BPD Symptoms are defined as a pervasive pattern of instability in interpersonal relationships, self-image and affect, combined with marked impulsivity, beginning in early adulthood. The following conditions are often present:
- Individuals with BPD make frantic, demanding efforts to avoid real or imagined abandonment. This perception leads to changes in self-image, affect, cognition, and behavior. Changes in plans can lead to intense fear, followed by rage and despair. The individual may think that they are “not important” that they “cannot stand this” “that they are bad” or, “that this always happens”. This creates intolerance for being alone and escalates or exaggerates the need to have other people with them at all times. Most of my clients tell me that they just “cannot stand” being with themselves, alone. Constant company with the TV or radio on, or some other stimuli will help them to “stay out of their heads”. It may also distract them from dramatic and upsetting self-talk. If they escalate, self-harming may result, in order to generate, by manipulation, the kind of support they believe they need.
- Unstable and intense relationships are common place for the individual with BPD. BPD individuals may idealize potential rescuers/caregivers, even demanding a great deal of time together. They will also share very intimate details of their lives much too early in the relationship. It is typical for this idealization to evaporate with time. When this happens the individual with BPD will devalue the rescuer/caregiver they previously adored. This grows out of the belief that the other person does not care enough, give enough, and is not “there” enough. BPD clients explain this as the’ glass half empty’ habit of thinking. The inability to self sooth and the fear of abandonment means the BPD individual cannot bear the thought of giving up this caregiver relationship. Begging to be allowed back into the relationship is common. Effective interpersonal relationships depend upon a stable sense of self and a capacity for spontaneous emotion, including self-regulation and a tolerance for painful stimuli.
- Many people with BPD have a persistent, unstable sense of self. There are sudden and dramatic shifts in their goals, values, and vocational ambitions. They may have sudden changes in opinions, friends, and sexual identity. They can vacillate between the roles of the dramatic, needy patient and the angry, righteous avenger of past mistreatments. Some BPD individuals describe feeling as though they do not exist at all. Lack of meaningful relationships and nurturing support exacerbates this condition.
- Individuals must display damaging impulsivity in at least two of the following areas in order for a diagnosis of BPD to be named: gambling, money mismanagement or extreme overspending, binge eating, substance abuse, high risk sexual encounters, or reckless, high speed driving.
- Recurrent suicide ideation or self-mutilation (by cutting, burning, biting) may also manifest. Self- destructive acts usually occur after a stressor or due to the overwhelming fear of being abandoned. Suicidal behaviors are used by the BPD individual to shape or manage their environment. It is used to avoid change, to keep people near you and to avoid painful situations. Suicidal ideation for the BPD individual can bring an intense sense of relief and control. As a cautionary note, we must also remind readers that any suicidal ideation must be taken very seriously, and at no time is it disregarded as “simply a manipulation”. We treat all suicide thoughts with serious care and concern.
- Individuals with BPD may display affective instability due to a marked reactivity of mood (for example, intense dysphoria, irritability, anxiety, lasting a few hours to a few days). This instability is marked by periods of anger, panic or despair that are not relieved by any fleeting feelings of well-being or self-satisfaction. These episodes indicate intense internal or external stressors in the BPD individual.
- Individuals with BPD experience intense feelings of emptiness. Many of my clients tell me that they have no awareness of a higher self, of their inner goodness, of their true-self, nor of the divine child within. Whatever term that is used to describe their core being, they cannot locate this sense of goodness within themselves.
- BPD clients will express inappropriate and intense anger due to anger regulation difficulties. They may display extreme sarcasm, enduring bitterness or verbal outbursts. Anger is expressed when they perceive a caregiver or lover as neglectful, withholding, uncaring or that they have abandoned them. The angry outbursts are followed by guilt, shame and low self-esteem. Anger regulation difficulties impair the ability to build stable relationships.
During periods of high stress or perceived feelings of abandonment, the individual with BPD may experience transient paranoid ideation or dissociation, lasting minutes or hours.
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