Does My Girlfriend/Boyfriend Have Borderline Personality Disorder?

A person suffering with Borderline Personality Disorder is often not as they  seem.

Are you trying to determine if someone in your life may suffer from Borderline Personality Disorder? You will soon find out that this is a complex question. There are no simple behavioral checklists; no definitive tests. Identifying Borderline Personality Disorder requires having a working knowledge of the disorder and some insight into the past life of the person in question.

Borderline Personality Disorder is a disorder of the emotions. Imagine a person who is extremely sensitive to rejection (fearful of even perceived or anticipated rejection) and has a limited ability to modulate their emotional impulses (love, fear, anger, grief, etc.). To protect themselves from their own feelings, they are prone to adopt a multitude of dysfunctional rationalizations and cover-ups.

For example, a person suffering from BPD may so fear rejection in a new relationship that they recreate themselves in the image of a person they believe would be lovable. When the negative emotions for making such a sacrifice surface - and not having the ability to modulate them, they lash out at the target of their affections for "making them do it" - rather than face their own feelings of inadequacy / fear of rejection, ultimately damaging the relationship they so fear losing, and reinforcing their feelings of inadequacy / fear of rejection.

What is going on in a Borderline Personality Disorder sufferer's mind and how they are acting can be two entirely different things.

To the sufferer, BPD is about deep feelings, feelings often too difficult to express, feelings that are something along the lines of this (2):

• If others really get to know me, they will find me rejectable and will not be able to love me; and they will leave me;
• I need to have complete control of my feelings otherwise things go completely wrong;
• I have to adapt my needs to other people's wishes, otherwise they will leave me or attack me;
• I am an evil person and I need to be punished for it;
• Other people are evil and abuse you;
• If someone fails to keep a promise, that person can no longer be trusted;
• If I trust someone, I run a great risk of getting hurt or disappointed;
• If you comply with someone's request, you run the risk of losing yourself;
• If you refuse someone's request, you run the risk of losing that person;
• I will always be alone;
• I can't manage by myself, I need someone I can fall back on;
• There is no one who really cares about me, who will be available to help me, and whom I can fall back on;
• I don't really know what I want;
• I will never get what I want;
• I'm powerless and vulnerable and I can't protect myself;.
• I have no control of myself;
• I can't discipline myself;
• My feelings and opinions are unfounded;
• Other people are not willing or helpful.

To the family members, BPD behavior is often very frustrating can feel unfair and punitive - something like this (3):

• You have been viewed as overly good and then overly bad;
• You have been the focus of unprovoked anger or hurtful actions, alternating with periods when the family member acts perfectly normal and very loving;
• Things that you have said or done have been twisted and used against you;
• You are accused of things you never did or said?
• You often find yourself defending and justifying your intentions;
• You find yourself concealing what you think or feel because you are not heard;
• You feel manipulated, controlled, and sometimes lied to.

As such, the most obvious "symptom" of Borderline Personality Disorder is a lifelong pattern of instability in interpersonal relationships, self-image and emotions.

Why is Borderline Personality Disorder Difficult to Diagnose

Borderline Personality Disorder is a relatively recent addition to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization International Statistical Classification of Diseases and Related Health Problems (ICD). Accordingly, the majority of practicing mental health professionals graduating prior to 2000 have not been trained on the diagnosis and the treatment of this complex disorder as part of their professional curriculum.

Additionally, the clinical definition of Borderline Personality Disorder is very broad. It is defined in terms of nine criteria of which 5 or more are indicative of the disorder. This translates to 255 clusters of criteria, or constellations as they are known, any one of which is diagnostic for BPD. Within these constellations, there are high functioning borderlines that operate well in society and whose disorder is not very obvious to new acquaintances or the casual observer. Also within these constellations are the low functioning borderlines who are more apparent as they can't hold jobs, or they self-harm (cutting). Suicidal attempts/ideation and anorexia/bulimia are some of the most serious aspects of this disorder - yet, many with the disorder do not exhibit either.

Proper diagnosis and treatment of Borderline Personality Disorder is spotty at best with community healthcare providers, marriage counselors, and family therapists who are often hesitant to diagnose or treat the disorder. As a result, most borderlines are undiagnosed or in treatment for other maladies such as depression or PTSD. If you suspect Borderline Personality Disorder, it is best to use a specialist, preferably one associated with a University.

Diagnostic Tests - Diagnostic Interview for Borderline Patients (DIB-R)

The Diagnostic Interview for Borderline Patients (DIB-R) is the best-known "test" for diagnosing BPD. The DIB is a semi structured clinical interview that takes about 50-90 minutes to administer. The test, developed to be administered by skilled clinicians, consist of 132 questions and observation using 329 summary statements. The test looks at areas of functioning associated with borderline personality disorder. The four areas of functioning include Affect (chronic/major depression, helplessness, hopelessness, worthlessness, guilt, anger, anxiety, loneliness, boredom, emptiness), Cognition (odd thinking, unusual perceptions, nondelusional paranoia, quasipsychosis), Impulse action patterns (substance abuse/dependence, sexual deviance, manipulative suicide gestures, other impulsive behaviors), and Interpersonal relationships (intolerance of aloneness, abandonment, engulfment, annihilation fears, counterdependency, stormy relationships, manipulativeness, dependency, devaluation, masochism/sadism, demandingness, entitlement). The test is available at no charge by contacting John Gunderson M.D. McLean Hospital in Belmont Massachusetts (617-855-2293).

Diagnostic Tests - Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionnaire is available from the American Psychiatric Publishing ($60.00).

Diagnostic Tests - Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. We have included a list of questions most often answered as "yes" by people with Borderline Personality Disorder .

Diagnostic Tests - Other

Other commonly used assessment tests are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). In addition there are some free, informal tests available - some BPDFamily.com members have found that these tests are helpful.

Author: Skip