Breaking Down BPD: A Look at the Diagnosis Criteria

It’s Borderline Personality Disorder Awareness Month! Last week, we both shared our stories about our lives and our diagnoses. This week, we’re taking a look at the 9 criteria for BPD diagnosis and how we fit into them. When diagnosing BPD, doctors and psychiatrists will generally look for how you fit at least 5 of these criteria. Let’s get into it…

Trigger Warning: Discussions of mental health and self-harm/suicidal thoughts.

1. Fear of Abandonment

Vonnie

As I’ve talked before, my abandonment issues started with my father’s departure to work abroad when I was ten years old. Since then, I’ve unconsciously been afraid of people leaving me. I had a deep, intense love for the ones around me. Even though this first abandonment had nothing to do with me, the following ones were registered as a pattern. Losing countless friends, in various ways, losing relationships, was showing my mind that I was the common denominator.

Part of the fear of abandonment is the efforts I made to keep people around. I used to avoid confrontation, which would at one point become the demise of the relationship because resentment took over. I would try my best to show people I was worth having around, by giving them gifts, showering them with affection, anything that would guarantee they’d stay. I’ve learned over time that when someone wants to stay in your life, they will accept you as you are. When they don’t, there’s nothing you can do to change their mind.

Becky

I can’t really pinpoint where my fear of abandonment came from, but my only guess is from how much I moved around as a child. My life has a lot of impermanence and that things can be so easily taking away from me. Maybe let’s what led to me feeling worried people are going to leave.

I think I put a lot of extra work into showing people how much they mean to me in an effort to keep them around. It’s like I have to prove them I’m worthy enough for them to keep around, even if they don’t need all of that to still want me around. On the other hand, I might push them away before they push me away. That way, it doesn’t feel like abandonment.

2. Unstable Relationships

Vonnie

I could write a novel on each friendship and relationship I’ve lost. There is an endless story for each person, each group of friends, each love that decided to leave me behind. Long story short, I would get too attached, and when the other person didn’t live up to the expectations I had formulated in my mind, or wouldn’t give back the same effort, I’d go from love to hate in an instant. I would get angry and passive aggressive, and completely ruin the relationship if they didn’t reassure me or diffuse the situation.

I still struggle with the resentment that comes from people not reciprocating as much as my mind thinks they should, a struggle that ties back to my self-image. They don’t pay enough attention to me, therefore I am unworthy and unlovable. They cancelled plans, therefore they hate me. From there, it’s the downfall unless I find a way to find logic in my reasoning and communicate openly with the person about how I feel and what they could do to avoid triggering me.

Becky

My life has been full of intense love and extreme losses, in both friendships and relationships. There are very few people that have stayed in my life for a long time, but more often that not my friendships and relationships are short-lived. I think friendships are easier for me to keep, but there’s been so many cases where I overreact and feel unwanted, so I’d cut off the friendship out of nowhere.

Anyone close to me knows that, especially when I was younger, I went through so many short relationships. To be fair, they often ended because something breakup worthy happened, but sometimes I’d just end it out of nowhere. I think this is a fear of something becoming to real and serious, so I had to run. I’ve been with my current partner for two years now and, boy, am I grateful for how much effort he puts in to understand me and my BPD.

3. Unsteady Self-Image

Vonnie

For me, it was constantly not knowing who I was. Growing up, I used to change my aesthetic a lot, because I didn’t know how I was supposed to be. Nothing made me feel right, nothing made me feel like myself, because I didn’t know who that person was. I would switch my look often, trying to find clothes and hairstyles and make-up that I would feel comfortable in, but each time it wasn’t enough.

The self-image goes beyond the perception of my appearance. I have moments where I feel like the kindest person on earth, then moments when I feel I’m the worst person and in reality I’m fooling everyone. There is no reality, though. There is nothing to tell me what kind of person I am, because it varies from one time period to another. Whenever I am going through an episode, I am particularly mean and bitter, then I feel guilty and the self-hate becomes unbearable. Other days, I feel that I’m not being appreciated enough for who I am. My self-image is a pendulum I can’t control, swinging slower or faster depending on some unknown force as it goes from one extreme to the other. Thankfully, sometimes there’s stability in how I perceive myself.

