The Diagnostic and Statistical Manual of Mental Disorders (the DSM) is the book used by psychiatrists to identify and diagnose patients with psychological problems and mental illnesses. The world of Psychiatry is constantly changing, so every now and then, a new edition of the DSM is published to provide needed updates. The fifth edition, the DSM V, came out on May 18, 2013. There were many changes to many different disorders, and among those was Borderline Personality Disorder, which I often call Dyslimbia. Most of what changed was the format of the diagnosis process rather than the symptoms themselves. Even so, I think it would be appropriate to review the DSM V’s criteria for Borderline Personality Disorder.
The defining traits are categorized into five sets: 1) Problems in “personality functioning” which is then divided into two categories, problems with self and problems with others. 2) “Pathological personality traits” (recurring emotional and behavioral traits due to mental illness), which is then broken into three categories: negative emotions, disinhibition, and antagonism. The other three categories are simply conditions of the disorder’s appearance, which I will briefly cover after we examine categories one and two. For the purposes of this blog post, we will examine category one. Next, we will examine the second set of symptoms as well as the three conditions attached to the symptoms. By breaking everything down, we will be able to see the symptoms in detail.
Category 1: Personality Functioning
Cat. 1, Group 1: Problems with Self
Problems with self include identity issues and difficulties with self-direction. Symptoms under identity issues include the feeling of not knowing who you are, feeling like your identity changes a lot, beating yourself down with criticism, feelings of emptiness, and, of course, “dissociative states under stress.” (See my blog series about dissociation if you don’t know about it.) As for self-direction, this refers to how people with Borderline have unstable or frequently changing life plans, interests, dreams, or even morals.
I will provide examples from my own experience as someone suffering from Borderline Personality Disorder. Throughout my entire life, I have beaten myself down with criticism, never believing in myself. Even when I won writing contests in college, even when I was constantly among the top students in my college classes, I still felt like I wasn’t doing enough and that I was actually an unintelligent person. Developing a solid sense of self (who I am) took years, since I often thought, said, and acted on completely different values. I was only able to find myself by dissociating and thinking of myself as being five “personalities” (or five different mindsets) in one person. At any given time, I am a mix of two or three of those five sides of me. Figuring out who you are, when different sides of you seem so completely incompatible, is a common struggle for those with Dyslimbia.
(For a time, in college, I also frequently experienced dissociation such as depersonalization, derealization, and even a few isolated cases of dissociative amnesia. These symptoms are under control now. If you’re curious about dissociation and what it means, see my blood series about dissociation.)
Cat. 1, Group 2: Problems with Others
Interpersonal issues have been split into problems with empathy and problems with intimacy.
People with Borderline Personality Disorder are perfectly capable of empathy, and in some cases, I believe we can be more empathetic than normal people given our heightened capacity for emotions. Nevertheless, when we are under stress or having mood swings, we have trouble understanding what others are actually feeling and what they need. Borderlines have a strong negative bias, often believing that others think negatively of them when no such negative feeling exists. To some, this interpretation bias could be considered a lack of empathy.
Here’s two examples you may be able to identify with. We’ll start small. The other day, I decided to wear mascara even though I very rarely wear any makeup. When my sister later asked if I was wearing mascara, I didn’t want to answer. I wanted to lie. To me, it seemed obvious that my sister had seen how bad I was at putting on makeup, and she was going to criticize me. However, I read my sister completely wrong; she actually wanted to say that the mascara looked good on me. With my negative bias, that never even occurred to me.
A more extreme example is my relationship with my father. Time and time again, I believe that he resents me or thinks poorly of me because of my inability to hold down a job. Often, I go for a few days without having any real talk with my father, even though we live together, because I feel like I “know” that he is disgusted with me. When I finally work up the courage to talk to him again, and I mention feeling useless, he is always supportive. He tells me that he knows I am trying, that I’m getting psychological and psychiatric help, and that he’s glad he is able to live with me. This never ceases to amaze me, since I always go back to thinking that he must think badly of me.
As for intimacy, this refers to the Borderline’s “intense, unstable, and conflicted close relationships.” Symptoms and markers include being distrustful, having fear of abandonment, sometimes interpreting things as abandonment that are actually not, and being too needy. In addition, there is the phenomenon sometimes called “switching,” where the person with Dyslimbia switches between idolizing someone and intensely hating someone. Having more balanced feelings toward someone is difficult for us; we are do-or-die, hate or love, worship or revile. Sometimes the intense feelings of loving someone result in becoming too obsessed with them and their lives, while the feelings of great dislike can result in complete withdrawal from the relationship.
For a classic example of the “switching” phenomenon, look at my first major romantic relationship that went on from age nineteen to twenty. While it is natural to absolutely adore one’s significant other, my idealization of my boyfriend and my emotional reliance on him reached unhealthy levels, to the point where he was my only support system. (Friends and family were out of the picture.) When that boyfriend broke up with me– and it was rather sudden from anyone’s viewpoint– I felt so hurt and angry that I refused to talk to him. I badmouthed him to everyone I knew. I wasn’t able to stop hating him until a full two years later, and even then, our friendship was sensitive and rocky. This is only one example of a lifelong pattern.
In addition, when I feel I have been abandoned, it destroys my world, leading to self-injury and long episodes of Major Depressive Disorder. It has been almost two years since my best friend stopped speaking to me because she no longer wanted to be friends with an atheist; two years have passed, and I still think of her and miss her every few days. This preoccupation with abandonment is a classic symptom of Dyslimbia.
That’s all for Category 1, Problems in Personality Functioning. This category covers the symptoms that were numbered 1, 2, 3, 7, and 9 in the older DSM IV. Next time, we will examine category two, “Pathological Personality Traits,” which includes three groups of symptoms: negative emotions, impulsivity, and hostility.