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Borderline Personality Disorder (cont.)

What Are the Symptoms and Signs of Borderline Personality Disorder?

Symptoms of BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM) and include

  • desperate attempts to prevent real or imagined abandonment;
  • unstable and intense relationships with others that alternate between seeing the other person as flawless and as worthless;
  • highly unstable self-image;
  • potentially self-damaging impulsive behaviors, like drug abuse or reckless driving;
  • repeated suicidal thoughts or behaviors, or self-mutilation (for example, cutting or burning themselves);
  • unstable emotional states, usually lasting a few hours to a few days;
  • persistent feelings of emptiness;
  • inappropriately intense anger or trouble controlling anger;
  • short-lived episodes of paranoia (extreme suspiciousness) or dissociation (disconnecting from sense of self and reality) that are caused by stress.

Of the above symptoms, mood instability and impulsivity (the tendency to act without thinking) tend to be the most specific to BPD. These two symptoms are thought to be the driving force behind the unstable relationships and chronic suicidal thoughts that are hallmarks of this disorder. In men, BPD tends to include more explosive anger and co-occur with substance abuse and antisocial personality disorder, while in women, this disorder more often co-occurs with eating disorders, as well as mood and anxiety disorders. People who suffer from a number of the above symptoms but not enough to qualify for having BPD are described as having borderline personality traits.

When Should I Call the Doctor about Borderline Personality Disorder?

As with any other mental health issues, the time to seek medical care for BPD is when the symptoms meaningfully interfere with the sufferer's life. Individuals with BPD often enter care when they experience negative changes in their lives, like divorce or another relationship loss or job loss. Other symptoms that indicate the need for treatment include, but are not limited to, eating disorders, sleep problems, significant depression, anger, anxiety or mood swings, self-injurious behaviors like cutting, and thoughts of dying or killing oneself.

How Is Borderline Personality Disorder Diagnosed?

There is no specific definitive test, like a blood test, that can accurately assess that a person has borderline personality disorder. Therefore, practitioners conduct a mental health interview that looks for the presence of the symptoms previously described. The professional also usually asks questions to explore (screen) whether or not other emotional problems like clinical depression, anxiety, alcohol abuse, dependence, and/or other addictions are present. Mental health professionals will also likely explore whether the individual is a safety risk by having homicidal thoughts, suicidal thoughts, or other thoughts of self-harm. As certain medical conditions can influence how BPD manifests (presents), the mental health examiner will likely refer the individual for a complete physical examination and any tests they may need to better understand their medical situation.

Medically Reviewed by a Doctor on 11/21/2016

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