9 Traits of Borderline Personality Disorder

[Music] there are nine traits of borderline personality disorder here to go into depth about each one is clinical psychologist dr. Romani dr. Romani thank you for being here clinical psychologist and one of my favorite people to interview thank you because the topics that you bring are so fascinating there they are fascinating everyone wants to know about them but you're actually a fantastic interview some things I was fishing for compliments so today we're talking about borderline personality disorder what exactly is that borderline personality disorder is a disorder of instability and impulsivity if you want to look

at it that way by instability we mean instability in their relationships instability in their moods instability in their behavior and instability in their sense of self so the world always feels like it's sort of moving up and down for them finally there's also a tremendous fear of abandonment that always cuts through this disorder so people who have borderline personality in addition to all of that instability live in chronic fear of real or even perceived abandonment for example someone even showing up late to dinner that could be experienced as a frank abandonment and then their response

to that is very strong often very angry very upsetting not only for the person with borderline personality but for the other people involved but I feel like we're all a little bit like that here's the thing I I don't disagree with you and the issue with all personality disorders is that they refer to an extreme of personality in essence okay so do we all get thrown off if we feel like somebody's gonna leave us maybe to a degree especially if we love or care about that person but we also have enough of a sense of

self to say I don't want him to go but if they go ultimately I'll be fine I'll cry it out for a few days we don't feel like we're gonna die you don't feel like we have to violently or aggressively or verbally assault another person most of us have a very solid sense of identity we may shift a little saying I don't know what I want to be when I grow up by and large I know I'm Romani we know who we are but a person with borderline personality that's constantly shifting sand they don't have

a strong sense of self they do not they do not in fact in fact we would call it identity disturbance it's not unusual for example for a person with borderline personality to want to change their name sometimes or completely change their look and cut off all their hair or change a color or change how they even dress that identity disturbance can be presented in a lot of different ways and it can be sort of throw other people off in their world think I thought you had this name last week and why you have this name

so it can be confusing there are nine traits that would define who someone who has borderline personality but before we get into those how is B P D borderline personality disorder different than all of these other personality disorders so as of right now and this will change over time there are ten personality disorders in the diagnostic manual we call the DSM ya or the Diagnostic and Statistical Manual of Mental Disorders there's also a different classification scheme called the icd-10 or the International classification of diseases I'm only making that technical point because people may run into

that if they were to for example see a medical record now do you know if dissociative identity disorder multiple personality is what it used to be called is one of those ten dissociative identity disorder is in a separate section of the diagnostic manual under a whole series of other dissociative disorders and it is often misdiagnosed borderline personality it's a very rare D ID is a very rare disorder and many times people who are called D ID if you will they actually have borderline personality okay so back to my original question what does how does more

line personality disorder differ from all these other ones borderline personality disorder is unique in the personality disorders for how unstable the emotional state of the person is they will go from angry to sad - cheerful in the same hour you will not see that kind of emotional instability with any other personality disorder even bipolar disorder bipolar is not a personality sorter and frequently borderline personality disorder and bipolar disorder get misdiagnosed by laypeople people were professionals in the field know the clear difference the difference between borderline personality disorder which is a personality disorder and bipolar disorder

which is what we call a mood disorder just like depression bipolar disorder is characterized by something called mania mania is a period of time it could last four to seven days even longer where the person has this incredibly expansive excitable mood sometimes even irritable they can go for days without sleep they could talk talk talk and not stop they'll empty everything out of their garage and you're not clear on what's going on they'll drive to Vegas with their life savings they'll spend they'll have sex they'll become very disinhibited but that goes on for days they

will not one day have a crash they will stay in that sort of high for many days and it's quite debilitating it's not unusual for a person during a manic episode to end up requiring psychiatric hospitalization yeah the reason borderline personality gets confused with bipolar disorder is because the person's moods are fluctuating so much but if the moods are fluctuating in one day that's more indicative of borderline personality our founder of med-surg hmm actually is very open saying that he has bipolar two disorder and it's one of the reasons he's so passionate about this company

