BPD Subtypes

When searching for information on BPD, I came across a set of subtypes that describe the various features of BPD. These subtypes are:

• Discouraged: this type of borderline is either avoidant, believing no-one will like them anyway, or overly dependent on others. They have an intense fear of abandonment. Borderlines of this type may also suffer from depressive symptoms.
• Impulsive: this is the most hated BPD type among professionals. People who are primarily impulsive tend to act before thinkign. This includes violence or other antisocial behavior. Conversely, they may also engage in constant approval-seeking.
• Petulent: borderlines of this type use passive-aggressive behavior, including emotional or physical self-abuse, to get their needs met by others. They have an intense fear of abandonment,, unstable self-image, and inability to express their needs properly.
• Self-destructive: this includes depressive and self-harming tendencies. People of this type may not have many BPD traits other than self-injury and affective instability, so they may not technically meet the criteria of BPD.

Please note that people with BPD may have some features of one type and some of another. I, for one, have features of the discouraged and petulent types.

All types except for the petulent borderline operate in an abandoned child mode. Petulent borderlines operate in an angry child mode. I do see this point, but I want to stretch that the angry child usually masks the needs of the abandoned child, as my therapist explained. I myself cannot feel sadness unless I've first expressed intense anger or rage. Yesterday, I found myself in such a situation. I had had a minor conflict with my husband which led me to fear abandonment. As I got back to the ward, the nurses were assuming I'd had a good day - after all, it was my anniversary -, and were encouraging me to think positvely. Now I could and maybe will at one point write up a whole post on the positivity paradigm, but suffice it to say I snapped. I had a rage that, after a lot of back-and-forth screaming between me and the nurses, led to me running off and wandeirng around grounds screaming. I could only start to feel the sadness and fear of abandonment after I'd blown off some steam and calmed down again.

BPD Criteria and Me

Yesterday, I came across someone going through the BPD criteria and describing how he met them. I thought I would do the same, so here goes. My diagnosis was based on DSM-IV-TR criiteria because the Netherlands has not yet implemented DSM5. You need to meet at least five criteria out of nine. I meet at least six and most likely two more.

1. Frantic efforts to avoid real or imagined abandonment. Well, I have a huge fear of abandonment, but my attempts at coping with it tend to lead to actually being abandoned. I often can predict when someone is going to abandon me, but am not sure whether this is a self-fulfilling prophecy, good empathy, or magical thinking.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is the one criterion I mostly don't recognize. Oh well, I do on occasion push my husband away by saying I don't love him anymore. In this sense, I am the stereotypical "I hate you, don't leave me" type. My husband says his presumption about borderlines is that people fight tooth and nail then five minutes later are cuddling.. I don't do that.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self. This is definitely me. As I pointed out in a previous post, I have no sense of self at all beyond the labels I carry, and in fact am just learning to use my own labels rather than those stuck on me. I tend to have my identity depend on how others see me.
4. Impulsivity in at least two areas that are potentially self-damaging (eg. spending, sex, substance abuse, reckless driving, binge eating). Binge eating an running off into dangerous situations for me (ie. going for walks without watching for traffic). This is not suicidal behavior. Spending when in a hyperactive mood.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Well, I self-harm and often make suicidal threats. when talking on the phone with my sister about my new BPD diagnosis, she said that mild self-injury like I do does not really count and that I make suicidal threats for attention. Well, I disagree with the "for attention" bit but really it doesn't matter.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). This is so true for me. I have rapidly shifting moods from irritable to anxious to hyper etc. My sister got talking of manic depression, but then moods have to last for a couple of days to weeks. Mine don't. I return to "normal" (ie. slightly depressed and irritable) or another mood episode within a day or so.
7. Chronic feelings of emptiness. I'm not really sure about this one as I have good reason to feel empty, ie. no job or extensive day activities. Then again, the feeling of emptiness can come for no reason and go with another perseveration or impulsive action.
8. Inappropriate, intense anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights). I don't physically fight but I do have recurrent temper outbursts. For me, I'm not too sure whether they're meltdowns or outbursts, but I do have them in situations other than when overloaded too.
9. Transient, stress-related paranoid ideation or severe dissociative symptoms. Well, duh. I have both actually. I get terribly paranoid when under stress and obviously have dissociative symptoms, ie. feelings of not being myself, chronic depersonalization and derealization, occasional amnesia.

I have been trying to find DSM5 criteria, but can't. I know a new model for diagnosising personality disorders has been proposed, which bases the diagnosis on a combination of impairments in personality functioning and personality traits, but this model is used for research purposes only.