This article will concentrate on explicating the 9 criteria according to which one was to be considered diagnosable with borderline personality disorder according to the DSM-IV:
1) Frantic efforts to avoid real or imagined abandonment – Temporary solitude is unbearable for the borderline. If a significant other distances himself from her, she will experience unbearable dysphoria. This dysphoria is oftentimes followed by explosive rage towards the world at large. She experiences such abandonment as a kind of victimization by the world of this significant other.
The sort of panic experienced by the borderline during such abandonment anxiety is neurobiologically detectable.
“One study utilized PET scanning to demonstrate that women with BPD experienced alterations of blood flow in certain areas of the brain when exposed to memories of abandonment. Particularly when they are alone, borderlines may lose the sensation of existing, of feeling real. Rather than embracing Descartes’ “I think, therefore I am” principle of existence, they live by a philosophy closer to “Others act upon me, therefore I am”(Kriesman, 2010).
Unfortunately, the borderline’s attempt to remedy this loneliness may take the form of potentially risky sexual behavior or liaisons, or manipulation by unscrupulous individuals who are willing to take advantage of her in her vulnerable state.
2) Unstable and intense interpersonal relationships, with marked shifts in attitudes toward others (from idealization to devaluation or from clinging dependency to isolation and avoidance), and prominent patterns of manipulation of others – The borderline is paradoxically terrified of both intimacy and separation. It should therefore come as no surprise that relationships with the borderline are extremely intense, unstable and unpredictable.
The borderline idealizes the significant other in her life until this other disappoints her in his ability to satisfy her emotional needs, at which point the borderline devalues him and sees him as the epitome of evil. This may take the form of avoidance, withdrawal of intimacy and affection, indifference and rejection. To be loved is to lose one’s identity through engulfment and to be rejected is to lose one’s identity through no longer having someone to define her. “The borderline vacillates between a desire for closeness to relieve the emptiness and boredom, and fear of intimacy, which is perceived as the thief of self-confidence and independence”(Kreisman, 2010).
Borderlines can be highly manipulative and “spoiled.” That make excessive and oftentimes unreasonable demands of their partners. One way in which the borderline typically manipulates her partner is through her well-known hypochondria and somatization. The borderline oftentimes oscillates from man-eater to damsel-in-distress, making herself seem vulnerable, weak, masochistic, and in constant need of rescue, oftentimes resorting to overt suicidal gestures in order to do so. Furthermore, the borderline tends to be highly seductive, tending to use her sexuality in order to get what she wants.
Paradoxically, the borderline is at once extremely empathetic in one respect and yet profoundly lacking empathy in other respects. On the one hand, they are empathetic insofar as they are very attuned to how others perceive them, by virtue of their hypersensitivity to rejection. They are constantly attempting to manipulate their own appearance and image in order to get what they want. On the other hand, they lack empathy insofar as they can be very selfish and enraged that others have a life outside of them.
In general, the borderline has disturbed interpersonal relationships because they have a distorted view of other people. Lacking object constancy, they struggle
“to understand others as complex human beings who nonetheless can relate in consistent ways. The borderline experiences another on the basis of his most recent encounter, rather than on a broader-based, consistent series of interactions. Therefore, a constant, predictable perception of another person never emerges – the borderline, as if afflicted with a kind of targeted amnesia, continues to respond to that person as someone new on each occasion”(Kriesman, 2010).
Because of the evanescent nature of her experience with her significant others, the borderline rarely learns from experience and tends to repeatedly make the same mistakes, landing her in the same sort of trouble over and over again. Her tendency towards codependency in particular leads her, many times, to return, for example, to the same abusive male over and over again even though it is clear that the individual will not change. In the end, the borderline wants the omnipotent, omniscient, totally reliable caregiver she lacked during her formative years.
3) Marked and persistent identity disturbance manifested by an unstable self-image or sense of self – This is one of the core attributes of borderline personality disorder. They “lack a constant, core sense of identity, jsut as they lack a constant, core conceptualization of others”(Kriesman, 2010). She tends not to see herself as possessing constant traits in general. She may deem herself beautiful because she won a beauty pageant, and yet, that same day, she might condemn herself as completely hideous because she remembers a man who rejected her in her past. There is neither nuance nor constancy in the borderline’s perception of herself or others. Her perception of herself and others is contingent entirely upon her current state. It is in this sense that she has totally “contingent” self-esteem. She only feels valuable or possessing self-worth while she is impressing or seducing others, and as long as this is not happening, she feels worthless and unloveable.
The borderline has an overriding sense of inauthenticity and fraudulence. While oftentimes projecting an omnipotent, composed and highly confident exterior, this is a cover for deep-seated insecurities, and its purpose is to shore up her fragile sense of self through the continual admiration of others. Whenever such admiration is withdrawn, either in reality or in her own mind, she reverts to feeling non-existent or worthless.
“This chronic sense of being a fake or sham probably originates in childhood…the pre-borderline often grows up feeling inauthentic due to various environmental circumstances- suffering physical or sexual abuse or being forced to adopt an adult’s role while still a child or to parent his own sick parent. At the other extreme, he may be discouraged from maturing and separating, and may be trapped in a dependent child’s role, well past an appropriate time for separation”(Kriesman, 2010).
No ultimate role or identity is ever really chosen. Instead of internalizing a consistent sense of identity, their experiences only constitute practice for “faking it” in other circumstances. “If he fails in the role, he fears he will be punished; if he succeeds, he is sure he will soon be uncovered as a fraud and be humiliated”(Kriesman, 2010).
