Tag Archives: Major Depressive Disorder

Reviewing BPD Criteria Part 2

Review

In the last post, we started to examine the criteria for Borderline Personality, or Dyslimbia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The defining traits are categorized into 5 sets: 1) Problems in “personality functioning,” 2) “Pathological personality traits” and three other categories that are conditions of the disorder’s appearance. These I will briefly cover after we examine categories one and two.

Category 2: “Pathological Personality Traits”

We reviewed category one last time, “personality functioning,” which was separated into problems with self and problems with others. Next we will take a look at category two, “pathological personality traits,” which are negative, recurring emotional and behavioral traits caused by mental illness. This category is broken into three sub-categories: negative affect (negative emotions, habits, and thoughts), disinhibition (impulsiveness), and antagonism (hostility).

Cat. 2, Group 1: Negative Affectivity

Easily Aroused Emotions

Under negative affectivity, the DSM lists emotional liability, anxiety, separation insecurity, and depression. Emotional liability refers to “Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.” One of the biggest problems for Borderlines is the occurrence of mood swings. The smallest things can change us from a good or neutral mood into livid irritation, frightening panic, or overwhelming hopelessness. The most insignificant of comments can make us suddenly terrified that we are being abandoned or fill us with a nagging craving for comfort resulting in neediness.

An example that reoccurs in my life is shame associated with depression. If I’ve done something wrong, such as snapping at a family member, telling a lie to get out of something, or failing to meet a self-imposed deadline, I usually own up to my mistake pretty quickly and try to make amends. That doesn’t stop the feelings, however. I become so depressed that I can’t do anything but lie in bed for a few hours, and I become so ashamed that I have urges to cut myself in order to punish myself for doing that one little wrong.

Disproportionate Emotions

For those with Dyslimbia, mood swings can be debilitating, interfering with everyday activities and messing up our relationships. Not only do our moods change easily, but the emotions we experience are often on a whole different level compared to those without Borderline Personality Disorder. Many people with this condition say that their problem is feeling too much. We are the people who feel like it’s actually the end of the world when people say it’s not. This what the DSM means when it says our emotions are out of proportion for the situation. Here are a few personal examples.

After a serious breakup, it would be normal to be depressed and maybe even see a counselor if it continues. However, after my last breakup, I attempted suicide and was barely saved. If someone tells me there’s a storm going through the area where my sister lives, I get so anxious that I feel sick, my heart races, and I start thinking, “What if she dies?” Some worry would be normal, but panic is not normal for such a situation. This last example kind of goes under group three, antagonism, as well, but here goes. I get insanely angry over the tiniest things. Knocking something over or spilling a drink can make me so angry I hit things or break things. If I read about people who are cruel to animals, I experience detailed fantasies of killing them and their families, images that are difficult to “turn off.”

Separation Insecurity

That pretty much covers the emotional liability piece. Now, we’ll take a look at separation insecurity. We often don’t like to admit it, and not everyone with Dyslimbia suffers this symptom acutely, but the majority of us feel like we simply cannot deal with abandonment or rejection. I’ve already given the example of trying to kill myself after I was suddenly dumped in my last major relationship. Long before that, the initial trigger that started my self-injury habit was being dumped by my first boyfriend. It isn’t just lovers that we can’t handle. The person who I considered to be my best friend rejected me and stopped all contact with me because of my atheism. It’s been almost two years since then, and I still think of her, missing her acutely, every few days. At first, I had thoughts of stalking her because I couldn’t deal with the separation. It felt, to me, like one of my own sisters had died. In reality, all that happened was I lost a friendship, which was for the best anyway because she was rather bigoted.

The DSM describes separation insecurity as, “Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.” In other words, because we fear abandonment so much, people with Borderline often feel like they will no longer be able to function or no longer to able to live if that person leaves us. That is what’s meant by “loss of autonomy.”

I can’t speak for everyone with Borderline Personality Disorder, but for me, I have never yet been able to live for my own sake. I require a loved one to live for, or else my life is worthless. Although I am trying to conquer this mindset in therapy, it still holds true for now. With no significant other, I am currently living for the sake of my Dad, who already suffers periodic depression and would never recover if I killed myself. All that to say, when the one person we have been living our lives for suddenly leaves us, our worlds are destroyed. In a spiritual sense, it is like we die each time our significant other leaves us, and we must start life again from scratch afterward. Speaking for myself, I was never autonomous to begin with.

Although the new DSM V does not mention this, the old DSM IV pointed out something else about Borderline separation insecurity: sometimes we believe we have been rejected or abandoned when, in reality, that hasn’t happened. This is extremely difficult for Dyslimba patients to admit, because while our logical minds are telling us that no evil was done to us, our powerful emotional minds are screaming at us that we’ve been cruelly forsaken.

