..classified as a major personality disorder involving dramatic, emotional, or erratic behavior; intense, unstable moods and relationships; chronic anger; and substance abuse." (Boucher, 1999, p. 33)
There are a number of criteria which, in line with DSM-IV, are used to identify and characterize this disorder. The first of these criteria refers to "...unstable and intense interpersonal relationships, with marked shifts in attitudes toward others (from idealization to devaluation or from clinging dependency to isolation and avoidance), and prominent patterns of manipulation of others.."(Boucher, 1999, p. 33)
Perception also plays an important role in the identification and understanding of the BDP patient. This refers particularly to social perception. Benjamin and Wonderlich (1994) recognized that BDP patients showed differences in social perception when compared to bipolar and unipolar subjects. In relation to this they found that "...BPDs view relationships with their mothers, hospital staff, and other patients with more hostility than mood disordered patients. BPDs see themselves as attacked by other patients and as part of hostile and noncohesive families. "(Boucher, 1999, p. 33)
Another aspect that identifies the BDP sufferer is "... intense clinging dependency and manipulation..." (Boucher, 1999, p. 33) This is a central characteristic of the BDP patient in terms of social interaction and is an aspect which also makes the treatment of this patient all the more difficult.
Therefore a further cardinal criterion of these patients is that they show major social dysfrucntionality. As Boucher in his study (1999) states,
Hostility enters on the heels of denial of dependency; as part of vehement denial, BPDs devalue the strengths and personal significance of others. Often, this takes the form of extreme anger when others set limits for relationships, or when separations are about to occur. Social perception is pervasively dysfunctional. (Boucher, 1999, p. 33)
Understanding BPD is a precarious and difficult issue in many instances. As stated, one of the issues surrounding BDP is the difficulty in diagnosis and assessment due to the interrelationships and similarities to other disorders and areas of mental concern. This is evidenced by the fact that while BDP is often diagnosed in children and adolescents, one has to must make allowance for other issues including eating disorders, substance abuse, and mood disorders that may be age specific.
BPD is often diagnosed in children and adolescents. However, considerable caution should be used when doing so, as some of the symptoms of BPD (e.g., identity disturbance, hostility, and unstable relationships) could be confused with a normal adolescent rebellion or identity crisis. (Coker & Widiger, 2005, p. 213)
1.2. Diagnostic and Statistical Manual of Mental Disorders (DSM)
As discussed above, the earlier history of the definition, identification and classification of Borderline Personality Disorder was unclear and uncertain - especially with regard to its differentiation from other neurotic conditions.
Due to this fact the Diagnostic and Statistical Manual of Mental Disorders, Second Edition, (DSM-II) contained very little that adequately described or identified the Borderline personality. However, inline with the growing definitions and awareness of BPD as a unique condition with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, (DSM-III), BPD became a diagnostically based on a systematic description of observable clinical characteristics. "This description was carried over to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised, (DSM-III-R) in 1987 and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in 1994. "(Excerpt from Personality Disorder: Borderline)
According to the DSM-IV (1994) BPD is a ":...pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of nine criteria." (Boucher, 1999, p. 33) Some of these criteria have been referred to in the above section. The following is a listing of the nine criteria.
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
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 (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
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).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty...
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