Borderline Personality Disorder - How to Diagnose and Cope

This article makes clear the diagnosis for Borderline Personality Disorder and suggests ways of coping.

Unlike physical problems, mental health problems are much more complex to diagnose. If you visited to ten different doctors with a broken leg, ten doctors would tell you that your leg was broken. If you visited ten psychiatrists with a variety of odd sounding emotional and "invisible" complaints I would be surprised if you came back with ten similar diagnosis. If you mix into this picture slight cultural differences, such as the reluctance in the UK to diagnose compared to the easy diagnosis handed out in the US, the picture becomes even more confused.

This is the way that doctors will describe and diagnose Borderline Personality Disorder.

Borderline Personality Disorder is characterized by a long standing pattern of instability in relationships, unstable self image and extreme impulsivity. It is usually apparent in early adulthood and exists in a variety of different contexts. It is indicated by 5 or more of the following:

Frantic efforts to avoid real or imagined abandonment.
Re-occurring patterns of unstable and intense relationships characterized by alternating extremes of idealization of a person and followed by devaluation
Unstable identity, a persistently unstable self image and sense of self.
Impulsivity in at least 2 areas that are self damaging such as dangerous driving, sex, spending, alcohol or drug abuse or binge eating.
Recurrent suicidal behaviour, gestures or threats or self mutilating behaviour.
Instability due to reactivity of mood, such as intense irritability, anger and hostility, boredom or anxiety usually lasting a few hours and rarely up to a few days.
Chronic feelings of emptiness.
Difficulty in controlling anger, or intense or inappropriate anger such as recurrent fights and ongoing misplaced anger.
Transient and stress related paranoid thinking or severe dissociative symptoms (losing sense of ourselves and reality) often experienced as feelings of "going crazy" or "out of control".

As you can see it's a severe pathology, which causes people immense distress. Having worked with many people with Borderline Personality Disorder I appreciate how difficult it is to treat. By definition it's part of the "personality" and as such is difficult (some would say impossible) to change; a bit like trying to change your sense of humour.

There are, as always, a range of medicines that can help. They seem to work well for some people and not for others. Other interventions that work are the simple, straightforward ones; things that act to stabilise and simplify rather than to add to the already busy psychopathology. The top three on my list are:

Consistency

People who are living with Borderline Personality Disorder are riding an emotional roller coaster. The last thing they need people around them to do is join in, which paradoxically, is what tends to happen. As difficult as it is, (and it is really difficult) it's important not to become part of the emotional roller coaster; to not be drawn into arguments, not to react to insults, rejection or adulation but to remain consistent, empathic and reliable.

Keep It Simple

Avoid complicated coping mechanisms. Re-enforce a general message that "feelings are not fact" and "feelings don't stay the same". No matter how bad we might feel, and people who live with Borderline Personality Disorder sometimes feel as bad as it's possible to get and are absolutely desperate and suicidal, it's important to remember that it won't stay the same. All feelings change.

Treat The Symptoms

As Borderline Personality Disorder shifts slowly over long periods of time it's often useful to concentrate on associated symptoms, such as providing ways to cope with anxiety and stress, how to deal with suicidal ideation or ways to quit drugs.

Borderline Personality Disorder is not an easy disorder to either diagnose or live with. It is often obscured by the high profile symptoms such as drug use or suicide attempts.

If you feel that you, or someone you know maybe suffering from this personality disorder try to find a professional who has a lot of experience dealing with it. It often confounds inexperienced professionals who unwittingly get pulled into the problems rather than stabilising them.

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