The term ‘borderline personality organisation’ was introduced by Otto Kernberg (1975) to refer to a consistent pattern of functioning and behaviour characterised by instability and reflecting a disturbed psychological self-organisation. The cluster of symptoms and behaviour associated with borderline personality include striking fluctuations from periods of confidence to times of absolute despair, markedly unstable self-image, rapid changes in mood, with fears of abandonment and rejection, and a strong tendency towards suicidal thinking and self-harm.
Borderline personality disorder is associated with significant impairment, especially in relation to the capacity to sustain stable relationships as a result of personal and emotional instability. For many the severity of symptoms and behaviours correlates with the severity of personal, social and occupational impairments, although this is not always the case. Some people with marked borderline personality disorder may be able to function at very high levels in their careers (Stone, 1993). Many people with borderline personality disorder recurrently harm themselves, usually to provide relief from intolerable distress, which for many can lead to significant physical impairment and disability.
Borderline personality disorder is associated with significant impairment, especially in relation to the capacity to sustain stable relationships as a result of personal and emotional instability. For many the severity of symptoms and behaviours correlates with the severity of personal, social and occupational impairments, although this is not always the case. Some people with marked borderline personality disorder may be able to function at very high levels in their careers (Stone, 1993). Many people with borderline personality disorder recurrently harm themselves, usually to provide relief from intolerable distress, which for many can lead to significant physical impairment and disability.
The main differences between the core symptoms of borderline personality disorder and other conditions are that the symptoms of borderline personality disorder undergo greater fluctuation and variability: psychotic and paranoid symptoms are transient, depressive symptoms change dramatically over a short period, suicidal ideas may be intense and unbearable but only for a short time, doubts about identity may occur but are short-lived, and disturbances in the continuity of self-experiences are unstable.
Family studies have identified a number of factors that may be important in the development of borderline personality disorder, for example a history of mood disorders and substance misuse in other family members. Recent evidence also suggests that neglect, including supervision neglect, and emotional under-involvement by caregivers are important. Physical, sexual and emotional abuse can all occur in a family context and high rates are reported in people with borderline personality disorder (Johnson et al., 1999a).
DSM-IV criteria for borderline personality disorder
A pervasive pattern of instability of interpersonal relationships and self-image, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (for example, spending, sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood (for example, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (for example, frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Source: [Borderline personality disorder: Treatment and management, National Clinical Practice Guideline, National Collaborating Centre for Mental Health commissioned by the National Institute for Health & Clinical Excellence, UK]