yeah to help people get on the website sign up for that free email digests to get the information that they need so that they can make healthier choices and be informed because like you said an expert could decide yeah if it's borderline personality if it's bipolar if it's all these other things but me and most of people watching we don't know and it's that that misconstrue is dangerous because the treatment for bipolar one or bipolar two is quite different than it is for borderline personality that's right and the fact of the matter is you can

have both of those disorders occurring at the same time bipolar with borderline personality and in fact in the realm of mental health that combination of disorders may represent one of the greatest treatment challenges we have in the field requires very very intensive treatment for a long time Wow all right what are this is gonna help me and I think a lot of the viewers truly understand it what are the nine tricks let's go yeah mm-hmm okay so the first trait we'll see is fear of abandonment that abandonment can be real or it can be perceived

and I perceived I mean that the person will feel I've just had an argument with this person they're going to leave me so they're always preparing for this abandonment and in trying to prepare for it all the time they almost make it happen you're gonna leave me you're cheating on me who were you with you're never coming back and they do this and they kind of grind the other person into the ground and I don't just mean in an intimate relationship this could be a friendship this could be a family member for example it could

even be a family member who says hey we're moving some of your stuff out of the garage because we're gonna sell the house that could easily turn a person with borderline personality disorder into a place where they're convinced that their family's trying to abandon them that's what I mean by it can be real or perceived abandonment and it often becomes a self-fulfilling prophecy mm-hmm okay what is the secondary unstable and really intense interpersonal relationships now obviously this can be an intimate relationship but it's any close relationship these relationships often start passionately and closely and they

want to be with someone 24 hours a day then very quickly there'll be very loud arguments that ramped up very quickly there'll be intense passion followed by intense anger followed by lots of Tears and the relationships always have a rollercoaster feel again this can be a family relationship it can be an intimate relationship it can even be a friendship or even workplace relationships almost all of their relationships are characterized by this level of intensity Wow the third symptom we see is what we call identity disturbance and by identity disturbance we mean a person that almost

literally doesn't know who they are they might even ask that question out loud I don't know who I am and in that way there is a chronic inside Who am I because if you don't know who you are it's almost like you don't know how to go through the world that identity disturbance can be manifested for example in a person chronically changing their appearance hair color hair style what they wear tattoos piercings you name it they'll change that they might even change their name there's a real lack of knowing who they are in the extreme

this identity disturbance can sometimes even look like a multiple personality situation where they actually pop into month mode where they actually pop into multiple identities one day they're one person I'll say today baby person is here I'll say the next day they'll say hey it's me I'm sexy such-and-such today so they'll actually even sometimes have this sense of that these are different personas that they inhabit but in general their identity is really disrupted and chaotic Wow all right so that's three I've already feel like three is three too many I'm exhausted listening to those more

a third of the way there yeah we're the way there the fourth is impulsivity impulsivity is this idea of acting out or behaving in a way without thinking about it so that could be manifested by oftentimes rather dangerous or problematic behaviors these things could be substance use binge eating binge spending gambling impulsive sexual behavior pretty when you tell me all these things that sounds like a manic episode it can't but see here's the thing with the manic episode that mania stays consistent right and borderline personality disorder could be ours and could be ours so they'll

act out at the moment so that's where for example it wouldn't be unusual to see a borderline personality disorder an individual finding themselves in major financial trouble because when they're feeling like they want to soothe their mood they'll go out and shop and shop and shop it's not unusual for example to see a substance use diagnosis coexisting with borderline personality because in some ways they use it as a tool to soothe so it's this acting out without thinking about it not thinking about the ramifications of the behavior and oftentimes it's a way to sort of

