The Behavioral Dimensions of Borderline Disorder

 

A Foundation for Understanding

 

The Behavioral Dimensions of Borderline Disorder • Genetic Causes and Environmental Risk Factors • Co-Occurring Disorders

 

The Black Sheep Project has chosen to use the the four Behavioral Dimensions of Borderline Disorder described below to help 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 your loved one. 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 your loved one 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 your loved one is affected by Borderline Disorder, their emotions may change quickly from one end of the spectrum to the other. They may also find it difficult to perceive others’ emotional responses in an accurate way, especially around unpleasant events. At times, they may overreact emotionally to events or situations, or have bland responses. Thier 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. Your loved one may have difficulty controlling your anger, justified or not, and the slightest event may result in a destructive outburst. They may even realize that they are overreacting but are unable to control the emotions that they 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 your loved one to gain control over their 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 loved one's behavior is important to helping them understand how to determine the approaches they take on their treatment path.

Impulsive behavior is behavior that harms you. Your loved may behave impulsively by recklessly spending money or binge eating. Or they may engage in more serious acts like excessive drinking, drug abuse, uncontrolled gambling, violent aggressive acts, or sexual promiscuity. They 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 know a person with Borderline Disorder who engages in these behaviors they may harm yourself physically by scratching or cutting their wrists, arms or other parts of their body, burning themselves with cigarettes, or overdosing with medications. This may be done in an attempt to have others take care of them, or to “get even” with someone or to get their way. More often, they may hurt themselves to relieve the emotional pain that they feel and to make life more tolerable when it has reached a level they can no longer tolerate.

These symptoms are very distressing for those who are in relationship with someone with Borderline Disorder. If your loved one engages in such behaviors, we at the Black Sheep Project recommend that they see a psychiatrist who is experienced and trained in Borderline Disorder to determine if they 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.

It's important to know the difference between hurting oneself for the reasons already discussed and the presence of a significant suicide risk. You can learn to understand the progression to suicide and determine the 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. Your loved one may then progress to finding themselves planning how they 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 your loved one 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 and your loved one. If your loved one has Borderline Disorder and engages in highly impulsive acts, such as the use of drugs and alcohol, their risk of suicide is between 4 and 9 percent according to historical data. Whether or not they fall into a high-risk category, if they feel themsleves at risk for the symptoms of suicide, or they do not feel safe for any reason, they need to get help quickly. Major depressive disorder and bipolar disorder are common co-occurrences in people with Borderline Disorder that put your loved one 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 family and friends mistaking reports of real suicide situations for parasuicidal behavior. It is essential that your loved one learns to stop parasuicidal behaviors. A treatment plan and a clinical professional can help them 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. We are with you, here to help you find a clinician who is just the right fit and create a way forward with the ones you love.

If you believe your loved one is at risk for attempting suicide, you should contact their physician if they 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 your loved one has Borderline Disorder, they may misperceive experiences, expecting the worst from others, even when nothing negative is actually happening. Difficulty with concentration, with organizing their 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 one's life.

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

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


Group 4: Markedly Disturbed Relationships

Given the groups of symptoms of Borderline Disorder discussed, it is not surprising that your loved one's life may be deeply affected by tumultuous relationships. If they are affected with Borderline Disorder, their feelings may fluctuate dramatically — idealizing a person, clinging to that person desperately for reassurance that they are alright because your loved one's well-being depends on that person, and then swings the other way — where a single wrong makes them believe this person to be selfish, uncaring and not supportive. Your loved one won’t be able to tolerate this situation for long, so they 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. They may have a hard time weighing the positive and negative characteristics of a relationship, partly because they may weigh the negatives too heavily and also because of difficulty with social reasoning. It may be difficult for them to form a balanced opinion of people, especially someone close to them. This makes it difficult to understand the expected normal shortcomings and frailties we all have. This may be because, when they are symptomatic, they may unrealistically believe that their problems are often the result of other people’s behaviors and not their own.

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