Information



BPD
Legacy Name: BPD


The Reborn Illumis
Owner: POURRITURE

Age: 14 years, 5 months, 1 week

Born: May 26th, 2012

Adopted: 14 years, 5 months, 1 week ago

Adopted: May 26th, 2012

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{ Borderline personality disorder }

The Reborn Illumis POURRITURE

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To live a life analogous to a soap opera is to live the life of a borderline personality. Wrought with emotional ups and downs, these individuals are known to be unstable and especially angry. What fuels the chaos are intense interpersonal needs and sudden shifts of opinion about others, who may be painted as loving, sensitive, and intelligent one minute and accused of neglect and betrayal the next. When left alone, even for short periods, borderline personalities feel intolerably lonely and empty. With romantic relations typically stormy and intense, they spend most of their time either making up or breaking up. They make frantic attempts to avoid abandonment, including suicidal gestures. In addition, they fail to realize that their clinginess via dramatic and drastic measures drives others away. - Millon et al., 2004 [3]
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Alternative diagnoses:

Aggressive personality disorder; emotionally unstable personality disorder; explosive personality disorder; impulsive personality disorder [8]

Common comorbidities:

ADHD; anxiety disorders; bipolar depression; eating disorders; dissociative identity disorder; post-traumatic stress disorder; substance abuse [3]

Five-factor model profile:

↑ Agreeableness; extraversion; neuroticism
↓ Conscientiousness; openness [4]

Evolutionary strengths and weaknesses:

Structurally defective personality (prone to decompensation into cyclophrenia); conflict between all polarities [7]
Enhancement -
Preservation -

Pleasure/pain

Accommodation -
Modification -

Passive/active

Individuation -
Nuturance -

Self/other

DSM-IV-TR 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., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
  • 5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).
  • 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
It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

DSM-5 Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and 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-mutilating 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-mutilating behavior covered in Criterion 5.)
  • 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating 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, 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. [2]

Alternative DSM-5 Criteria
A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas:
    1. Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
  • 2. Self-direction: Instability in goals, aspirations, values, or career plans.
  • 3. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
  • 4. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between overinvolvement and withdrawal.
B. Four or more of the following seven pathological personality traits, at least one of which must be (5) Impulsivity, (6) Risk taking, or (7) Hostility:
  • 1.Emotional lability (an aspect of Negative Affectivity ): Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
  • 2. Anxiousness (an aspect of Negative Affectivity): Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
  • 3. Separation insecurity (an aspect of Negative Affectivity): Fears of rejection by—and/or separation from—significant others, associated with fears of excessive dependency and complete loss of autonomy.
  • 4. Depressivity (an aspect of Negative Affectivity): Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior self-worth; thoughts of suicide and suicidal behavior.
  • 5. Impulsivity (an aspect of Disinhibition): Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
  • 6. Risk taking (an aspect of Disinhibition): Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
  • 7. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults. [2]

ICD-10 Criteria
Impulsive type
The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.

Borderline type
Several of the characteristics of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants). [9]

Functional Domains

Expressive Behavior: SpasmodicDisplays a desultory energy level with sudden, unexpected, and impulsive outbursts; abrupt, endogenous shifts in drive state and inhibitory controls; not only places activation and emotional equilibrium in constant jeopardy, but engages in recurrent suicidal or self-mutilating behaviors.
Interpersonal Conduct: ParadoxicalAlthough needing attention and affection, is unpredictably contrary, manipulative, and volatile, frequently eliciting rejection rather than support; frantically reacts to fears of abandonment and isolation, but often in angry, mercurial, and self-damaging ways.
Cognitive Style: CapriciousExperiences rapidly changing, fluctuation, and antithetical perceptions or thoughts concerning passing events, as well as contrasting emotions and conflicting thoughts toward self and others, notably love, rage, and guilt; vacillating and contradictory reactions are evoked in others by virtue of behaviors, creating, in turn, conflicting and confusing social feedback.
Regulatory Mechanism: RegressionRetreats under stress to developmentally earlier levels of anxiety tolerance, impulse control, and social adaptation; among adolescents, is unable to cope with adult demands and conflicts, as evident in immature, if not increasingly infantile, behaviors.