The lack of a core sense of identity oftentimes exhibits itself in marked instability in various aspects of their lives. For example, they may oftentimes switch the social groups or cliques. They change identities from one group to another, adapting like a chameleon to whatever social milieu they think might offer them validation. As such, questions of gender, sex and sexuality are oftentimes extremely problematic for the borderline, and they tend to lack a consistent core of such sexual identity. Rather than merely being promiscuous, the borderline oftentimes tends to “play the field,” continually fluctuating from one gender role to another, sexual orientation, sexual preference, and so on.
4) Impulsiveness in at least two areas that are potentially self-destructive, e.g., substance abuse, sexual promiscuity, gambling, reckless driving, shoplifting, excessive spending, or overeating – Commensurate with their lack of stable identity, the borderline tends to behave in habitually contradictory or inconsistent ways. They tend to lack impulse control and to engage in careless, reckless or potentially dangerous behaviors. The borderline therefore tends to struggle with having patience and with delaying gratification. This can cause serious interpersonal and occupational difficulties.
5) Recurrent suicidal threats, gestures, or behaviors, or self-mutilating behaviors – Most borderlines engage in both suicidal behavior and self-injuring behavior. This results both from their experience of intense and overwhelming depression, as well as constituting deals for manipulating others. Suicide attempts are oftentimes either half-hearted or feigned altogether, intended only to garner attention rather than with a serious intent to end one’s life.
In many cases, the borderline is crying out for help. Unfortunately, repeated suicide attempts may mask the seriousness and authenticity of the personality disorder, and the significant others in the borderline’s life stop taking her seriously. The attention she gets depreciates while the seriousness of her attempts escalates. It should therefore come as no surprise that suicide is very common among borderlines. In addition to straightforward cutting or burning, borderlines may punish themselves with binge eating, drinking, risky sexual practices or drug abuse.
Self-mutilation may function as an expression of self-hatred, attempts at suicide, or attempts at diverting from feelings of numbness or overwhelming psychological pain.
“Many borderlines deny feeling pain during self-mutilation and even report a calm euphoria after it. Before hurting themselves, they may experience great tension, anger, or overwhelming sadness; afterward there is a sensation of release and relief from anxiety”(Kriesman, 2010).
It may also, as mentioned before, serve to elicit sympathy from someone whose attention the borderline wants, or in order to get back at them by disturbing or frightening them. In other words, such self-aggression may be thinly veiled aggression towards others. It is common for borderlines to behave in ways that force others to contact emergency health or rescue services, for example.
6) Affective instability due to marked reactivity of mood with severe episodic shifts to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days – The mood swings of the borderline are both intense and short-lived. This is in stark contradistinction to someone with bipolar disorder, whose manic and depressive episodes may last for weeks on end. In contrast to this, the borderline may oscillate violently between irritability, elation, depression, and so on, several times in the same day. Indeed, their mood is as variable and contingent as their circumstances. This is another manifestation of their lack of an internal core identity.
7) Chronic feelings of emptiness – The lack of identity characteristic of borderline personality disorder produces unbearable feelings described of “emptiness.” This experience is palpable and agonizing for the borderline. In addition to instability due to reactivity of mood, therefore, the lack of impulse control typical of borderlines is oftentimes a response to unbearable feelings of boredom and emptiness. They want anything to do distract from the nothingness they experience. This partially accounts for their tendency to have numerous short-lived and intense relationships.
“Suicide may appear to be the only rational response to a perpetual state of emptiness. The need to fill the void or relieve the boredom can lead to outbursts of anger and self-damaging impulsiveness – especially drug abuse. Abandonment may be more acutely felt. Relationships may be impaired. A stable sense of self cannot be established in an empty shell. And mood instability may result from the feelings of loneliness. Indeed, depression and feelings of emptiness often reinforce each other”(Kriesman, 2010).
8) Inappropriate, intense anger, or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights – this is one of the most disturbing and frightening symptoms of borderline personality disorder. Typical of their mood reactivity, the borderline frequently lashes out in violent fits of rage. Significant others in the individuals life frequently find themselves walking on eggshells, for fear of activating the hair trigger of the borderline’s rage. These fits of rage may range from the emotionally damaging and unpleasant, to the physically dangerous.
“The anger may be sparked by a particular (and often trivial) offense, but underneath the spark lies an arsenal of fear from the threat of disappointment and abandonment…The rage, so intense and so near the surface, is often directed at the borderline’s closest relationships – spouse, children, parents. Borderline anger may represent a cry for help, a testing of devotion, or a fear of intimacy – whatever the underlying factors, it pushes away those whom the borderline needs most”(Kriesman, 2010).
9) Transient, stress related paranoid thoughts or symptoms of severe dissociation – this is another frightening symptom of BPD. It is this symptom which contributed to the label “borderline,” insofar as the individual appears borderline psychotic during these episodes, which are more characteristic of a psychotic disorder such as schizophrenia than they are of a personality disorder like BPD. During experiences of dissociation, the borderline feels unreal.
Elements of their personality may emerge in distinct situations, and these elements may appear to the borderline and to other observers as radically split off from the rest of their personality, and poorly integrated within it. Such episodes are typically triggered by severe stress. The same is true of the delusions of persecution by the borderline. They may oftentimes feel as though others are persecuting them or seeking to harm them, in a manner similar to that of the schizophrenic. What distinguishes these episodes from psychosis, however, is their transience. They are not full-blown psychotic episodes that last months on end, but may last only a few days or even hours, comparable to the transience of their mood reactivity.
Kreisman MD, Jerold J.; Hal Straus (2010-10-25). I Hate You–Don’t Leave Me: Understanding the Borderline Personality (Kindle Location 1154). Penguin Group US. Kindle Edition.