What are the criteria for Borderline Personality Disorder?
Borderline Personality Disorder, or BPD for short, is a diagnosis given to people with pervasive and long-standing difficulties with regulating emotions and associated erratic behavior and unstable interpersonal relationships.
What is "Emotion Mind"?
A person with these difficulties is likely to be emotionally sensitive, getting more emotionally distressed than others in response to environmental or internal triggers, and taking longer to settle back down to a baseline of emotional stability afterwards. This is often referred to as “quick to light, slow to burn out”. As a result, this individual spends longer in what can be termed “emotion mind”, which is a mental space dominated by strong emotions and their associated action urges.
Strong emotions affect brain function
Research shows us that while experiencing strong emotions the frontal lobes of the brain are essentially offline. This is significant for an individual with BPD because frontal lobe functions include being able to anticipate future consequences resulting from current actions, choose between possible behaviours, and override or suppress socially unacceptable behaviour. Therefore, with these important higher order functions lost, a person in emotion mind is at risk of acting out the action urges they are experiencing, without considering consequences. Anger is an example of this. The action urge for anger is often yelling, throwing something, stamping feet and so on. These behaviours generally reflect inadequate planning, disregard for consequences, and are likely to be socially unacceptable, but nevertheless a person may do all of these when in emotion mind. All core emotions have associated action urges and acting on them inappropriately is partly responsible for the unsettled interpersonal relationships and behavioural instability common in people with a diagnosis of BPD.
There are nine criteria listed for BPD, and to receive this diagnosis a person must meet five of them. We will now consider the criteria in the light of the above discussion. The specific criteria are written in bold text.
Two of the criteria clearly relate to problems in emotion regulation as discussed above and these are Emotional changeability or hyperactivity and Difficulties controlling intense anger. These criteria refer to “too much” emotion and under-control of emotions, but problems in emotion regulation can also describe over-control of emotions and insufficient emotional experiencing. This later is reflected in two other criteria, namely Feelings of emptiness or emotional numbness and Disconnectedness.
The criteria Impulsive behaviour is clearly a result of emotion mind as discussed above, as is Difficult interpersonal relationships. Self-injurious behaviour is a criteria that describes deliberate self-harm often used by an individual with BPD because it has the effect of reduce or numbing the experience of intense emotions.
The eighth criteria is Uncertainty about self-image or identity, and it is reasonably straightforward to envisage how having highly variable emotional experiences and erratic behaviours are likely to interfere with a person’s capacity to experience “self” as a stable and consistent ongoing entity.
The final criteria is Fear of abandonment, and can be seen as relating to poor sense of self and unstable relationships. A poor sense of self is likely to generate intense fear of being alone, and this fear of abandonment may well be reinforced by frequent relationship ruptures.
Life for people with Borderline Personality Disorder and their close friends and family members can be very difficult indeed at times. If you or someone close to you has these sorts of difficulties please consider making an appointment. There is a very effective treatment available for BPD, called Dialectical Behaviour Therapy, or DBT for short, which has been developed specifically for people who struggle in the ways described above. I encourage you to refer to the article What is Dialectical Behaviour Therapy? for more information.