Borderline Personality DSM Criteria

With May being Borderline Personality awareness month I have decided from time to time to reintroduce posts that covered this section. The first one of the so called series deals with the criteria "required" to meet the diagnosis of Borderline Personality Disorder.

Borderline Personality DSM Criteria

Ever since I started this blog I have been spending a lot of time cruising different posts on various issues of mental health and the lack of quality information is troubling so I figured the best way to start, besides me posting a not nice comment that people should do their homework before opening their mouths, is to start with the manual or encyclopedia of mental illness. For of you that are not familiar with the DSM its real name is Diagnostic and Statistical Manual of Mental Disorders and most doctors refers to it when diagnosing a patient. They are on version five right now and the current edition, number 4, was created in 1994 but there was an update if you will in 2000. The next edition is due out in 2012. The information that I will use comes from the last update.

To meet the Borderline Personality Disorder criteria if you will a score of at least five out of nine is required, this is a test you want to fail by the way. Anyway I will list the criteria then try to explain it in english using examples from my own life. Bare with me as this is the first time I have ever tried to do this.

A quick review first - BPD consists of three separate personalities in which two are not real but perceptions and they are, well how I see them, 1) High Self Image 2) Low Self Image 3) Real Self Image. Remember the purpose of BPD is to maintain a high self image level but like I said it is not real but a perception. K, lets get started.

1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

- basically this means if your buddy says he can not come over because he is busy you take it as he does not like you anymore so you do what it takes to ensure yourself your thought is not true. Some people will cause a commotion that will ensure that they get people's attention for even if it is negative attention it satisfies the thought that you are not alone which is more important then the consequences you will have to deal with for causing the commotion. Personally this area really shows up when someone is late or cancels at the last minute and it takes a lot of work to remember sometimes things happens and it is not the person abandoning me.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

- there is a very good book out on the marketplace and the title sums up this criteria very well "I hate you, don't leave me". This one took me a long time to figure out but I knew I was doing it at the time. I could be in a relationship where the other person was just constantly on my nerves so my stress was high as heck and I knew I should get out of the there. The next day this person was the best thing that ever happened to me so it rules out all the insecure doubts I had the day before and then the next day that person was back on my nerves and then the next day.... it is all about perception and which personality is at work: if it is a high BPD day you are better then the queen and everything is perfect, if it is a low BPD day I really have no idea why I am wasting my time on you. It is a rather pain in the ass but once your on the road to recovery it is one of the first areas that calms down, mind you this is also a big reason why therapists do not like treating people suffering with Borderline Personality Disorder for when the person is in the positive stage therapy appears to be going great but when it is in a negative stage the person is more concerned about the therapists saying the wrong thing (in a BPD mind) so they are on guard to attack in order to serve their self image then the actual therapy involved. Like I said recognizing the three stages is a massive step so you realize what you are doing and why.

3. identity disturbance: markedly and persistently unstable self-image or sense of self.

- pretty self explanatory the highs and lows you see with relationships with other people are the same issues you have in the relationship with yourself. Good days I am on top of the world and on bad days I spend the entire day trying to convince myself I should keep breathing. My depression/MDD really kicks in on bad days so I tend to go a lot lower.

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.

- on high BPD days you believe you are invincible so normal rules do not apply to you. In my case I do what I want for I am too smart not to get caught or I am better then the average person. Lots of fun in the high BPD stage but it is also incredibly dangerous. The sex part is basically trying to bang everyone you meet at the extreme end but being promiscuous also satisfies the attention needed to boost the self image. The sex part means nothing to me and has never been an issue but it can be for a lot of people with BPD. My real self shyness and awkwardness prevents promiscuity even on my high end BPD days

