Borderline Personality Disorder Diagnosis detailed explanation of symptoms:


    1. Abandonment Fears. These fears should be distinguished from the more common and lesssevere phenomena of separation anxiety. The perception of impending separation orrejection, or the loss of external structure, can lead to profound changes in the BPD patient’sself-image, affect, cognition, and behavior. Individuals with BPD are interpersonallyhypersensitive and may experience intense abandonment fears and inappropriate angereven when faced with criticisms or time-limited separations. These abandonment fears arerelated to an intolerance of being alone and a need to have other people with them. Franticefforts to avoid abandonment may include impulsive actions such as self-injurious or suicidalbehaviors. It was originally postulated that fear of abandonment developed as a result offailures in a child’s development during the rapprochement phase (from age one-and-a-halfto two-and-a-half). However, empirical evidence has not borne this out.
    2. Unstable, Intense Relationships. Individuals with BPD are frequently unable to seesignificant others (i.e., potential sources of care or protection) as other than idealized (ifgratifying), or devalued (if not gratifying). This is often referred to as “black and whitethinking,” and in psychological terms, reflects the construct of “splitting.” When anger initiallyintended toward a loved one is experienced as dangerous, it gets “split” off to preserve theloved one’s goodness. Relationship instability is thought to be a symptom of early insecureattachment characterized by both fearful distrust and needy dependency.
    3. Identity Disturbance. The disorder of self which is specific to borderline patients ischaracterized by a distorted, unstable or weak self-image. Borderline patients often havevalues, habits, and attitudes which are dominated by whomever they are with. Theinterpersonal context in which these identity problems get magnified is thought to begin withnot learning to identify one’s feeling states and the motives behind one’s behaviors.
    4. Impulsivity. The impulsivity of the borderline individual is frequently self-damaging, in itseffects if not in its intentions. This differs from impulsivity found in other disorders such asmanic/hypomanic or antisocial disorders. Common forms of impulsive behavior forborderline patients are substance or alcohol abuse, bulimia, unprotected sex, promiscuity,and reckless driving.
    5. Suicidal or Self-injurious Behaviors. Recurrent suicidal attempts, gestures, threats, orself-injurious behaviors are the hallmark of the borderline patient. The criterion is soprototypical of persons with BPD that the diagnosis rightly comes to mind wheneverrecurrent self-destructive behaviors are encountered. Self-destructive acts often start in early adolescence and are usually precipitated by threats of separation or rejection or byexpectations that the BPD patient assume unwanted responsibilities. The presence of thispattern assists the diagnosis of concurrent BPD in patients whose presenting symptoms aredepression or anxiety.
    6. Affective (Emotional) Instability. Early clinical observers noted the intensity, volatility andrange of the borderline patient’s emotions. It was originally proposed that borderlineemotional instability involved the same problems of affective irregularity found in personswith mood disorders, particularly depression and bipolar disorder. It is now known thatalthough individuals with BPD display marked affective instability (i.e., intense episodicdepression, unrest, anger, panic, or despair), these mood changes usually last only a fewhours, and that the underlying dysphoric mood is rarely relieved by periods of well-being orsatisfaction. These episodes may reflect the individual’s extreme reactivity to stresses,particularly interpersonal ones and a neurobiologically-based inability to regulate emotions.
    7. Emptiness. Chronic emptiness, described as a visceral feeling, usually felt in the abdomenor chest, plagues the borderline patient. It is not boredom, nor is it a feeling of existentialanguish. This feeling state is associated with loneliness and neediness. Sometimes theirexperience is considered an emotional state and sometimes it is considered a state ofdeprivation.
    8. Anger. The anger of the borderline patient may be due to temperamental excess (a geneticvulnerability) or a longstanding response to excessive frustration (an environmental cause).Whether the cause is genetic or environmental, many individuals with BPD report feelingangry much of the time, even when the anger is not expressed overtly. Anger is often elicitedwhen an intimate or caregiver is seen as neglectful, withholding, uncaring, or abandoning.Expressions of anger are often followed by shame and contribute to a sense of being evil.
    9. Psychotic-like Perpetual Distortions (Lapses in Reality Testing). Borderline patientscan experience dissociation symptoms: feeling unreal or that the world is unreal. Thesesymptoms are associated with other disorders, such as schizophrenia and Post TraumaticStress Disorder (PTSD), but in those with BPD the symptoms generally are of short duration,at most, a few days, and often occur during situations of extreme stress. Borderline patientsalso can be unrealistically self-conscious, believing that others are critically looking at ortalking about them. These lapses of reality in the BPD patient may also be distinguishedfrom other pathologies in that generally the ability to correct their distortions of reality withfeedback remains intact.
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