sue the mood at the time yeah but it can be quite dangerous yes while they're doing that they're not addressing the problem these are all band-aids they're all band-aids and but at the moment they're not thinking of it as a band-aid it's almost like the sense of I don't want to feel this way so I'm going to do something so in the short term it actually feels like a good strategy right now I feel different yes isn't this great without thinking like whoa I just spent five thousand dollars that I don't have that's right yes

okay all right what is the fifth trait with somebody who has borderline personality disorder the fifth trait is actually a rather dangerous one this is where we often see recurrent suicidal behavior or suicidal thoughts people with borderline personality disorder have relatively high rates of suicide attempts now these suicide attempts may be away at times for example to avoid that sense of abandonment I'll show you you think you're gonna leave me and they'll harm themselves so that will draw the person back trying to keep them safe it's the person saying if you leave me I'll kill

myself leave me I'll kill myself or they'll call a person while they are in the midst of taking pills or harming themselves and saying hey I just want you to know this is what I'm doing most other human beings would come to their side or now they haven't been abandoned this also can manifest in other behavioral patterns for example you might see cutting so a person may cut their arm now that is considered sort of a suicidal gesture because I could ultimately harm them or self harming gesture so that all falls in that place but

like I said this can be dangerous because even if the person was borderline personality disorder didn't if you will intend to die they were actually using it as a cry for help it can go too long for example they may actually take too many pills and it would be too late they may actually attempt to hang themselves and actually hang themselves or strangle themselves so this is where it becomes a very dangerous disorder from a management perspective and again it's often a response to this inner pain that they feel like they cannot manage it's almost

as though in that moment they want to be alive but at the same time they want to be dead because they can't manage that pain and that's a lot of that borderline back and forth I want to take a moment just right there to tell the viewers that if they themselves ever feel way to the bottom of this video there are links to the suicide prevention hotline and if you know somebody who may have up at this point these traits make sure you go to bed circle comm and utilize those free resources and get on

the digest for borderline personality disorder because this is always changing this is all the way we're always learning more and the the first step mm-hmm it's to know about it that's the first that's why you're watching this video because you want to know about it now the next step is to go in deeper and really keep that education up to date so when you say stuff like that where we're actually talking about a potential life-and-death scenario I want people to know that there are resources out there that's why we do this that's why we're here

doing this med circle comm that is your next step what is the sixth personality or the sixth trait of someone with be PD the sixth trait is something we call affective instability which is a fancy way of saying their moods are sort of all over the place that's where we can see those mood shifts in even a couple of hours going from angry to sad so it's it's this affective instability where moods can shift and fluctuate in a very short period of time so the person will feel it's for an individual borderline personality disorder it's

as though they always act in line with their emotion they don't stop to inhibit it and that's a big issue in borderline personality which is almost saying I'm having a feeling I can manage this feeling it's as though they feel it's like a tidal wave it takes them over if they feel angry they express that anger strongly if they feel sad they express that anger because the problem of that I think would I feel angry I go nope I'm not gonna show anybody or if I feel sad I go no no one's gonna know I'm

sad and this is the opposite of it so it's that that mood instability is actually a very classical part of the borderline personality presentation and it's what sort of plays into all of these other traits because if somebody is their moods are always up and down of course their relationships are going to be all over the low if their moods are always up and down you can see how they don't have a stable sense of self so it's a key hallmark of this disorder that their moods are all over the place and they have a

lot of difficulty regulating those moods and it's here where you can also see this becomes a very difficult disorder to manage and it's also why a lot of people confuse it with others it's also why other people confuse it with other disorders like bipolar disorder because of that misunderstanding that bipolar means moods are all over the map not in the same day and that's what you see in borderline personality Wow they overreact to everything that's happening in their environment it's as though they're hyper reactive whereas a person might react to anger with this much of

a blip up a person borderline personality will go all the way up to here and that hyper reactivity is the core of one of the big horse a borderline personality yes okay what number does that bring us to number seven so we have seven eight and nine to go okay number seven is that the person with borderline personality chronically feels empty so they'll often report I feel like there's nothing inside of me I feel like a drum I feel like a hollow shell now if anyone feels empty what do you think they want to do