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

- I don't really like this category as they are talking about attention seeking behaviors on the extreme end. I have a self harm history but the last reason I do it is for attention and the great lengths I will go to hide it pretty much cements it. to many people are automatically labeled BPD when they self harm but this has more to do with lazy doctors and therapists who jump to conclusions. If I want attention from self harm I would display it at every chance I get but the number of actual scars would be really low as all you need is a few to get the desired effect but I have hundreds and have been "caught" three times participating in self harm behavior and two of those times I did it because I understood I was in danger and needed help immediately. When I was in the hospital the last time I wrote the people in charge of my care a letter that should have been taken as a suicidal intent letter but they chose to ignore it and I believe they felt I was just seeking attention, if a picture of my son was not running through my brain my ass would be dead. Every suicidal treat or gesture should be taken with a 100% seriousness and this category is dangerous because of it. Do you really want to take the chance that the gesture or threat is not real? A wrong response can end up with a dead body. If a BPD person in your life uses this type of threat to gain attention call the police every single time as they are a risk to themselves or others and trust me if they were in it just for attention this behavior will quickly seize to exist. I am hoping in the next version of DSM this criteria will at the very least be reworded.

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).

- I deal with depression as well so this category really does not apply to me as my bad depressive stages tend to lasts for weeks if not months. The reason behind this category is your created self image is so flimsy that it is hard to work off of it as one moment you are way up there and the next your digging out of a hole which is why BPD go through such great effort to maintain there perceived self image. It is difficult for those around the person when he or she is all over the place but try living with the damn thing.

7. chronic feelings of emptiness

- this never effected me in the BPD sense until I started to become aware of the different stages of personality and perception, Now I see my life as something I did not own or participate in for a very long time for I was to focused on keeping steady the self image I had created. Not a nice day when you realize your life has been one big lie.

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

- BPD is created initially to protect yourself from the world that you are in so everything comes down to safety. When I feel someone is putting my self image at risk I attack for the most part as this is the basis of the disorder, I need to send a message that this will not be tolerated and make sure the person fully understands this or in some cases makes sure they do not come back. It takes a lot of work like I continually mention to maintain a rocky self image and when someone seems to attack it you take it very personally. The last person you want to get into a confrontation with is someone with BPD as our lives have been one confrontation after another so we tend to be very good at it and we don't know how to lose. A simple comment along the lines of "You should have done this instead of that" may seem innocent to someone without BPD but when this disorder is a part of your life that comment just said that you are not very smart and not very aware of the situation so it attacks the core beliefs that we had created in our self image especially when the person is untreated and has not acknowledged the different stages of personality and perception. Think of something you have total belief in and how would you react if someone attacked it, its the same thing.

9. transient, stress-related paranoid ideation or severe dissociative symptoms

- For whatever the reason my brain can see someone and believe that the person has no good intentions what so ever. The big one in my life is my mental doctor who a lot of the time I believe does not care what happens to me so he just wants to give me the fastest answer possible to get me out of his office. I actually have a problem with this with the majority of people in the medical community so I go in with a belief that the only person who cares about me is me so I need to be on constant guard when dealing with them. The problem is those who take the BPD stigma so seriously add to this by treating me like a leper so for a long time I saw the whole community based off of a few nitwits but within time I have gotten better mostly due to a buffer I now have in place that requires me to think and view the whole picture before responding. I try to give all the professionals a chance but very few will get a second or third shot with me which is something I am trying to work on. Another part to this criteria is what I call making people go away - I end a relationship with a friend or partner and a few days later I will not even acknowledge that they are alive or even right in front of me as my brain does not believe it should store information or emotions on someone who is no longer in my life so when I end a relationship my brain takes the name out of my inner directory and throws it into the garbage. Awhile back I ran into an ex girlfriend who I was with for over two years in high school and I was looking at this woman, who at one point I would swear up and down the street that I would love til the end of time, and couldn't figure out if I even knew this person. Later on in the day parts of the memory that contained her showed up but it took a lot of effort on my behalf to do so. If you are in my life I will go to great lengths to make sure that your are happy and safe but if you are not in my life you are no longer a concern. Everyone I meet gets a chance to enter my life in some way or another though a friendship or a relationship or even as a acquaintance as long as I can see that their is something positive about the person as I will not surround myself with negative people but when your in your in and when your out you are really out. Someone can go from a loving girlfriend to a stranger in the blink of an eye which is kind of good as I really do not carry a lot of baggage but it is sad that a person can go from one extreme to the other which causes internal guilt now that I see the picture for what it is.

