301.83 Borderline Personality Disorder

DSM-IV diagnostic criteria:

A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as 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-injuring behavior 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-injuring behavior covered in Criterion 5
5. recurrent suicidal behavior, gestures, or threats, or self-injuring behavior
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 anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

As far as I know, I have never received a diagnosis of borderline personality disorder. Because I have (some) history of self-harm (e.g., cutting), I think some people may have assumed this was one of my diagnoses.

However, there are some of the criteria that are so wrong for me that I think it's unlikely I would receive, or agree with such a diagnosis. Aside from that, diagnosis of borderline personality disorder can be stigmatizing, and associated with a poor prognosis. It originally got its name due to symptoms that seemed to be borderline schizophrenic. I don't think that 'emotionally unstable personality disorder', a suggested replacement name, is better.

1. I never actually try to avoid abandonment - in fact, I am more likely to suggest the endings of relationships, to make things easy for the person if they wish an ending, and I do know how to take no for an answer. I have absolutely no wish to hold on to illusions regarding relationships, and if they have been based upon false pretenses, I have to let go. The idea of 'clinging' is abhorrent to me.

2. I suppose that it might seem like I have a pattern of having some unstable and intense interpersonal relationships, but I think my two long-term relationships (both at least 7 years in length) could hardly be counted as unstable.

3. It is difficult to hold on to a strong sense of identity when messages from society say that someone in my position is lazy, a quitter, manipulative, avoidant, needy, high maintenance, embarrassingly excessive, out of touch with reality, negative, etc.

4. Impulsivity in binge eating or drinking: check.

5. I have an ongoing wish to die, but I don't like the wording of 5., and don't think of myself as emotionally manipulative in my expression of that wish. As for self-harm, it has been many years since my cutting phase, and in total it only happened a certain number of times through the years. It turned out to be a coping mechanism that didn't 'stick'.

6. My moods are usually stable (depressed).

7. I suppose that a chronic feeling of emptiness is similar to a chronic wish to die - except I am not actually all that sure that I am emptier than most people.

8. I had an anger phase in my mid-to-late 30s or so as I was starting to get in touch with my repressed rage, but things have been a lot calmer for some time, and for most of my life, I have probably been far less irritable and angry than most people.

9. I suppose my delusions from 2005-2008 might fit this category.

Maybe I have fit enough of the criteria at certain times in my life? Certainly not in early adulthood, though. I think my attempt at self-diagnosis gives a more comprehensive or helpful perspective.