Tag Archives: DSM

Reviewing Borderline Criteria Part 3

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.

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Reviewing BPD Criteria Part 1

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.