Anyway five plus out of nine means your a leper ... I mean you meet the required standards to be diagnosed with Borderline Personality Disorder, if you passed I am sorry but remember doctors are not always right and with enough work you will prove them wrong and societies stigma for that matter. If you failed be thankful but remember just because someone is BPD does not automatically make them a bad person. The part that gets me is that I was not diagnosed until I was in my thirties and when I told people of my diagnosis some of them began to treat me different and others ended their relationships with me but do they not realize the person I was a long time ago was also BPD just not officially diagnosed. Guess that tells you how powerful the stigma is when it makes smart people stupid.

***After thought - like everything else on this blog this is my opinion and my perspective. Use what you learn here as a starting off point not as a confirmed medical or therapeutic diagnosis. If the above diagnostic criteria read like your life story go see your doctor or a therapist to make sure that you are a leper .... did it again I mean BPD. Then come back and I will try to help you interpret the message that they gave you

The Symptoms Of My Depression

Some of the following might be typical for others dealing with depression and some may be unique to just me. If after reading this post you identified with to many of the specific points do yourself a favor and contact your doctor. Depression is treatable but it is not a fight you want to do on your own.

1. The urge to sleep. Sleep is the great escape for a lot of people and the thought of staying in bed all day wrapped tightly in blankets seems a lot more appealing then facing life head on. I have gone through periods where I averaged over twelve hours a day yet had to fight the urge to go back to bed within hours after getting up.

2. Weight issues. Some people end up eating way too much as a mean of comfort but I always seem to go the opposite way and just stopped eating. Not good when someone asks when was the last time that you ate and you ask what day it is.

3. Nothing makes you feel better. Some days every positive thought in the world is not only unable to lift you up it is unable to bring a smile to your face. The larger problem is when bad days stretch into weeks and possibly months.

4. Suicidal ideation. Not good when you spend too much time arguing with your brain that suicide is the bad choice. Before my illness hit I had a million and one reasons why I would never commit a permanent solution to a temporary problem, three years later I am down to one and thank goodness it is all I need. By the way if your having suicidal thoughts get your ass to the hospital

5. Overly emotional. Something small and on most days insignificant is able to send you straight over the emotional edge then Houston there is a problem. Bad days when the plow truck comes by moments after I finish shoveling has me contemplating my own existence.

Major Depression is literally sucks the life out of your body when it is at its peak. For some people medication does provide enough of a distraction so you get down to the really dirty work that most people call therapy. All the technical jargon is listed below.

The DSM Criteria for Major Depressive Disorder is the following:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation

Borderline Personality Disorder DSM Criteria Expained

Ever since I started this blog I have been spending a lot of time cruising different posts on various issues of mental health and the lack of quality information is troubling so I figured the best way to start, besides me posting a not nice comment that people should do their homework before opening their mouths, is to start with the manual or encyclopedia of mental illness. For of you that are not familiar with the DSM its real name is Diagnostic and Statistical Manual of Mental Disorders and every doctor refers to it when diagnosing a patient. They are on version five right now and the current edition, number 4, was created in 1994 but there was an update if you will in 2000. The next edition is due out in 2012. The information that I will use comes from the last update.

To meet the Borderline Personality Disorder standards if you will a score of at least five out of nine is required, this is a test you want to fail by the way. Anyway I will list the criteria then try to explain it in english using examples from my own disorder. Bare with me as this is the first time I have ever tried to do this. If it goes well then I will do the same for the other disorders that I do have and heck maybe even take requests.

A quick review first - BPD consists of three separate personalities in which two are not real but perceptions and they are, well how I see them, 1) High Self Image 2) Low Self Image 3) Real Self Image. Remember the purpose of BPD is to maintain a high self image level but like I said it is not real but a perception. K, lets get started.

