BPDball

"Can't be abandoned if I abandon you first! hahaha please kill me"

### Frequency

Estimated 1.6% of the population but the true percentage is likely much higher due to misdiagnosis

### Likes

Shopping sprees
Living life on the edge
Anyone who gives me the slightest amount of attention

### Dislikes

Being abandoned
Being rejected
Being left on read for more than two seconds
Making decisions
Neurotypicals that are able to live normal happy lives

**Borderline Personality Disorder** (**BPD**) is a personality disorder characterised by pervasive instability of interpersonal relationships, distorted sense of self, and strong emotional reactions. **BPDball** is often found engaging in self-harm and other dangerous behaviour. They also struggle with a constant feeling of emptiness, fear of abandonment, and detachment from reality. BPDball also commonly associates with Depressionball, substance use disorders. and eating disorders.

BPD is often stigmatised in both media and the psychiatric field.

## Signs and symptoms

BPD is characterised by the following nine signs and symptoms:

* Frantic efforts to avoid real or imagined abandonment
* Unstable and chaotic interpersonal relationships and self-image, alternating between extremes of idealisation and devaluation, also known as 'splitting'
* Markedly disturbed sense of identity and distorted self-image
* Impulsive or reckless behaviours (e.g., impulsive or uncontrollable spending, unsafe sex, substance use disorders, reckless driving, binge eating)
* Recurrent suicidal gestures or self harm
* Intense or uncontrollable emotional reactions and rapidly shifting between different emotional states
* Chronic feelings of emptiness
* Inappropriate, intense anger or difficulty controlling anger
* Transient, stress-related paranoid ideation or severe dissociative symptoms

Other symptoms may include feeling unsure of one's identity, morals and values; having paranoid thoughts when feeling stressed; depersonalisation; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes. Individuals with BPD often have comorbid conditions, such as depressive or bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder.

## Causes

As the cause with other mental disorders, the causes of BPD are complex and not fully agreed upon. Evidence suggests that BPD and PTSD may be related in some way. Most researchers agree that a history of childhood trauma can be a contributing factor, but less attention has historically been paid to investigating the casual roles played by congenital brain abnormalities, genetics, neurobiological factors, and environment and learned coping skills that deal with stress. These different factors together suggest that there are multiple factors that may contribute to the disorder.

## Diagnosis

Diagnosis of Borderline Personality Disorder is based on a clinical assessment by a mental health professional. The best method is to present the criteria of the disorder to a person and to ask them if they feel that these characteristics accurately describe them. Actively involving people with BPD in determining their diagnosis can help them become more willing to accept it. Some clinicians prefer not to tell people with BPD what their diagnosis is, either from concern about the stigma attached to this condition or because BPD used to be considered untreatable; it is usually helpful for the person with BPD to know their diagnosis. This helps them know that others have had similar experiences and can point them toward effective treatments.

In general, the psychological evaluation includes asking the patient about the beginning and severity of their symptoms, as well as other questions about how these symptoms impact the patient's quality of life. Issues of particular note are suicidal ideations, experiences with self-harm, and thoughts about harming others. Diagnosis is based both on the person's report of their symptoms and on the clinician's own observations. Additional tests for BPD can include a physical exam and laboratory tests to rule out other possible triggers for symptoms, such as thyroid conditions or a substance use disorder.

### *Diagnostic and Statistical Manual*

The *Diagnostic and Statistical Manual of Mental Disorders* fifth edition (DSM-5) defines the main features of the condition and an individual must meet five of nine criteria to receive a diagnosis of Borderline Personality Disorder. These criteria are described as a pervasive pattern of instability in interpersonal relationships, self-image, and affect, as well as markedly impulsive behaviour. In addition, the DSM-5 proposes alternative diagnostic criteria for BPD in section III, "Alternative DSM-5 Model for Personality Disorders". These alternative criteria are based on trait research and include specifying at least four of seven maladaptive traits. According to Marsha Linehan, many mental health professionals find it challenging to diagnose BPD using the DSM criteria, since these criteria describe such a wide variety of behaviours. To address this issue, Linehan has grouped the symptoms of BPD under five main areas of dysregulation: emotions, interpersonal relationships, sense of self, and cognition.

### International Classification of Disease

The World Health Organisation's ICD-10 defines a disorder that is conceptually similar to BPD, called *Emotionally Unstable Personality Disorder*. Its two subtypes are described below.

##### Impulsive type

At least three of the following must be present, one of which must be (2):

1. Marked tendency to act unexpectedly and without consideration of the consequences
2. Marked tendency to engage in quarrelsome behaviour and to have conflicts with others, especially when impulsive acts are thwarted or criticised
3. Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions
4. Difficulty in maintaining any course of action that offers no immediate reward
5. Unstable and capricious (impulsive, whimsical) mood

##### Borderline type

At least three of the symptoms mentioned in *impulsive type* must be present [see above], with at least two of the following in addition:

1. Disturbances in and uncertainty about self-image, aims, and internal preferences
2. Liable to become involved in intense and unstable relationships, often leading to emotional crisis
3. Excessive efforts to avoid abandonment
4. Recurrent threats or acts of self-harm
5. Chronic feelings of emptiness
6. Demonstrates impulsive behaviour, e.g., speeding in a car or substance use

The ICD-10 also describes some general criteria that define what is considered a personality disorder.

