What Even Is BPD?

Ever feel like the therapy world is just a game of alphabet soup? Well, you aren't alone. From ADHD to OCD there are so many acronyms to keep track of. And while you may be familiar with those examples, you probably don't know much about BPD. Well, you have come to the right place! In this post, I will go through the characteristics and diagnostic criteria for BPD. This is not an offical assessment. It is to provide information, not to diagnose.

BPD stands for borderline personality disorder. It is a mental health diagnosis that has 9 main characteristics. Of those 9 characteristics, only 5 are required to be present in someone for diagnosis. So, not everyone with BPD is going to present the same way. Some people meet all 9 characteristic descriptions and some people don’t. For example, not everyone diagnosed with BPD tries self-harm or attempts suicide. And for that matter, not everyone who DOES self-harm or attempts suicide meet the criteria for BPD diagnosis.

The nine characteristics as outlined by the DSM-V-TR:

1. Intense efforts to avoid abandonment: (Note: the DSM says “real or imagined abandonment.” I do not include this because frankly, you define what equals abandonment to you. Now that does not mean that we are being abandoned just because we are afraid of it. This is why mindfulness skills can help calm the nervous system so we can actually assess whether we are being abandoned or not. Spoiler alert: we probably are not.) This can show up a number of ways. Some common ones show up as pushing people away before they can push you away, i.e. breaking up with someone before they can break up with you, cutting contact with people that your rational self wouldn’t necessarily cut-out. Remember though, this can show up in many different ways depending on the person. Some people send thirty texts in a row because they aren’t getting a response or blocking someone because they aren’t responding to punish them. Basically, “I’m going to hurt you before you can hurt me.”

   
   

2. A pattern of unstable and/or intense relationships that swing from idealizing to devaluation (i.e. that is your absolute favorite person or they hate you or you hate them and the relationship is completely terrible/toxic/etc.) Basically, you have a history of any relationship (not just romantic, though often it is easiest to see in romantic relationships) that are intense and unpredictable. They are often short and swing between high conflict and high affection. I love you, I hate you. I can’t live without you, you are ruining my life, and on and on. This is due to the black and white thinking that comes with BPD symptoms.

   
   

3. "Markedly and persistently" unstable sense of self or self-image. Have you ever struggled when someone asked you to tell them about yourself, and your mind couldn't think of a single thing to say about yourself? That may be because you are not connected to your core self. I also want to say from my personal and clinical experience, it is NOT that you do not have a self, it is that you are out of touch with it. You may be able to name a couple things you like or one to two identities (like your job title), but overall, you do not really know how to connect to who you see yourself as. Or you may have a sometimes very negative view of self with very occasional thoughts of "man, I am great today. Just killing it!" The former is usually the norm, the latter tends to be the exception.

   
   

4. Impulsivity in at least two areas that have the potential to be self-damaging. Do you spend a lot of money when you need a boost? Do you struggle to drink, smoke, etc., in moderation? Do you over-indulge in anything because you are emotional, like food, exercise to the point of pain, or even sex? Do any of these indulgences involve risk? That could be impulsivity. This can look a lot like bipolar mania, which is why, a lot of times, clinicians mistake BPD for bipolar disorder.

   
   

5. Recurrant Suicide threats or behavior, or "self-mutilating" behavior. Do you wish you didn't exist...like a lot? Do you ever hope you just blink out of life without consequence? Those are examples of passive SI (suicidal ideation). This characteristic can be as passive as those all the way through concrete and planned suicide attempts. Self-harm can have a number of definitions from skin-picking til you bleed to cutting and burning. There are so many forms that it is hard to state all of them. The basic thing is this: if you do something physical to cause pain or harm to yourself for the sake of relieving your emotional overwhelm, it might be self-harm.

   
   

6. Affective instability which basically means intense mood swings. This can show up with ANY emotion. When you are happy or excited, you can become intensely out of touch with consequences. When you are in love, you can seem obsessed. When you are angry, you can be aggressive and rageful. Basically, when you have feelings they are very intense and can change on a dime. One second you are so utterly obsessed with a romantic partner or friend and the next you hate them beyond words, then the next you are grieving the relationship like they died (often sobbing or self-harming to cope). Your emotions make no sense to others and don't even make sense to you half the time.

   
   

7. Chronic feelings of emptiness. This one is harder to explain. This can show up as a constant pit in the stomach, a hole you are trying to fill that just isn't going away. You try the impulsive behavior to make you feel alive or connected or anything that isn't this emptiness but nothing works. Some people try to fill this emptiness with achievements, "if I just get to the right level of my career," for instance, "then I won't feel empty." But then you complete the goal and you still feel unfulfilled. I think some of this is due to the lack of self-connection and until the sense of self is better developed, you will likely continue feeling empty. But, that does not mean there is no hope. There is even when it feels impossible. I can't guarantee you will never feel empty or alonee again, but I do promise that there are things to try before letting the emptiness swallow you.

   
   

8. Intense anger or difficulty controlling anger. Remember how I said rage can seem like it comes out of nowhere? Well here we are again. Let me say this time, that you do not get to "control" your feelings, but you can keep them from controlling you. In fact, most people have been taught skills for how to control their behaviors (some to the point of completely ignoring their emotions). I'm guessing that if you relate to this one, you never learned some of the "basic skills" others did. And you know what, it isn't necessarily your fault. This does not mean that you can use BPD as an excuse for being rude or even cruel. It just means, that you have to try and learn the "basics" later in life. Which is the whole point of DBT, but more on that in another post.

   
   

9. The last one is pretty abstract, temporary, stress-related paranoia or severe dissociation symptoms. This looks like getting overly into your daydreams and fantasies. They become so vivid they may start to feel real in those moments. Or maybe you sometimes aren't sure your life isn't really real when you are stressed. Maybe you are paranoid that if you write your feelings down or tell someone (including those you trust or even clinicians) about what happens in your head, someone will somehow use this to hurt you or something equally bad will happen. At my worst, I had to remind myself that other people cannot read my mind and even if they could, why would strangers listen to my mind specifically. Like it did not make sense but when I was stressed (especially when I felt "crazy") despite logic, my anxiety told me to not trust anyone because everyone was judging me and seeing how awful I was. Yeah, that was not true but man did it FEEL true. And that is what BPD symptoms really are, feeling over logic. Emotions run the show and logic and regulation can just dissapear at any moment when emotions take over.

And that is BPD as a diagnosis. Now this is not intended as an assessment but rather to provide some insight into what BPD is and how the characteristics might show up. This is also not an exhaustive list of possibilities. Everyone is different, and so, like with anything, any of these can show up with different levels of severity or in different manifestations.

I'll end with this, if you relate to any of these and think you need a true assessment, reach out to a clinician. Find a professional that works with BPD diagnoses and ask to be formally assessed. You have agency here. Always.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is a critical resource for mental health professionals. It provides standardized criteria for the classification of mental disorders.

For reference:

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Revision (DSM-5-TR). Arlington, VA: American Psychiatric Publishing.