1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

- basically this means if your buddy says he can not come over because he is busy you take it as he does not like you anymore so you do what it takes to ensure yourself your thought is not true. Some people will cause a commotion that will ensure that they get people's attention for even if it is negative attention it satisfies the thought that you are not alone which is more important then the consequences you will have to deal with for causing the commotion. Personally this area really shows up when someone is late or cancels at the last minute and it takes a lot of work to remember sometimes things happens and it is not the person abandoning me.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

- there is a very good book out on the marketplace and the title sums up this criteria very well "I hate you, don't leave me". This one took me a long time to figure out but I knew I was doing it at the time. I could be in a relationship where the other person was just constantly on my nerves so my stress was high as heck and I knew I should get out of the relationship but the next day this person was the best thing that ever happened to me so it rules out all the insecure doubts I had the day before and then the next day that person was back on my nerves and then the next day.... it is all about perception and which personality is at work: if it is a high BPD day you are better then the queen and everything is perfect, if it is a low BPD day I really have no idea why I am wasting my time on you. It is a rather pain in the ass but once your on the road to recovery it is one of the first areas that calms down, mind you this is also a big reason why therapists do not like treating people suffering with Borderline Personality Disorder for when the person is in the positive stage therapy appears to be going great but when it is in a negative stage the person is more concerned about the therapists saying the wrong thing (in a BPD mind) so they are on guard to attack in order to serve their self image then the actual therapy involved. Like I said recognizing the three stages is a massive step so you realize what you are doing and why.

3. identity disturbance: markedly and persistently unstable self-image or sense of self.

- pretty self explanatory the highs and lows you see with relationships with other people are the same issues you have in the relationship with yourself. Good days I am on top of the world and on bad days I spend the entire day trying to convince myself I should keep breathing. My depression/MDD really kicks in on bad days so I tend to go a lot lower.

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.

- on high BPD days you believe you are invincible so normal rules do not apply to you. In my case I do what I want for I am too smart not to get caught or I am better then the average person. Lots of fun in the high BPD stage but it is also incredibly dangerous. The sex part is basically trying to bang everyone you meet at the extreme end but being promiscuous also satisfies the attention needed to boost the self image. The sex part means nothing to me and has never been an issue but it can be for a lot of people with BPD. My real self shyness and awkwardness prevents promiscuity even on my high end BPD days

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

- I don't really like this category as they are talking about attention seeking behaviors on the extreme end. I have a self harm history but the last reason I do it is for attention and the great lengths I will go to hide it pretty much cements it. to many people are automatically labeled BPD when they self harm but this has more to do with lazy doctors and therapists who jump to conclusions. If I want attention from self harm I would display it at every chance I get but the number of actual scars would be really low as all you need is a few to get the desired effect but I have hundreds and have been "caught" three times participating in self harm behavior and two of those times I did it because I understood I was in danger and needed help immediately. When I was in the hospital the last time I wrote the people in charge of my care a letter that should have been taken as a suicidal intent letter but they chose to ignore it and I believe they felt I was just seeking attention, if a picture of my son was not part of my life my ass would be dead. Every suicidal treat or gesture should be taken with a 100% seriousness and this category is dangerous because of it. Do you really want to take the chance that the gesture or threat is not real? A wrong response can end up with a dead body. If a BPD person in your life uses this type of threat to gain attention call the police every single time as they are a risk to themselves or others and trust me if they were in it just for attention this behavior will quickly seize to exist. I am hoping in the next version of DSM this criteria will at the very least be reworded.

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).

- I deal with depression as well so this category really does not apply to me as my bad depressive stages tend to lasts for weeks if not months. The reason behind this category is your created self image is so flimsy that it is hard to work off of it as one moment you are way up there and the next your digging out of a hole which is why BPD go through such great effort to maintain there perceived self image. It is difficult for those around the person when he or she is all over the place but try living with the damn thing.

