder, you may misperceive experiences, expecting the worst from others, even when nothing negative is actually happening. Difficulty with concentration, with organizing your thoughts and behaviors, difficulty being able to think through a complex problem adequately or to determine reasonable alternatives and the consequences of those alternatives are also hallmarks. This also includes, difficulty with perception of important events, thinking and reasoning that may result in faulty decisions that could have highly detrimental consequences.

People with Borderline Disorder often report difficulty participating in reasonable conversations to solve problems, or accurately remembering the content of these situations afterwards. They may also have difficulty with social reasoning, to the point that it results in difficulty in having mature, successful and sustained personal relationships.

Episodes of Paranoid Thinking: Research notes that those with Borderline Disorder are more likely to expect others to behave badly toward them than those who do not have the Disorder. When under the threat of real or imagined abandonment, or severe stress, when under the influence of drugs or alcohol, or with certain classes of stimulants or amphetamine, some with Borderline Disorder become suspicious and have trouble thinking rationally. Episodes of paranoid thinking may occur, when they may believe others are trying to harm them. Such episodes may last a few hours or a few days or longer. Rarely, those with Borderline may experience hallucinations.

Dissociative Symptoms: Dissociative Symptoms are marked by periods of time where you cannot remember what you said or did. They can be so severe that the person actually splits off part of their thinking, feeling and behavior and temporarily creates one or more separate personalities. When this occurs it is referred to as multiple personality disorder. Multiple personality disorder presents in an unknown but small percentage of those with Borderline Disorder.

Magical Thinking: Magical Thinking uses highly unrealistic thoughts and beliefs to solve the problems of your life.

Depersonalization: You may feel as if you are living in a dream or unreal, detached and not a part of the world. Your body may feel numb or empty.

Unstable Self-Image or Sense of Self: You may feel that your concept of yourself is dependent on others, on their behavior and attitude. You may feel you have little worth no matter what you accomplish, and little sense of what your values and beliefs are. You have difficulty feeling centered in the world. Other’s opinions matter more than your own.  


Group 4: Markedly Disturbed Relationships

Given the groups of symptoms of Borderline Disorder discussed, it is not surprising that your life may be deeply affected by tumultuous relationships. If you are affected with Borderline Disorder, your feelings may fluctuate dramatically — idealizing a person, clinging to them desperately for reassurance that they are alright because your well-being depends on them, and then swings the other way — where a single wrong makes you believe they are selfish, uncaring and not supportive of you. You won’t be able to tolerate this situation for long, so you may swing back the other direction again. These extremes make relationships very difficult and the cycle repeats itself over and over.

Black-and-White Life: Many with Borderline say they see themselves and others in terms of black and white, good and bad, and have difficulty dealing with the gray areas of relationships. You may have a hard time weighing the positive and negative characteristics of a relationship, partly because you may weigh the negatives too heavily and also because of difficulty with social reasoning. It may be difficult for you to form a balanced opinion of people, especially someone close to you. This makes it difficult to understand the expected normal shortcomings and frailties we all have. This may be because, when you are symptomatic, you may unrealistically believe that your problems are often the result of other people’s behaviors and not your own.

Frantic Efforts to Avoid Real or Imagined Abandonment: If you struggle with Borderline, you may have an uncontrollable fear of being abandoned. Even brief separations from those who are important to you or those you have come to depend on are very difficult and may cause your symptoms to flare up. Or, you may have an equally strong fear of being too closely involved and losing your individuality and self-control or being hurt. You may have a deep desire to escape from relationship to avoid being hurt or abandoned.


Diagnostic Criteria

The Diagnostic Criteria are drawn from the DSM-5. Most clinical professionals will refer to these criteria when discussing Borderline Disorder, which is indicated by 5 or more of the following:

Early onset and long-standing course.

  1. Frantic Efforts to avoid real or imagined abandonment.

  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

  3. Identity disturbance: markedly and persistent 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).

  5. Recurrent suicidal behavior, gestures, threats or self-mutilating behavior.

  6. Affective instability due to a marked reactivity of mood (e.g.; intense episodic dysphoria (a state of feeling very unhappy, uneasy, or dissatisfied), 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.

What is the Diagnostic and Statistical Manual of Mental Disorders?

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) serves as a common reference for clinical professionals working in the mental health field. Created with input from leading experts, the DSM-5 provides healthcare providers with clear, consistent criteria to help them diagnose and treat mental health disorders.

Copies of the DSM-5 can typically be found in the reference sections of most public libraries and is available for sale through most booksellers. As with any professional reference, it is always a good idea to work closely with somebody knowledgeable in the field to interpret what the information in the DSM-5 may mean for your unique circumstances.

 

What does “Borderline” mean?  

The origin of the word “Border Line” to discuss and define Borderline Disorder traces back to 1938, when psychoanalyst Adolph Stern coined the term to show that while, at the time, some patients had symptoms that sounded like other disorders, their condition sat at the “borders” and couldn’t be said to actually have any of them. It was not until 1980 that the medical community formally recognized Borderline Disorder with its inclusion in the DSM. The word, and how it is used now in people’s casual language to convey an aura of instability, plays a role in perpetuating some of the stigmas related with Borderline Disorder.