they want to feel that emptiness up and for a person with borderline personality disorder that filling up either happens to other people or in appropriate ways of regulating it like shopping spending eating something to fill in that sense of emptiness but imagine that the psyche of a person with borderline personality sort of almost has a little hole in the bottom so whatever they put in is coming right out so they're always struggling with that sense of I need to feel whole I need to feel whole and they look to the outside world to fill them

whereas for the rest of us we do feel whole inside there may be days that are harder for us but we feel a whole sense of it if something it's all imagine like an endoskeleton like something that supports us from the inside if we don't have that we collapse so the person with borderline personality it's as though they sometimes don't fully have that psychological skeleton within within them so they often do feel as though they're collapsing and they feel empty it's a very panic inducing feeling for me yeah it sounds like it number eight is

another symptom that causes a lot of interpersonal difficulty because it's manaphy by inappropriate and intense shows of anger so when anything frustrates them and it can even be what seems like a very small slight kind of thing by other people they will blow up and not just verbally but quite frequently physically they'll throw things they'll become physically combative they'll become assaultive but they'll scream and yell and the show of anger happens so quickly and that's what throws people off it's very quick and it's very intense that it terrifies everyone around them adults children family members

and so as a result people will say because of this particular symptom they often walk on eggshells around the person with borderline personality because they're so afraid of angering them and MEP only be this big disproportionate volcano of anger so over time everyone is just like being very very careful around them but the fact of the matter is in fact it's it's beautifully said by some of the researchers in this field that people with borderline personality disorder have this really really thin skin so they feel everything and they over feel it as a result and

so they become hypersensitive to all of these stimuli in their environment and more often than not they react with anger I I've seen that reaction from the pets pets a certain person mm-hmm and immediately their body language changes yeah what's going on with this dog and I said oh well you know mark just freaks out over the littlest things so when the Rovers around he gets really nervous you know picking up on that yeah I don't know what he's gonna do was it so the slightest thing can happen so you could see now jump that

to a person and for a person that can happen in all situations then what we see on the back end of this is that a person with borderline personality has these strong shows of anger they feel really regretful about it they feel about a borderline personality disorder the person who's been diagnosed with that when they have these bursts of anger and they come off of that they feel remorseful not only remorseful then they're terrified because they're like everyone's going to remember the mean nap yeah you see how the cycle cycle it's a huge cycle so

there's a lot of embarrassment humiliation frustration with themselves and then what they do that anger they had out no they have it at themselves they get angry at themselves and what could happen then a greater likelihood of self harm so what borderline personality is it's lots of emotional loops that keep playing out to the detriment of the person with the disorder as well as the people around and on a small timeline I mean within a day or so within an hour um I don't know what's going to set the person off it could be a

glance that's the wrong way it could be missing the color of their dress or noticing the color of their dress you just don't know and this is why for family members or loved ones or co-workers of individuals with borderline personality disorder they often don't know if they're coming or going and they they're actually they're feel like they're living in an alternate universe and they often blame themselves how could I do this differently the answer is there's not much you can do talk about some things that they can do around these Co to survive through this

a little bit but what is the final trait of someone who has BPD this last trait is actually relatively severe when we do see it the technical term for it is transient stress induced paranoid ideation are they're psychotic some tomato Logie or even dissociative symptoms I have no idea what's that it's a fancy way of saying that under stress particularly significant stress from time to time a person with borderline personality disorder may experience frankly paranoid symptoms really believe other people are out to get them or harm them you know a sense of conspiracy they may

actually hear voices but the voices are very much negative and and harmful and they're scared of them so they literally look psychotic and in fact if they were seen at that moment in time a mental health practitioner might actually think they're psychotic it's just they're screwing the surface what do you mean they look psychotic they look like they've broken off from reality that they almost look like they're delusional they're saying I see people it might very well be that you know I hear my mother's voice it's talking to me she hates me why does she

