What are the common characteristics of borderline personality disorder?

Common Characteristics of Borderline Personality Disorder

Borderline personality disorder is fundamentally characterized by a pervasive pattern of instability across three core domains: interpersonal relationships, self-image, and emotions, combined with marked impulsivity that typically emerges in early adulthood. 1

Core Clinical Features

Emotional Dysregulation

• Rapid mood swings, intense irritability, and difficulty controlling anger are hallmark features that distinguish BPD from other psychiatric conditions 1
• Affective instability is more chaotic and reactive in nature compared to the episodic mood changes seen in bipolar disorder 1
• Emotional lability occurs predominantly in interpersonal contexts and is often precipitated by real or imagined relationship events 2, 3
• Feelings of chronic emptiness are a persistent feature that contributes to the overall emotional instability 2

Interpersonal Dysfunction

• Unstable, intense interpersonal relationships characterized by alternating extremes of idealization and devaluation define the relational pattern 1, 2
• Chronic fears of abandonment and intolerance for being alone drive much of the interpersonal chaos 3
• The relationships are more tumultuous and chaotic compared to the socially isolated and awkward relationships seen in schizophrenia 4

Identity Disturbance

• Unstable self-concept and varying sense of identity are core features, though these may decline or change expression in later life 1, 5
• Lack of a stable sense of self stems from impairments in underlying attachment organization 3

Impulsivity and Self-Harm

• Recurrent suicidal attempts, non-lethal self-injury, and generalized impulsivity are defining characteristics that carry significant clinical risk 1, 2
• Self-destructive behaviors include excessive spending, impulsive sexual activity, reckless driving, and self-mutilation 1, 2
• Suicidal behavior is strongly associated with BPD, which is the most frequently diagnosed personality disorder in suicidal contexts 1

Additional Features

• Transient, stress-related paranoid ideation occurs during periods of heightened distress 2
• Severe dissociative symptoms, including experiences of unreality of one's self or surroundings, manifest during crisis periods 1, 2
• Periodic intense anger outbursts that are difficult to control 2

Diagnostic Requirements

At least five specific characteristics from the diagnostic criteria must be present to establish the diagnosis 1. The disorder requires onset in early adulthood with a pervasive pattern across multiple contexts 1.

High Comorbidity Burden

• Mood disorders co-occur in 83% of cases, anxiety disorders in 85%, and substance use disorders in 78% 2
• The disorder is frequently comorbid with major depression, bipolar disorder, and PTSD 1, 5

Etiology

The development involves a complex interaction of genetic predisposition, neurobiological vulnerability, and adverse childhood experiences including sexual abuse, physical abuse, or neglect 1, 5, 6. Family psychopathology, including history of suicidal behavior, bipolar illness, or substance abuse, contributes to risk 1.

Assessment Considerations

Structured interviews are superior to self-report questionnaires due to the characteristic lack of insight in individuals with BPD 1, 7. Evaluation requires gathering information from multiple sources using developmentally sensitive techniques, as informant discrepancies provide additional diagnostic information rather than invalidating the diagnosis 1, 8.