Borderline personality disorder[i] (BPD) is one of the 10 personality-related illnesses recognized by the American Psychiatric Association. Mental health experts commonly view it as one of the most difficult conditions to accurately identify. BPD has nine core symptoms however the presence of these symptoms isn’t the only thing doctors consider when making their diagnoses.
The difficulties associated with borderline personality disorder begin with the name of the condition itself. Mental health practitioners and researchers once thought that the illness marked a border between other, more familiar health conditions. However, this concept has long been discarded, and the American Psychiatric Association identifies BPD as a distinct member of a larger group of ailments called Cluster B personality disorders[ii].
Still, the term borderline personality has not left common usage. Some people assume that it means people with BPD are only slightly affected by their condition. In reality, this is far from the case.
In addition to borderline personality disorder, the family of cluster B conditions includes narcissistic personality disorder, antisocial personal disorder and histrionic personality disorder. Doctors group these conditions together because they have similar basic effects on the personalities of adults. These effects include[iii]:
A crucial point to remember is that the diagnosable symptoms of all Cluster B personality disorders make it much harder for affected people to live productive and stable lives.
When they begin assessing their patients for a BPD diagnosis, mental health professionals look for the presence of any of nine officially defined symptoms. These core symptoms[iv] are:
The possibility of a diagnosis arises when at least five of these symptoms appear at the same time or within a brief span of time.
There is more to diagnosing borderline personality disorder than looking for the presence of the nine possible core symptoms. Doctors also gauge how much these symptoms alter a person’s ability to function or experience a reliable sense of well-being. Specific indicators of harm that must exert a significant effect include[v]:
In addition, when diagnosing BPD, doctors look for specific, harmful personality characteristics. There are two groups of these characteristics. The first includes negative emotional traits such as:
The second group of harmful characteristics is centered on a lack of personal or social inhibitions. Signs of this lack include:
Some of the symptoms of borderline personality disorder and other personality-based conditions overlap with the normal range of behavioral and emotional changes that occur in preteens and teenagers. This makes sense, since adolescence marks a time of frequent and extensive physical, social and psychological change.
In recognition of the overlap between temporary adolescent instability and damaging changes in long-term personality, doctors do not diagnose cases of BPD or any other personality disorder in people under the age of 18. This does not mean that younger people don’t undergo harmful changes in normal personality development. However, it does mean that doctors must wait before they can mark a clear difference between normal teen development and mental illness.
There is another complicating factor when it comes identifying the symptoms of borderline personality disorder. Namely, the condition often appears in combination with other diagnosable mental health problems. In a significant number of people, these problems include substance abuse and/or substance addiction. In fact, as many as half of all people diagnosed with BPD have a substance problem[vi] in any given year.
The presence of drug or alcohol problems can worsen the symptoms of both abuse/addiction and borderline personality disorder. In addition, the overlap between substance use disorders and BPD can make it more difficult for addiction specialists and mental health professionals to develop effective treatment plans.
At Transformations Treatment Center, our staff of addiction treatment specialists are aware of the connection between mental health disorders and substance use problems. Trained, licensed and certified therapists are ready to treat co-occurring disorders by creating an individualized treatment plan that addresses the specific needs of each client.