This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D. — a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program — to help us better understand borderline personality disorder by talking about its signs and treatments.

Dear Dr. Pat,

I am a 43-year-old woman and have slowly come to the conclusion that I might have borderline personality disorder.  I know this might seem weird to self-diagnose, but a friend suggested it to me and I’ve done some reading and I think she might be right. I am really emotional – I can go from on top of the world to downright depressed in a matter of minutes. I also tend to have really, really intense relationships. We fall in love, I can’t imagine life without him, but then it blows up, and I am terrified of being left but it inevitably ends in what feels like disaster. When I was younger, I had a big problem with cutting, which I don’t do much anymore, other than when I am feeling really distressed and disconnected and need a way to bring myself back. I’ve been this way as long as I can remember. Honestly, I’ve come to realize all of this is ruining my personal life – my friends are tired of all my drama.  I’ve been in therapy before – in my teens and 20s, when I had some suicidal stuff – but nothing recently. I’m at a point in my life where I need to address this. What do you think? Could this be borderline or am I just a train wreck – or maybe that’s the same thing? The stuff I read about this, it doesn’t sound good.

Thanks,
Anne

Dear Anne,

It is very insightful that you have been able to think about your experiences and wonder about borderline personality disorder. Diagnosing borderline personality disorder is best done with a thorough assessment by a psychiatrist. However, many of the issues you describe are consistent with this diagnosis. Borderline personality disorder has a number of distinct features including:

• Dramatic mood swings and intense emotions that are difficult to control.
• Frantic efforts to avoid abandonment.
• Recurring intense and often unstable moods that swing dramatically from  hyper-attached love to loathing.
• Poor sense of self.
• A tendency to be impulsive in ways that could be personally dangerous (spending too much, substance use, reckless driving,  binge eating, alcohol overuse).
• Recurrent suicidal behaviors or threats or self-harming behavior, like cutting.
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days.
• Feelings of emptiness.
• Having paranoid thoughts when under stress.
• Intense anger.

Not all of these need to be present to make the diagnosis, and some people have just a handful of these traits, but can find them quite debilitating. These features begin in adolescence or early adulthood.

There are a number of different personality disorders, borderline being one of the most well known. The term “personality disorder” is somewhat unfortunate as it can make the individual feel that there is something fundamentally wrong with them – that their very personality is somehow defective. It is important to understand that, like other forms of mental illness, personality disorders arise from a mixture of genetic and environmental factors. Research has shown alterations in neurotransmitter activity as well as differences in areas of the brain involved in emotional reactivity and processing social interactions. Often, individuals with borderline personality disorder have experienced childhood trauma and some have proposed renaming the disorder “complex PTSD,” although it is clear that not all individuals with borderline personality disorder have had this experience.Borderline personality disorder affects somewhere between 2 percent and 6 percent of the population.