An example from my life is when my good friend (with benefits) dropped out of the college we went to and returned to his hometown. Since he had been doing poorly in school for several semesters, and frequently voiced the opinion that he didn’t like his major, it should not have been unexpected that he dropped out. However, for a while there, I firmly believed he left the school because he was sick of me, and even though we were not in a committed relationship, I believed that he had abandoned his responsibility to stay with me. (A lot of time has passed since then and though we do not often talk, we are on friendly terms and I have apologized for my neediness.)

Anxiety

Anxiety and depression are negative emotions in the negative affectivity group. Literally speaking, this refers to transient (temporary) feelings; however, it’s also well-known that clinical mood disorders often co-occur with Borderline Personality Disorder. “Comorbidity” is the presence of two or more disorders at the same time in the same patient. Major Depressive Disorder (AKA clinical depression), Generalized Anxiety Disorder, and many variations of anxiety such as Social Phobia can be comorbid with Dyslimbia. But whether they are temporary feelings or full-on disorders, depression and anxiety are difficult to deal with either way.

I have Generalized Anxiety Disorder, and as a result, I never stop worrying, even about the smallest things. I have experienced panic attacks, which are harmless but extremely frightening; you actually feel as if you are going to die. Anxiety about upcoming social situations and anxiety about school were the main triggers in the past. (Now, I manage my anxiety with medication, and do not experience panic attacks.) DSM V also mentions “fears of falling apart or losing control” under anxiety. I don’t know if this is the case for everyone with Dyslimbia, but one of my biggest fears is losing control of myself and doing something terrible.

Depression

Depressivity is described in the DSM V as, “Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.” Which of these symptoms show up and how strong they are varies by individual with Borderline Personality Disorder. For me, all of them are applicable.

I have Major Depressive Disorder comorbid with my Dyslimbia, and when I’m not panicking or raging, you can count on me to be depressed in bed, unable to motivate myself to function. Ultimately, this led me to seek help from Social Services (Disability). My emotions and my spirit tell me that both my situation and the world at large are hopeless, beyond redemption. While the logical part of my brain disagrees, it is not strong enough to overcome the feelings most of the time. As for pervasive shame, I am a professional at self-loathing. There is no one in this world that I hate more than myself. I believe that, objectively, someone like me deserves to be killed.

I already gave an example of my suicidal behavior. There have been five instances where I set out with the intention of taking my own life, though only two were fully thought-out plans (which failed or were interrupted, resulting in hospitalization). Not everyone with Dyslimbia has tried to kill themselves and some will never go that far. However, pretty much all of us suffer from recurring thoughts about suicide. My preoccupation with thoughts and wishes for my death was termed “suicidal ideation,” by my psychiatrist, and the thought pattern became deeply ingrained within me even when I had absolutely no intention of acting on such thoughts.

Fortunately, modern medicine, along with therapy and support, can usually correct this problem over time. After trying no less than fifteen different antidepressants, I finally found that taking and staying on Zoloft significantly reduced my suicidal ideation. It was actually pretty amazing. For four and a half years, I was tortured by suicidal ideation. But by the sixth week of being on zoloft, suddenly my mind didn’t want to keep wasting time thinking about dying. I have passing thoughts related to suicide once or twice a week, but they are never strong ones anymore. Starting in September 2016 and on, I no longer want to kill myself (though I would deserve it if I happened to die). Note that Zoloft is only the medicine that worked for me, and the one that works for you may be different.

Alongside “Thoughts of suicide and suicidal behavior,” the old DSM IV used to include “selfmutilating behavior,” AKA self-injury such as cutting. The new DSM V does not list self-harm as a criteria for Borderline anymore. However, it is a symptom of many who suffer from the disorder, and I feel that it goes hand in hand with discussions of negative affectivity and depression. Self-harm includes such habits as cutting oneself with a blade such as a razor or knife, and burning oneself with lighters, cigarettes, hot objects, or hot liquid. There are many faces of self-harm and I don’t want to go into detail for fear of triggering someone.

There is no one absolute reason for why people self-harm; the reason depends entirely on the specific person. One thing that is fairly true across the board, however, is that cutting grants some form of immediate gratification, whether you were after the pain, the scar, the sight of blood, the feeling of punishment, or any other reason. People with Borderline Personality Disorder have a long-standing reputation of falling prey to various forms of immediate gratification where an alternative with delayed gratification would be healthier. You could say we have addictive personalities. That makes us much more likely than the average population to form a habit of cutting.

This information covers symptoms 1, 5, and 6 in the old DSM IV. Thank you for taking the time to explore the symptom of Negative Affectivity with me. Next time, we will cover Disinhibition (impulsiveness) and antagonism, which are also included in Category Two, “Pathological Personality Traits.”