Becky

When I was growing up, I went through so many different phases trying to find out who exactly I was. I think because my brain was so consumed by the several mental illnesses going on, I never really found the time to discover myself. I tried every hair colour, makeup style, and personality type you can imagine. Still, none of it felt quite right.

After I went through therapy and several other treatments for BPD, as well as other mental health issues, it started to get better. Because my head felt clearer, I had more time to figure out who I am and the kind of person I want to be. I think now I’ve found that, and I’ve been taking steps towards building myself into the person I finally know I am.

4. Impulsive/Destructive Behaviours

Vonnie

Although I often fantasize about ways in which I could ruin my life, I push through them. However, I know many people experience this symptom which leads to substance abuse, sex, self-harm, overspending, or putting oneself in danger.

Becky

I think a lot of people, to some extent, can show impulsive behaviour. Every now and again, we react irrationally and make on the stop decisions that could have some negative consequences. I experience this to a certain degree. When I was a teenager/young adult, I engaged in a lot of behaviour that would negatively effect my life. I took partying at university way to far every night and tried everything under the sun to soothe the way that I was feeling.

Luckily, it never got extremely bad and I didn’t do anything too extreme. Impulsive behaviour seems quite manageable for me these days, but perhaps that’s just because I overthink the consequences big time.

5. Suicidal Behaviour/Self-Injury

Vonnie

I’ve had suicidal thoughts since I was thirteen. I hated my life back then, so the solution was ending it all. However, when I was younger, there was this unwavering hope that my life would get better. What caused problems was when it didn’t, and I felt worse than I was used to. I found myself close to committing suicide many times, with one attempt a few years ago when almost everyone I cared about abandoned me. I thought everyone would be better off without me, and after starting to self-harm a month prior to the attempt, I found it wasn’t enough.

My attempt was unsuccessful, as I was stopped by someone. The year that followed, I experienced so much guilt for being alive, as if I was on borrowed time and eventually I’d try again. I had a few scares since, but haven’t gone as far as attempting again. Nowadays, the thoughts have subsided after an accident I had that could’ve taken my life, which put things into perspective.

Becky

This has really been a big part of how I experience BPD. Ever since I was a teenager, I’ve intentionally engaged in suicidal behaviour, from thoughts or escalating to suicide attempts. For me, BPD makes me believe that a lot of my problems would disappear by ending my life. 

Deep down, I know it isn’t true, but it’s an overwhelming thought that I can’t shake. When I’m on medication, or trying different therapies, these feelings definitely subside, but it’s a constant worry about when they might spring up again.

6. Extreme Mood Swings

Vonnie

My mood can switch from nothing. I could be standing in the middle of a party, and suddenly I feel awful and want everyone to disappear, but mostly I want to disappear. I’m often finding myself in distress, and the source of the mood swing is nowhere to be found. I would describe it as walking on a wooden bridge during a sunny day, then suddenly there’s a storm that knocks you off the bridge, except you manage to hang on to the edge with your hands.

Your hands are suffering from holding onto the rough material as the wind sways you back and forth, but you know if you were to let go, it would be the end. That is how waiting for a mood swing to pass feels to me. I need to hang on during the storm, because I know it won’t last and the sun will show up again.

Becky

Everyone close to me has seen this first hand. The way I’m feeling can change with the click of a finger. I can go from being in this elevated and euphoric mood, to sudden feelings of doom, anger, and heavy levels of depression.

This can be so frustrating. It’s that same recurring issue with BPD–you never know when things are going to 180º. I really try to make the most of the highs. That’s because I know that the lows could take over at any moment.

7. Chronic Feelings of Emptiness

Vonnie

Sometimes I feel too many emotions, and the way my brain learns to protect itself is to feel nothing. I simply refuse to give into having an outburst. So I push the emotions down as deep as I can and cause myself to feel numb. It would be a talent if it wasn’t causing serious consequences on my well-being. Emotions can’t stay buried for long, but I consider it’s fine to set them aside if I’m not in the mood to examine them one by one, doing so for a long time can cause them to come back at an unexpected time.

