Borderline Personality Disorder

Excerpt

Borderline personality disorder (BPD) is a mental health condition characterized by pervasive patterns of instability in mood, self-image, and interpersonal relationships. People with BPD commonly have distorted perceptions of themselves and others, leading to difficulties in maintaining stable and healthy relationships. Individuals with BPD experience intense and rapidly shifting emotions, have difficulty regulating their emotions, and engage in impulsive behaviors. Fear of abandonment can drive maladaptive behaviors, including impulsivity, self-harming behaviors, and suicidality. Individuals with BPD can suffer from chronic feelings of emptiness. Mood disorders, anxiety disorders, eating disorders, posttraumatic stress disorder, other personality disorders, and substance use disorders can complicate BPD.

The concept of BPD has evolved, and its history reflects changes in psychiatric understanding and diagnostic classifications. Hippocrates recorded early descriptions of intense, divergent moods. What would later be recognized as BPD can be traced back to observations in the 1930s and 1940s. Psychiatrists such as Adolph Stern and Frieda Fromm-Reichmann made observations of patients who didn't neatly fit into existing diagnostic categories. In the 1950s, borderline conditions were often considered within the spectrum of schizophrenia. Psychiatrist Kurt Schneider used the term "borderline" to describe patients who were on the border between neurosis and psychosis. The term "borderline" gained more recognition in the 1960s and 1970s as psychiatrists and psychologists began to see a distinct group of patients with specific symptom patterns that didn't neatly fit into existing diagnostic categories. Otto Kernberg and other psychoanalysts played a significant role in defining and describing borderline traits during this time.

The formal recognition of BPD as a distinct diagnosis came with the publication of the third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. This marked a significant shift from previous conceptualizations, providing specific criteria for diagnosis and contributing to increased research and understanding. Subsequent editions of the DSM, such as the DSM-IV in 1994 and DSM-5 in 2013, refined the diagnostic criteria for BPD. These revisions aimed to improve the reliability and validity of the diagnosis, addressing some of the controversies and criticisms associated with earlier editions.

The current version of the DSM, the DSM-5-TR, divides personality disorders into Cluster A, Cluster B, and Cluster C. Each cluster encompasses a distinct set of personality disorders with commonalities regarding symptoms, behaviors, and underlying psychological patterns.

Cluster A refers to personality disorders with odd or eccentric characteristics. These include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Individuals within this cluster often exhibit social withdrawal, peculiar or paranoid beliefs, and difficulties forming close relationships.

Cluster B comprises personality disorders with dramatic, emotional, or erratic behaviors. This cluster includes antisocial personality disorder, BPD, histrionic personality disorder, and narcissistic personality disorder. Individuals within this cluster often display impulsive actions, emotional instability, and challenges in maintaining stable relationships.

Cluster C consists of personality disorders with anxious and fearful characteristics. These include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Individuals within this cluster tend to experience significant anxiety, fear of abandonment, and an excessive need for control or perfectionism.

Despite the historical division of personality disorders into clusters, there are limitations when approaching personality disorders in this manner, and it is not consistently validated in the literature.