Tag Archives: Identity Disturbance

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.

Sense of Self Part 3: Support Your Sense of Self

“Identity disturbance” is a benchmark symptom of BPD, characterized by “markedly and persistently unstable self-image or sense of self.” This sense of not knowing who you are can manifest in many ways, and many people with Dyslimbia struggle to cope. In this blog series, we’ve discussed the importance of directional thinking and coming to understand and predict your own behaviors. In this final part, I’m throwing together some of my miscellaneous thoughts about Sense of Self.

Self-Affirmation

One of the best ways to continuously encourage and strengthen your sense of self is to affirm it. Self-affirmation means honestly complementing yourself. Some people struggle with this—myself included. It can feel so silly to self-affirm, and I have such a hard time believing what I’m saying, like that “I’m attractive” or “I’m a good person.” Most days I don’t really believe I’m worth anything. In order to combat this, first find a method of self-affirmation that you can live with, and then repeat it enough so that you slowly start to accept it.

Someone recommended that I look at myself in the mirror every day and say my self-affirmation aloud; I couldn’t stand doing this! Instead, what I try to do is write out examples of when I’ve done things worth being proud of; and in my journals, I frequently assure myself that I’m doing the right thing and that I’m a good person. Find a form of self-affirmation that works for you. Though you may have to force yourself to do it on most days, if you self-affirm enough, your mind will slowly start to believe the things it hears.

Friends and Family

You will never have a stable sense of self if you are not in a supportive environment. Even if you were self-affirming every day, if you are surrounded by toxic people, your mind won’t be able to accept the good things you’re telling it. Toxic people are people who cause you large amounts of stress or people who put you down or discourage you. It’s extremely important for people with Dyslimbia to have supportive people around them. If possible, try to make sure you have at least one friend or family member who will study your “sense of self” with you—somebody who knows and accepts you for who you are.

Directional Thinking: Using Objects

Directional thinking is the continued process of channeling your thoughts in one direction, or toward one theme or lesson. Making sense of self your “theme” to think on for a while can be very beneficial. In everything you do, try to draw things back to how they relate to self-understanding. My best friend came up with a great idea to aid this kind of directed thought.

Pick an object that is carried with you or is frequently within sight. This could be a bracelet or any form of jewelry, a clock, your favorite pen, your water bottle, or even your shoes. Then, every time you catch yourself looking at or touching the object (e.g., fidgeting with a bracelet), remind yourself of that day’s theme and think on it—consciously direct your thoughts. This use of objects seems like a great way to help directional thinking, and I’m excited to try it myself.

This Week’s Personal Example

This is an example from my life of how it can help you to have a good sense of self. I frequently battle with suicidal ideation, and due to certain circumstances, I knew that the suicidal thoughts were going to be worse in the next few days to weeks. Knowing this about myself, I then designed a plan; I made a list of ten things I can do to distract myself next time I start thinking suicidally. In order to make an effective list, I had to know exactly what kind of activities would work for me and which ones wouldn’t work. For example, I didn’t put “do chores” on the list, because that takes me a lot of energy and might make me feel worse in a crisis. Instead I listed more mindless activities, such as watching anime, playing my favorite card game, and reading a book.

I can’t stress this enough: unless you know yourself very well, coming up with effective coping strategies will be nearly impossible. So take some time, please, to develop your sense of self and battle the dangerous Identity Disturbance.

Sense of Self Part 2: Know Thyself

Developing a Sense of Self

One of the criteria for Borderline Personality Disorder is “Identity disturbance: markedly and persistently unstable self-image or sense of self.” What this means is different for everyone, but basically it’s a sense of not really knowing who you are. This can be debilating, and many people with Dyslimbia struggle with it. Therefore, it becomes useful and even essential to develop a good sense of your own identity. There are several ways that beginners can go about doing this.

Goals

When it comes to developing a sense of self, it’s important to set goals. This is because “knowing yourself” means knowing what you want. Most people have life objectives or plans for their career or living situation, etc., but it’s much more important to list short-term goals—even daily ones. Meeting those goals will boost your self-confidence and sense of self, and you can learn about yourself from your failures and shortcomings, too. As for me, I have the following daily goals: Do some exercise (even if it’s just a short walk), find a social activity (such as calling a friend on the phone), engage in something therapeutic (talk counseling, mindfulness exercises, meditating), do something relaxing, do something useful or helpful (chores, work, etc.), and be sure to eat enough. You can also benefit from having personality goals; for example, I want to be a “Courageous, Healthy, Helpful, Capable, Strong, and Self-Controlled” person.

Personal Example

Examining your reactions to certain events or your patterns of thought can also help you develop a sense of self. For a personal example from last week, I meditated and examined my responses to grief and loss. This is because a death occurred in my family last week. I realized that my pattern of grieving is generally as follows: Shock, Anger, Guilt, Depression, and slow Acceptance. Knowing this about myself means I can better monitor and understand my responses and behaviors. When I feel like blaming someone for my cousin’s death, I make a mental note that this is normal Anger-stage grieving for me, and try to behave kindly, not judging myself, until I am past that stage.