hate me oh I'd say everyone's out to get me or I know it you know something terrible is about to happen or that kind of thing it's very and they're very firm in their belief in addition included in this trait or symptom is this idea that people with borderline personality disorder can sometimes experience what we call dissociative identity or symptoms of dissociation in those cases they may actually break off and start behaving like a child and you're convinced they're a child because of that when we see that dissociative pattern when I've seen it clinically I've

seen an adult woman in my office literally take on the posture of a four year old child this was years and years ago but I will always stay with me that wow she just became something else and it was then in that moment I learned about how borderline personality disorder can look a lot like dissociative identity disorder something that's popularly termed multiple personality disorder because under severe enough stress you will see them dissociate into what feels like another personality but it's all subsumed under the borderline personality disorder and it requires a lot of assessment two

different high recently I interviewed a woman named Ann Cena who has 11 personalities during that interview will link to a below this video she went into her one of her alters which was a three year old girl and I felt like I was talking to a three year old child I did not feel like I was talking to an adult pretending like she saw through your toys like oh she's a this is a three year old girl so I can very easily see how borderline personality disorder and diid or multiple personalities would yes be confused

and then you'll see that what you'll see in a person the D ID they may not have as much of the emotional instability the anger all of those other symptoms of fear of abandonment that may not be presenting there that's a lot of how we sort of sort those two out it takes time you're not gonna you're not going to decipher this or the first pass with someone that's why we need to see people a few times for assessment to really be definitive in a diagnosis we give them and diagnosis really is a tool to

drive treatment that's its function not to label someone do you have to have all nine no get the day rise out of nine five out of nine and classically what we see are the fears of abandonment the interpersonal issues the difficulties with regulating emotion and then the other stuff can pop in and out and in fact there are theoreticians out there Theodore Millan is was a really important personality theorist and he argues that there's actually subtypes of borderline personality that there are some borderline personality individuals who are more depressed there are some that are more

acting out there are some that are more petulant and throw tantrums and that each of those styles of borderline personality may require different kinds of treatment for the people who believe that they have someone in their life who has borderline personality disorder what is your advice to them in any way possible try to get that individual into therapy because there are therapeutic models that can help the person with borderline personality manage some of these strongly managed some of these strong reactions the challenge is that the form of therapy you need to do with them is

really almost lifelong and pretty regular like multiple times a week so it gets challenging from a cost basis to be honest with you how do you approach somebody who will go off on the littlest thing the best way to start is not to approach a person who's borderline personality on the you're all over the place and interacting crazy or something like that but rather maybe focus on one of the other what we call comorbid symptoms something that's causing a lot of distress for the person with borderline personality for example they may be depressed they may

be anxious they may be having problems with spending or eating make that the treatment target to get them in the door at least and then a skilled therapist should be able to see this pattern the treatment of choice that has been shown consistently by the evidence base to show the best success outcomes with borderline symptoms is a treatment called dialectical behavior therapy or DBT with DBT the person not only gets regular therapy they also kind of get lots of regular follow-up almost on a daily basis and they work in group therapy to almost learn how

to work with other individuals so it's very intensive but if a person can get their loved one into that form of therapy in a holistic manner you may actually get them to a place where there more safe that maybe you're running on a more even keel with in your family system but it is a lifelong commitment this isn't a one-off you've got to be committed to this model of therapy in the long term well this is all great information as a starting point for people who are interested about this topic we're gonna talk in our

next video about what causes this and your family and also some more treatment options doctor Romani always so insightful to have you here thank you thank you thanks for watching your next step is to head on over to med circle comm and sign up for the med circle digest what is it well med circle will send you the latest articles and the latest videos on the mental health topics that matter most to you so go to med circle comm sign up for that digest and let's keep this journey on better mental health moving forward [Music]