Understanding Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is a complex mental health condition characterized by intense emotions, impulsive behavior, unstable relationships, and an unstable sense of self. Many people with BPD also struggle with suicidal thoughts and self-harming behaviors.
Getting an accurate diagnosis is the first step towards effective treatment. There are a few different types of assessments that mental health professionals use to evaluate if someone has BPD.
Self-Report Tests
Self-report tests involve filling out a survey or questionnaire about your thoughts, feelings, and behaviors. These tests can be a starting point to assess if you may have BPD traits.
Some common self-report tests used to screen for BPD include:
- McLean Screening Instrument (MSI)
- Borderline Symptom List (BSL)
- Personality Assessment Inventory (PAI)
While these tests may indicate possible BPD, they cannot provide a definitive diagnosis. But they can give your mental health provider insight into what symptoms you are experiencing.
Interviews
A skilled mental health professional will conduct an in-depth clinical interview to get a thorough history of your symptoms.
The interview aims to understand how long symptoms have persisted, how much distress they cause, and how significantly they impair your daily functioning.
An interview can also uncover any related issues, such as past trauma, substance abuse, self-harm behaviors, or other mental health conditions.
Observation
In addition to asking questions, your provider will simply observe your behaviors, emotional responses, and thought patterns during your visit.
For example, they may notice how you describe yourself and if your view of yourself shifts dramatically.
Or they might identify intense emotional reactions that seem disproportionate to the situation being discussed.
Subtle observations like these can provide clues about the BPD diagnostic criteria.
Diagnostic Criteria
Mental health professionals diagnose personality disorders like BPD based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The DSM-5 specifies nine diagnostic criteria for BPD. Displaying at least five of them indicates significant dysfunction to warrant a BPD diagnosis.
The nine BPD criteria revolve around the following areas:
- Unstable/intense relationships
- Impulsivity
- Suicidal ideation or self-harming behaviors
- Intense/uncontrollable anger
- Chronic emptiness
- Paranoia/dissociation under stress
- Identity disturbance
Reviewing the diagnostic checklist ensures a systematic approach to identify enduring maladaptive personality dysfunction.
Co-Occurring Conditions With BPD
BPD rarely occurs alone. More often, people with BPD also meet the criteria for at least one additional mental health condition.
The most common co-occurring disorders include:
Mood Disorders
Mood disorders like depression, bipolar disorder, and persistent depressive disorder frequently appear with BPD. It is often hard to disentangle BPD mood swings from distinct mood episodes.
Sometimes depressive symptoms precede BPD onset; other times, mood changes happen after BPD develops. Managing both conditions together is essential for recovery.
Anxiety Disorders
Many people with BPD also live with excessive fear or worry. Anxiety disorders like generalized anxiety disorder, social anxiety, panic disorder, PTSD, and OCD tend to accompany BPD.
This combination makes sense since BPD involves emotional instability and heightened reactivity to interpersonal stressors.
Eating Disorders
Disordered eating affects up to 50% of people with BPD. The compulsive behaviors serve as maladaptive coping mechanisms to deal with painful BPD emotions.
The most common eating disorders seen with BPD are bulimia nervosa and binge eating disorder.
Substance Use Disorders
Impulsivity and emotional distress also increase the likelihood of substance abuse for people with BPD. Up to 75% of individuals with BPD struggle with alcohol or drugs.
Self-medication provides temporary relief but ultimately worsens BPD symptoms. Managing both conditions is key to sustained healing.
Getting Proper Testing and Treatment
Since BPD rarely occurs in isolation, it is critical to get comprehensive testing to identify any co-occurring mental health or substance use disorders.
Integrated treatment that addresses BPD and all other diagnosed conditions together usually has the best outcomes.
Psychotherapy
Talk therapy helps people with BPD better understand their emotions, improve relationships, and develop healthy coping strategies. The most effective modalities include dialectical behavior therapy (DBT) and mentalization-based therapy.
Medication
While no medications treat BPD itself, certain prescriptions help manage accompanying issues like depression, anxiety, and impulse control. Common options include antidepressants, mood stabilizers, and antipsychotic medications.
Adjunct Treatments
Other interventions like meditation, art therapy, or peer support groups also facilitate the healing process. Multifaceted treatment tailored to the individual offers the best chance for overcoming BPD.
Getting the right diagnosis through comprehensive testing makes it possible to find the appropriate treatment plan. With compassionate support and evidence-based care, even those suffering greatly from BPD can achieve emotional stability and more fulfilling lives.
FAQs
What are some self-report tests that screen for BPD?
Common self-report tests used to assess potential BPD traits include the McLean Screening Instrument (MSI), Borderline Symptom List (BSL), and Personality Assessment Inventory (PAI). While these cannot definitively diagnose BPD, they help identify symptoms to explore further.
What are the 9 diagnostic criteria for BPD in the DSM-5?
The 9 criteria cover unstable relationships, impulsivity, suicidal/self-harm behaviors, intense anger, emptiness, stress-related paranoia/dissociation, and identity disturbance. Showing at least 5 criteria indicates significant dysfunction for a BPD diagnosis.
Why do mood disorders and BPD often appear together?
It is often difficult to separate BPD mood shifts from bipolar or depressive episodes. Sometimes mood issues precede BPD, while other times BPD develops first. Managing both concurrently is important for recovery.
What treatments help people with co-occurring BPD?
Integrated psychotherapy addressing BPD and co-occurring conditions together has the best outcomes. Dialectical behavior therapy, medications for other disorders, and supplemental therapies facilitate healing.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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