Structural Domains

Self-Image: UncertainExperiences the confusions of an immature, nebulous, or wavering sense of identity, often with underlying feelings of emptiness; seeks to redeem precipitate actions and changing self-presentations with expressions of contrition and self-punitive behaviors.
Object-Representations: IncompatibleInternalized representations comprise rudimentary and extemporaneously devised, but repetitively aborted learnings, resulting in conflicting memories, discordant attitudes, contradictory needs, antithetical emotions, erratic impulses, and clashing strategies for conflict reduction.
Morphologic Organization: SplitInner structures exist in a sharply segmented and conflictual configuration in which a marked lack of consistency and congruency is seen among elements; levels of consciousness often shift and result in rapid movements across boundaries that usually separate contrasting percepts, memories, and affects, all of which lead to periodic schisms in what limited psychic order and cohesion may otherwise be present, often resulting intransient, stress-related psychotic episodes.
Mood/ Temperament: LabileFails to accord unstable mood level with external reality; has either marked shifts from normality to depression to excitement, or has periods of dejection and apathy, interspersed with episodes of inappropriate and intense anger, as well as brief spells of anxiety or euphoria. [6]

Abandonment anxiety:

The stormy interpersonal life of the borderline personality, where action flows freely from mood, is legendary. Although everyone wants a special someone, many borderlines hunger for that one relationship to validate their very existence, a powerful or nurturing figure who can make them feel secure. At the beginning, they feel magically involved, idealizing their partner, putting him or her on a pedestal as the greatest thing the world has ever seen. Because their partner is so special, borderlines are special, too, for it is they who are the recipient of the love and affection of this perfect person. Distance is intolerable and separation unthinkable.

As a consequence of their concentrated need to be intensely emotionally connected with someone, borderlines have tremendous abandonment fears. For most borderlines, being attached to someone rises to the level of a pseudo-biological need, like water or air. Even when securely involved in a relationship, fears of abandonment impose themselves on reality to an almost delusional degree, as if their self-cohesiveness or self-identity might dissolve if the relationship were to end. They may feel, for example, that they are nothing without a certain person, life would be empty without him or her, and their very existence depends on preserving the relationship. To compensate these fears, significant others should nurture, love, and protect the borderline, always be physically available, and never leave.

Fears of abandonment are not confined to fantasy, but instead distort borderlines' perception of the communications and actions of others as part of everyday life. They are easily provoked by things that others would never notice. Innocent or irrelevant events or comments may be construed as implying criticism or condemnation. Other events are perceived as their loved one's waning affections or others have refused to consider their feelings or simply no longer care. Even efforts to establish simple boundaries may signify total rejection, the borderline's worst fear. As a result, minor events are regularly given unintended significance and blown completely out of proportion, producing major interpersonal catastrophes. From the perspective of borderlines, they will soon be cast aside, left lost and alone, with no one to care. The feeling that someone important to the subject is actively distancing may provoke an emergency reaction, punctuated by a tearful, helpless paralysis and a near manic hyperactive display of anger. [3]

Subtypes of the borderline personality:

Discouraged (with avoidant, depressive or dependent features) borderlines are pliant, submissive, loyal and humble. They feel vulnerable and in constant jeopardy; hopeless, depressed, helpless, and powerless.

Petulant (with passive-aggressive features) borderlines are negativistic, impatient,restless, as well as stubborn, defiant, sullen, pessimistic, andresentful. They are easily slighted andquickly disillusioned.

Impulsive (with histrionic or antisocial features) borderlines are capricious, superficial, flighty,distractible, frenetic, andseductive. Fearing loss, they becomeagitated, gloomy andirritable. They are potentially suicidal.

Self-destructive (with depressive or masochistic features) borderlines are inwardly-turning, intropunitivelyangry, conforming and deferential.Ingratiating behaviors have deteriorated.They are increasingly high-strungand moody and are possibly suicidal. [5]

Differential diagnoses:

Sites and Sources
1. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.

2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Washington, DC: American Psychiatric Association.

3. Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (2004). Personality Disorders in Modern Life (2nd ed.). New Jersey: John Wiley & Sons, Inc.

4. Kelly, D. (2012). Borderline Personality Disorder. Retrieved from http://www.ptypes.com/borderlinepd.html

5. Millon, T. (2006). Personality Subtypes. Retrieved from http://www.millon.net/taxonomy/summary.htm

6. Millon, T. (2006). Capricious/Borderline Personality. Retrieved from http://www.millon.net/taxonomy/borderline.htm

7. Millon, T. (2012). Disorders of Personality: DSM-IV and Beyond (3rd ed.). New Jersey: John Wiley & Sons, Inc.

8. World Health Organization. (2010). International Statistical Classification of Diseases and Related Health Problems 10th Revision. Retrieved from http://apps.who.int/classifications/icd10/browse/2010/en#/F60.3

9. World Health Organization. (2010). The ICD-10 Classification of Mental and Behavioural Disorders. Retrieved from http://www.who.int/classifications/icd/en/bluebook.pdf

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