Sometimes I don’t induce the feeling of emptiness, rather it overwhelms me. I don’t know where it comes from, but it is one of the worst feelings I experience. When I’m numb, I tend to think of everything I could do to harm myself, all while not caring. I could attempt to end my life and I wouldn’t care, and that’s what scares me the most. I could engage in dangerous behaviors and only feel the consequences when my emotions come back. It’s not a state of mind that I can handle well.

Becky

Like Vonnie, intense emotions are all-consuming for me. I feel everything so deeply. Yet, somehow, those feelings of emptiness and nothingness still creep up on me. There’s definitely a link to that and the depressive side of BPD. So, when I feel depressed, it really takes over my whole body and my entire life. There’s this sudden feeling that life means absolutely nothing and I could just sit in a dark room and feel so completely numb.

More of my life is definitely the experience of emotions to the full extreme, so the emptiness only creeps up on me every now and then.

8. Problems With Anger

Vonnie

At home, I can be calm one minute, then someone says one phrase that steps on my nerves, and suddenly I’m someone else. It’s like I’m watching from the outside of my body, wondering what I’m doing. I don’t recognise myself anymore, but I can’t stop the tantrum from happening. I’m on automatic mode, while my real self sits back and watches, wondering already how I’m going to fix what I broke. Contrary to popular opinion, I don’t intend to upset my loved ones. It’s difficult to explain that to my parents, or my friends who might not be aware that it’s a mechanism I can’t quite control.

These anger issues stem from lifelong trauma, from boundaries being stepped on and control of my own self taken away from me. So even if someone says or does something that doesn’t seem serious from the outside, inside my brain buttons are pushed. For example, I have a hard time staying calm when my parents give their opinion on my life, because of expectations they set on me in the past. I have a very difficult time not yelling when I’ve put on a boundary several times, yet they keep testing the limits of said boundary and making me repeat myself. A lot of my reactions are influenced by how much I’m feeling that day, or that moment. If I’m stressed or exhausted, I’m prone to responding negatively.

Becky

When I was a teenager, anger was this all-consuming feeling that almost became a personality trait. I had so much hatred for life, and whatever was going on in my brain, that it just became a way that I reacted to everything. I threw intense tantrums, lashed out at my family and friends, and found it so hard to see anything but anger for the world. It was so easy to push my buttons, it was like flicking a switch and suddenly I was this uncontrollable ball of rage.

My anger issues have definitely subsided as I’ve gone into adulthood, but they are definitely still present. The way that I react to things, especially stuff that wouldn’t as much as upset a ‘normal’ person, has roots in anger. I really struggle to stay calm in situations, which often leads to a reaction or response fuelled by anger. It’s definitely better now, but by no means has that anger completely disappeared.

9. Loss of Contact With Reality

Vonnie

I often find myself dissociating in public. Whether I’m walking around, or I’m at a party, or worse — at a concert, sometimes I lose contact with reality. My sight fixates on a meaningless point while my mind spirals, going down like an endless well. I don’t remember how I got there, or where I’m going, I see the world around me in slow motion. Fortunately, I’m easily brought back to reality if someone notices, if not I tend to take longer to come back to myself. However, this can happen several times during a day, or even a few hours. Coming back to reality doesn’t mean I won’t disconnect again in a few minutes.

Sometimes these moods are brought by someone saying or doing something that makes retreat into the depths of my mind, but sometimes I get stuck on emotions that appeared out of nowhere. I can’t predict when or where it’ll happen, but these dissociative episodes happen often.

Becky

I think I’m lucky that I don’t experience this too much, at least not in incredibly intense ways. For me, the world around me is so very real and perhaps I even feel it and see it too intensely. Maybe I did feel this way a bit when I was younger, so as I’ve gotten older I’ve tried to ground myself in reality a lot more.

I’ve got such an appreciation for life now, and maybe this comes from being so close to losing my life many times in the past. It took a lot of time, but I now see a lot more value in the world around me so I put in as much effort as possible to be so present in it.

If you are affected by anything in this article, please reach out to a professional, close friend, or seek help local to you.