According to the DSM-5, Personality Disorders are characterized by “impairments in personality functioning and the presence of pathological personality traits”. Borderline Personality Disorder is one of ten personality disorders listed in the DSM-5. The DSM-5 lists several criteria that must be met in order for someone to be diagnosed with Borderline Personality Disorder. They are quoted as follows:
Borderline Personality Disorder (BPD) affects about 4% of the general population, and at least 20% of the clinical psychiatric population. (Kernberg and Michels, 2009) In the clinical psychiatric population, about 75% of those with the disorder are women. BPD is also significantly heritable, with 42-68% of the variance associated with genetic factors, similar to that of hypertension. BPD can also develop due to environmental factors such as childhood neglect and/or trauma, insecure attachment, and exposure to marital, family, and psychiatric issues. (Gunderson, 2011)
Some of the key components of BPD include self-harm, or suicidal thoughts and actions, dichotomous thinking, and low emotional granularity. People that present with reoccurring suicidal thoughts and actions, combined with a fear of abandonment, are commonly diagnosed with BPD. These two characteristics make BPD easily recognizable, but this diagnoses is often not used. The emotional volatility, recurrent crises, and self-injurious behaviors of those with BPD are often seen as willfully manipulative episodes, and not a sign of illness. (Gunderson, 2011) Yet, it is important to take these thoughts and actions seriously, as one never knows when someone may actually decide to end their life.
Beck believed that dichotomous thinking was a key cognitive characteristic of those with BPD, and posits that this type of thinking “contributes to the emotional turmoil and extreme decisions of these patients, as lack of ability to evaluate things in grades of gray contributes to the abrupt and extreme shifts patients with BPD make” (Beck, et. al. 2004). (Suvak, Litz, Sloan, Zanarini, Barrett, and Hofmann, 2011) These “shifts” that Beck mentions occur when a person goes back and forth between thoughts of positive self-regard and negative self-regard, as well as positive and negative thoughts about others.
“Emotional granularity refers to individual differences in the ability to distinguish
among emotional states and is a function of how information about valence and arousal is incorporated into representations of emotion (Barrett, 2004). Individuals high in
granularity represent their emotional states with high specificity (i.e., with a great deal of distinction between similar emotional states; e.g., anger is clearly distinct from annoyance), whereas individuals low in granularity represent their emotional states in
more global terms (i.e., all negatively valenced states are represented as “feeling bad” or “depressed”).” (Suvak, et. al., 2011)
A Case Study