Personality Type

Another interesting way to work on your sense of self is to find out your personality type. There are many types of personality tests and some are more helpful than others. I have always found the Myers-Briggs Typology to be the best test for learning about oneself. In this test, you are given a four-letter Type (there are 16 total) in response to your answers. Each letter represents a different dimension of behavior or character. I am an INFJ.

The first dimension, I versus E, means extraverted or introverted. While introverts get most of their energy from being alone, extraverts usually draw energy from other people in social interactions. The second dimension is sensing versus intuitive (S and N). Sensing types are generally more practical and in touch with their senses, and think about things in terms of parts and pieces. Intuitive types usually prove more abstract and theoretical, thinking about things in terms of the big picture. T and F stand for Thinking versus Feeling, and this depends upon how you make most of your decisions. If you are very objective in your decision-making, you are probably a T, while an F thinks subjectively. Finally, the fourth letter would be J or P, Judging versus Perceiving. J types show more organizational and planning habits, while Ps tend to be more spontaneous and flexible.

With a test like the Myers-Briggs, you can understand a) where you draw your energy, b) how you relate to the world, c) how you make your decisions, and c) how spontaneous or premeditated your actions tend to be. Knowing this much about yourself can be really helpful. With better understanding comes a better chance of adjusting your behaviors.

Remember that understanding yourself can help you in a pinch. When you feel empty or dissociated or extremely out of it, having a solid identity to cling to can save you.

Sense of Self Part 1: Directional Thought

What is Directional Thinking?

Many people with BPD struggle with negative self-image and difficulty controlling their thoughts and emotions. The fight to gain control of my racing emotional thoughts can be debilitating. That’s why I’ve decided that practicing “directional thinking” is a great idea.

Directional thinking simply means focusing your thoughts on a particular theme or idea, in order to have more control of the “inner dialogue” that everyone possesses. Many churches have discovered this secret and use it by writing or reading daily spiritual devotionals. The devotionals give you a particular theme, topic, or Bible passage to think hard about. Every time you catch yourself thinking scattered or emotionally charged thoughts, try to fit or redirect your thoughts into the “theme” given that day.

Not everyone likes spiritual devotionals, though. I’m an atheist, for example. In a case like this, you must think up your own self-devotional. Pick a theme you want to think about, something that has a lot of bearing on your life. For my first “devotional,” I chose to think about my Sense of Self for a week. I’d like to share my experiences with readers in this multi-part blog series on Sense of Self.

Identity Disturbance

Everyone goes through times of uncertainty or change, and everyone makes occasional decisions they later regret or don’t understand. For people with Borderline Personality Disorder (or Dyslimbia), though, these occasions are chronic and recurring. One of the criteria for BPD is “Identity disturbance: markedly and persistently unstable self-image or sense of self.” What this means is different for everyone, but basically it’s a sense of not really knowing who you are.

For me, “identity disturbance” manifests in several ways. First, since I also have a dissociative disorder, I sometimes feel like I have multiple personalities. My desires are so conflicted between totally different options, to the point where I feel like I am more than one person. Even if you know you don’t have multiple personalities, though, identity disturbance can still be very real and very frightening. I often become mentally anguished because I have this idea of who I’m supposed to be, and yet I’m doing things that don’t fit with that model, leaving me confused and frustrated. Identity disturbance is different for everyone, so if you care to share, please comment below. At any rate, it’s a problem that most people with BPD have to battle.

Today’s Example

In order to have a more stable self-image, it’s important to have goals concerning what kind of person you want to be. For instance, I want to be a “courageous, healthy, helpful, capable, strong, and self-controlled” person. Then, when I feel I don’t know who I am, I think about small steps I can take to become more like my ideal self. Equally as important, I give myself examples of how I’m already a person who shows many of those qualities. Let’s look at an example of this kind of directional thought from my own life.

Last night, I made an unwise decision and drank to excess, waking up today sick and hung-over. I also slept in very late, and realized my goals for the day could not be met thanks to my bad decision. On top of that, I received an invitation to a job interview on very short notice—with an intimidating company. As a result, I began to have a lot of racing thoughts, crippling anxiety, and intense self-loathing. Then I considered what I could do to calm my thoughts, and remembered my theme of Sense of Self.

Distracting from my panic, I told myself what I had done recently that proved I am “capable, strong, and self-controlled.” I thought about what small steps or actions I could take toward my goals, and how each one would prove I am “courageous” or “healthy” or “helpful.” To my surprise, exercising this directed thinking helped me through the intense anxiety until my medicine had time to kick in.

In summary, I believe directional thought could be a great tool for people with Borderline. In the next part of this blog series, I’ll continue discussing my experiences as I try to form a stable sense of self.