7. chronic feelings of emptiness

- this never effected me in the BPD sense until I started to become aware of the different stages of personality and perception, Now I see my life as something i did not own or participate in for a very long time for I was to focused on keeping steady the self image I had created. Not a nice day when you realize your life has been one big lie.

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

- BPD is created initially to protect yourself from the world that you are in so everything comes down to safety. When I feel someone is putting my self image at risk I attack for the most part as this is the basis of the disorder, I need to send a message that this will not be tolerated and make sure the person fully understands this or in some cases makes sure they do not come back. It takes a lot of work like I continually mention to maintain a rocky self image and when someone seems to attack it you take it very personally. The last person you want to get into a confrontation with is someone with BPD as our lives have been one confrontation after another so we tend to be very good at it and we don't know how to lose. A simple comment along the lines of "You should have done this instead of that" may seem innocent to someone without BPD but when this disorder is a part of your life that comment just said that you are not very smart and not very aware of the situation so it attacks the core beliefs that we had created in our self image especially when the person is untreated and has not acknowledged the different stages of personality and perception. Think of something you have total belief in and how would you react if someone attacked it, its the same thing.

9. transient, stress-related paranoid ideation or severe dissociative symptoms

- For whatever the reason my brain can see someone and believe that the person has no good intentions what so ever. The big one in my life is my mental doctor who a lot of the time I believe does not care what happens to me so he just wants to give me the fastest answer possible to get me out of his office. I actually have a problem with this with the majority of people in the medical community so I go in with a belief that the only person who cares about me is me so I need to be on constant guard when dealing with them. The problem is those who take the BPD stigma so seriously add to this by treating me like a leper so for a long time I saw the whole community based off of a few nitwits but within time I have gotten better mostly due to a buffer I now have in place that requires me to think and view the whole picture before responding. I try to give all the professionals a chance but very few will get a second or third chance with me which is something I am trying to work on. Another part to this criteria is what I call making people go away - I end a relationship with a friend or partner and a few days later i will not even acknowledge that they are alive or even right in front of me as my brain does not believe it should store information or emotions on someone who is no longer in my life so when I end a relationship my brain takes the name out of my inner directory and throws it into the garbage. Awhile back I ran into an ex girlfriend who I was with for over two years in high school and I was looking at this woman, who at one point I would swear up and down the street that I would love til the end of time, and couldn't figure out if I even knew this person. Later on in the day parts of the memory that contained her showed up but it took a lot of effort on my behalf to do so. If you are in my life I will go to great lengths to make sure that your are happy and safe but if you are not in my life you are no longer a concern. Everyone I meet gets a chance to enter my life in some way or another though a friendship or a relationship or even as a acquaintance as long as I can see that their is something positive about the person as I will not surround myself with negative people but when your in your in and when your out you are really out. Someone can go from a loving girlfriend to a stranger in the blink of an eye which is kind of good as I really do not carry a lot of baggage but it is sad that a person can go from one extreme to the other which causes internal guilt now that I see the picture for what it is.

Anyway five plus out of nine means your a leper ... I mean you meet the required standards to be diagnosed with Borderline Personality Disorder, if you passed I am sorry but remember doctors are not always right and with enough work you will prove them wrong and societies stigma for that matter. If you failed be thankful but remember just because someone is BPD does not automatically make them a bad person. The part that gets me is that I was not diagnosed until I was in my thirties and when I told people of my diagnosis some of them began to treat me different and others ended their relationships with me but do they not realize the person I was a long time ago was also BPD just not officially diagnosed. Guess that tells you how powerful the stigma is when it makes smart people stupid.

Let me know what you thought of this little exercise and maybe I will try another diagnosis in the future. Every time I write the word diagnosis I think of Girl, Interrupted and I want to write diag nonsense, wonder what Freud would think about that.

***After thought - like everything else on this blog this is my opinion and my perspective. Use what you learn here as a starting off point not as a confirmed medical or therapeutic diagnosis. If the above diagnostic criteria read like your life story go see your doctor or a therapist to make sure that you are a leper .... did it again I mean BPD. Then come back and I will try to help you interpret the message that they gave you