This is part three of the blog series reviewing the criteria for Borderline Personality Disorder, or Dyslimbia, according to the new DSM V (Diagnostic and Statistical Manual of Mental Health Disorders). First, we looked at category one, “Problems in Personality Function,” which was divided into two groups: problems with the self and problems functioning with others. Difficulties with sense of self, problems with empathy, and problems with intimacy were included, covering criteria 1, 2, 3, 7, and 9 in the older DSM IV. Next we started to look at category two, “Pathological Personality Traits,” which is divided into three groups: Negative Affectivity, Disinhibition, and Antagonism. Last time, we focused only on Negative Affectivity, which included emotional liability, separation insecurity, anxiety, and depression. Let’s move on.
Category 2, Group 2: Disinhibition and Risk Taking
Inhibitions are thoughts and feelings that inhibit (prevent) certain actions. Your inhibitions prevent you from doing foolish or unsafe things. You should have inhibitions preventing you from stealing, for example. It follows that “Disinhibition” is when your natural inhibitions are not working. A similar concept is “impulsiveness,” the tendency to do something on impulse rather than thinking it through. Recklessness, or taking risks on purpose is closely tied to this. People with Dyslimbia traditionally have a lot of problems in these areas.
Examples of disinhibition are promiscuous sexual life, binge drinking, impulsive drug abuse, self-injury such as cutting, spending sprees, gambling, yelling at someone or impulsive speech, and in extreme cases, vandalism and violence. In college, I binged on alcohol quite often in my second and third years. This happens to many college students, though, so I’ll give some other examples. There were a few times in my life when I had sex without protection, which could have easily been disastrous. I had a cutting problem from age 18 until just last year, when my antidepressant kicked in and made me less inclined to do it. I have done some drugs on impulse before just to escape negative feelings. All these examples together show that I had a real problem with disinhibition and recklessness.
Category 2, Group 3: Antagonism.
Antagonism is also called hostility and is described in the DSM as, “Persistent or frequent angry feelings,” or “anger or irritability in response to minor slights and insults.” People with Borderline experience many emotions, but it’s often said that one of the strongest and scariest of those emotions is anger. We feel angry more often than we should, and/or our anger is felt more deeply and strongly than it is by “normal” people. Anger in Dyslimbia patients is often blown out of proportion; that is to say, the smallest things can set us off into fury under the right circumstances.
Extreme anger is something I have dealt with frequently from a very young age. I am fairly good at controlling it in public or around other people, but I let loose when I’m by myself. I curse, yell, growl, punch things, and kick them too. I have a history of breaking things in my home. For me, the rage comes on suddenly, and can be triggered by the smallest things, such as the computer freezing up, sudden loud noises, failing to understand a school subject, and behavior problems with my cat or dog. The rage is very difficult to control, but fortunately, it rarely lasts longer than a few minutes at a time. Appropriate ways to deal with these outbursts are tearing up cardboard boxes, hitting a punching back, going for a run, or listening to music that you can empathize with. Hostility is a problem I still struggle with each day.
So far we have covered Category 1, “Problems in personality functioning,” and Category 2, “Pathological personality traits.” This post has covered symptoms 4 and 8 in the old DSM IV criteria. The last three elements of Borderline diagnosis are straightforward, and rather than lists of behavior problems, they are simply conditions that must be met to be diagnosed. Category three says that the symptoms listed in the other categories must be chronic, long-term problems that happen in many different situations, rather than just having a hard time in your life for a few days or weeks in a handful of situations. Basically, it has be a recurring issue.
Category four says that the symptoms listed above must not be due to factors such as the individual’s age or “socio-cultural environment.” Teenagers are often impulsive and disinhibited, for example, so people under eighteen cannot be diagnosed with Borderline Personality Disorder. The patient must be suffering the symptoms not because of his age but because of a distinct disorder (Dyslimbia). People in crime-ridden parts of cities may be more likely to abuse drugs or engage in other reckless behavior that shows disinhibition. A person can only be diagnosed with Borderline if his or her symptoms are not simply due to a bad environment. Similarly, low income families or social minorities often have symptoms of anxiety, depression, and hostility. To be diagnosed with Borderline, the symptoms must be not be caused by environment alone.
Category 5 says that the symptoms listed above are “not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).” In other words, if your symptoms can be explained by a head injury or by being on drugs, you won’t qualify for a diagnosis of Dyslimbia. Instead, you must exhibit the symptoms when not on drugs and without head injury or similar physical trauma.
We have covered all of the symptoms of Borderline Personality Disorder as described in the new DSM V. These include identity issues, difficulties with self-direction, problems with empathy, problems with intimacy, depression, anxiety, overblown emotions, separation insecurity, disinhibition, and antagonism. Now that we know the criteria for Borderline Personality Disorder, we can begin discussions on how to deal with it, and what’s it’s like to live with it in daily life. Thank you for joining me for this blog series.