### Millon's subtypes

American psychologist Theodore Millon has proposed four subtypes of BPD. He suggests that an individual diagnosed with BPD may exhibit none, one, or multiple of the following

 **Petulant borderline** (including negativistic features)
 **Impulsive borderline** (including histrionic or antisocial features)
 **Self-destructive borderline** (including depressive or masochistic features)

### Misdiagnosis

Individuals with BPD may be misdiagnosed for a variety of reasons. One reason for misdiagnosis is because BPD has symptoms that coexist (comorbidity) with other disorders such as depression, post-traumatic stress disorder (PTSD), and bipolar disorder.

## History

The coexistence of intense, divergent moods within an individual was recognised by Homer, Hippocrates, and Aretaeus, the latter describing the vacillating presence of impulse anger, melancholia, and mania within a single person. The concept was revived by Swiss physician Théophile Bonet in 1684 who, using the term *folie maniaco-mélancolique*, described the phenomenon of unstable moods that followed an unpredictable course. Other writers noted the same pattern, including the American psychiatrist Charles H. Hughes in 1884 and J. C. Rosse in 1890, who called the disorder "borderline insanity". In 1921, Kraepelin identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.

The first significant psychoanalytic work to use the term "borderline" was written by Adolf Stern in 1938. It described a groups of patients suffering from what he thought to be a mild form of schizophrenia, on the *borderline* between neurosis and psychosis.

The 1960s and 1970s saw a shift from thinking of the condition as borderline schizophrenia to thinking of it as borderline affective disorder (mood disorder), on the fringes of bipolar disorder, cyclothymia, and dysthymia. In the DSM-II, stressing the intensity and variability of moods, it was called cyclothymic personality (affective personality). While the term "borderline" was evolving to refer to a distinct category of disorder, psychoanalysts such as Otto Kernberg were using it to refer to a broad spectrum of issues, describing an intermediate level of personality organisation between neurosis and psychosis.

After standardised criteria were developed to distinguish it from mood disorders and other Axis I disorders, BPD became a personality disorder diagnosis in 1980 with the publication of the DSM-III. The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder". The DSM-IV Axis II Work Group of the American Psychiatric Association finally decided on the name "borderline personality disorder", which is still in use by the DSM-5 today. However, the term "borderline" has been described as uniquely inadequate for describing the symptoms and characteristics of this disorder.

### Etymology

Earlier versions of the DSM - before the multiaxial diagnosis system - classified most people with mental health problems into two categories, the psychotics and the neurotics. Clinicians noted a certain class of neurotics who, when in crisis, appeared to straddle the borderline into psychosis. The term "borderline personality disorder" was coined in American psychiatry in the 1960s. It became the preferred term over a number of competing names, such as "emotionally unstable character disorder" and "borderline schizophrenia" during the 1970s. Borderline personality disorder was included in DSM-III (1980) despite not being universally recognised as a valid diagnosis.

## Personality and Behaviour

"I'm a personality disorder duh, I'm pretty sure it's pretty self explanatory with the information above"

BPDball is extremely emotional having constant mood swings from one extreme emotion to the other, they are in a constant state of distress and can go from adoring you to despising you within seconds. They often engage in self-destructive behaviours falling down an endless spiral as their condition seems to eternally deteriorate. They also respond very defensively to criticism and struggle with their sense of self and being.

## How to draw

1. Draw a ball with a black outline.
2. Draw a line in a lighter shade of black horizontally through the ball.
3. Fill the space below with the same shade of black and the space above with white.
4. Draw the Hand of Eris (vertical line with two c shape curves pointing outwards from the line) in a middle grey at the centre of the ball.
5. Add the eyes and you're done!

## Relationships

### Family - Cluster B (dramatic)

* ASPDball - Sometimes I find you the most exciting to be around, other-times you're just a nightmare, others generally tell me to avoid you
* HPDball - My slightly more attention seeking sister
* NPDball - I'm not you I'm not you I'm not you I'm not you

### Friends

* Depressionball - Who here isn't friends with you though :'(
* Anxietyball - Lets overthink and become overwhelmed by our own paranoia together! yay hahaha
* Bipolarball - Sometimes people confuse us with each other which we both hate but we can still relate to one another on many levels
* PTSDball - We hang out sometimes, some people think they and Bipolar are my parents for some reason

### Frenemies

* Alcoholismball - You act like my toxic ex, you make me feel like shit but sometimes I just can't live without you
* DIDball - Sometimes people think I'm you thanks to my unstable personality and the drastic mood swings I have

### Enemies

* Neurotypicalball - I'm not just being over dramatic! Wait please don't go, if you leave me I'll kill myself
* OCDball/OCDPball - You are literally my polar opposite; if you are order, I am disorder

## Further Information

### Official Mental Health Informational Websites

* National Institute of Mental Health - BPD
* WebMD - BPD
* Paitent.info - Emotionally Unstable Personality Disorder

### Wikipedia

* Borderline Personality Disorder
* Personality Disorder
* Cluster B personality disorders

### Online Communities

* r/BPD
* r/BorderlinePDisorder
* r/BPDlight
* r/BPDmemes