Key Features of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a common but complex mental disorder that is typically characterized by affective instability, marked impulsivity, suicidal ideation and/or behaviour, and severe deficits in occupational and interpersonal functioning (Bender et al. 2001; Oldham 2006; Lieb et al. 2004; Skodol et al. 2005). The features of BPD are generally considered to consist of three core features: emotional instability, impulsivity, and interpersonal turmoil (Paris, 2005; Gunderson & Ridolfi, 2001). These core features map onto the diagnostic criteria for BPD outlined in the DSM-IV-TR (APA, 2000).

Emotional instability consists of intense and volatile affects, often involving anger, anxiety, or depression. In contrast to mood and anxiety disorders, these affect experiences are not typically sustained over extended periods of time. Instead, shifts in emotional states occur relatively rapidly, and are often associated with external triggers such as stress and interpersonal disappointment. Other emotional features of BPD can include chronic feelings of emptiness or loneliness. Difficulties in tolerating and regulating these affects are thought to contribute to many of the behavioural symptoms of BPD.

Impulsive symptoms may consist of suicidal threats or behaviours and/or non-lethal self-injury, such as inflicting deliberate wounds. Impulsivity may also involve other self-destructive activities such as substance abuse, binge eating, and risky sexual activity.

Interpersonal turmoil is represented by intense reactions to interpersonal stressors such as loss, rejection, or perceived abandonment. Interpersonal instability can be thought of as a disturbed sense of attachment with others. Relationships are often marked by insecurity and a fluctuating appraisal of others as either good or bad. This is also thought to be associated with a disturbed sense of identity, an unstable self-concept that may shift depending on the immediate interpersonal context.
The above features may be conceptualized as reflecting (1) intense emotional pain and (2) awkward or self-defeating efforts at expressing and handling this pain (Zanarini & Frankenburg, 2007).

Severity of Borderline Personality Disorder

BPD occurs along a continuum of severity. More severe cases of BPD tend to have a greater number of co-morbid Axis I disorders and a relatively high degree of impaired occupational and interpersonal functioning (Zanarini & Frankenburg, 2007). By contrast, patients with milder forms of BPD may be able to work productively and remain socially active. The degree of motivation to recover and the capacity for engaging in treatment are other factors indicative of relative severity (Zanarini & Frankenburg, 2007).