Borderline Personality Disorders: A Case Study

DESCRIPTION
There has been no change in the diagnostic criteria from the DSM-IV to the DSM-5 with regards to diagnostic criteria for borderline personality disorder. Borderline personality disorder is defined by the American Psychiatric Association in the DSM-5 (2013) as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts” (Borderline Personality Disorder). There are nine criteria listed in the DSM-5 (2013) that are utilized as indicators that the individual meets the diagnostic definition of BPD. The individual must meet a minimum of five of the criteria
Individuals with BPD meeting the first criterion will have

difficulty with the probability of them experiencing abandonment, whether real or imagined. They feel a need to be around others and experience fear of being by themselves or alone. They will perceive sudden changes affecting their scheduled time with others, such as cancelation of plans or running late, as being abandoned. Their reaction will be represented with fear or inappropriate anger to the event. The abandonment is viewed as a response to their behavior or self-worth. These individuals will take frantic efforts to avoid the perceived abandonment with can be as extreme as suicidal behavior.
A history or pattern of unstable, extreme, or volatile relationships may be present meeting the second criterion. They may develop intimate relationships, romantically and in a patient-therapist context, with others rapidly. Thus, revealing very intimate details early in the relationship and requiring that frequent time be spent with each other. These methods are to limit the feeling of abandonment that may be experienced as a new relationship develops. Although they are quick to develop intimate relationships, the individual with BDP may quickly switch their feeling from hot to cold for the individual. They may feel that they are not being valued or given the appropriate attention that they deserve.
Individuals with BPD demonstrate empathy for others and can demonstrate nurturing behavior. However, this behavior is with the intention that the other person will reciprocate the behavior in return when they desire it. They may prefer more comfortable with establishing a relationship with a pet than with another individual. They may also demonstrate sudden changes in their view of others, from extreme positive to an extreme negative or vice versa. This sudden shift is dependent if they suddenly feel an idealization or fear abandonment.
The third criterion identifies that the individuals demonstrate a fluctuating or unstable sense of self.

They will demonstrate sudden shifting of personal goals, values, or career plans. This can be in expressed in changes of opinion on job satisfaction or career aspirations. Opinions can additionally vary in choice of friends, value system, and sexual identity. These sudden changes may represent a pattern of the individual sabotaging themselves as a goal is about to achieved. Thus, they may drop out of school just before graduation or display self-destructive behavior in a positive, supporting relationship. These individuals may be characterized by recurring periods of unemployment, uncompleted education, or separation and divorce. Although, their self-image is often negatively based on being bad or evil, they may experience feelings that they are nonexistent. Periods of nonexistent self-image coincide with periods of lacking emotional attachment with others or a positive support system.
The fourth criterion is meet by the individual demonstrating potentially self-destructive impulsive behavior. This impulsiveness must be in a minimum of two behaviors; such as unsafe sex, poor financial money management, substance abuse, binge eating, or reckless driving as examples. Behaviors that include self-mutilation or suicidal behavior are not included in the self-destructive behavior of the fourth criterion. They are represented by the fifth criterion. Self-mutilation or suicidal behavior

to prevent abandonment are also covered under the fifth criterion.
Individuals with BPD have an 8-10% rate of completed suicide (APA, 2013). Suicidal threats and acts of self-mutilation, such as cutters or burners, is commonly found in these individuals. Suicidal threats and self-mutilation often precede events where threats of separation or rejection by companions is expressed or there is a fear of abandonment. They may suffer from self-inflicted handicaps from uncompleted suicidal attempts or accidents during episodes of self-mutilation.
Individuals may display rapid, abrupt shift in their moods from their being in a state of dissatisfaction, irritability, or anxiety representing the sixth criterion. These states commonly last only a few hours and rarely more than a few days. These mood shifts may be related to the individual’s extreme reactions to interpersonal stresses. Thus they will shift from chronic feelings of emptiness, seventh criterion, to episodes of intense, inappropriate anger or have difficulty with anger management, eighth criterion. This lack of anger management can be represented in physical altercations, quick to anger, or a constant mood of anger. Thus, they present with sudden outbursts or sarcasm when they feel emotionally neglected by a companion or caregiver. However, they will often experience episodes of grief or guilt in their behavior and experience an evil or bad self-image. They may experience temporary paranoid ideation or suffer from dissociative symptoms, such as depersonalization, during periods of high-stress (Ninth Criterion).
The prevalence rate for borderline personality disorder is estimated to be between 1.6% and 5.9% of population (APA, 2013).

The variance may be the result of the comorbidity of BDP with depressive, eating, substance use, and post-traumatic stress disorders which mimic some of the diagnostic criteria. BPD is represented in a large portion of prison inmates, with a prevalence rate of 30% (Mancke, Bertsch, & Herpertz, 2015). In the general population aggression is more commonly associated with male. However, BPD is 75% more likely to occur in women. The research conducted by Mancke, Bertsch, & Herpertz found that BPD reduces the gender difference in regards to aggression differences between the genders. However, males were shown to demonstrate more impulsive behavior and explosive episodes of

anger.
The course of borderline personality disorder displays a degree of variability of the disorder. Commonly, the disorder is represented with increased severity and instability on early adulthood. This period is characterized with a decrease of impulse control. Thus, there is an increase of risk of suicide during early adulthood. Additionally, young adults are more common to suffer from the results of self-destructive behavior. During middle adulthood, the majority of patients demonstrate stability in careers and interpersonal relationships. Often about 50% of BPD sufferers no longer meet the minimum of the required five criteria.