Borderline Personality Disorder

Borderline personality disorder (BPD) belongs to a larger group of mental health conditions called Cluster B personality disorders. All Cluster B conditions are distinguished by varying degrees of erratic behavior, difficulty maintaining emotional control and an inability to control impulsive or reckless behaviors. BPD is largely characterized by a poor ability to regulate emotions and related problems maintaining stable relationships. The symptoms of BPD cover a wide range, so problems can differ considerably from person to person.

Stats and Facts

  • BPD affects as many as 5.9% of adults (about 14 million Americans) at some point in their lives. It affects 20% of people admitted to psychiatric hospitals and 10% of people in outpatient mental health treatment.1
  • An estimated 85% of people with BPD have a co-occurring mental illness. The highest incidence rates are dysthymia (a chronic type of depression) and major depressive disorder, which combined affect 60% of people with BPD; and substance use disorder, which affects 35% of people with BPD.2
  • Somatic symptom disorder usually begins by age 30.3

Signs and Symptoms of BPD

  • Mood swings
  • Rage and angry outbursts
  • Irritability
  • Impulsive thoughts and behaviors
  • Extreme sensitivity to rejection
  • Severe depression
  • Feelings of emptiness or worthlessness
  • Thoughts of suicide and self-harm
  • Troubled interpersonal relationships
  • A tendency to alternate between idealizing and vilifying others

Diagnostic Criteria

According to the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, a person must exhibit five or more of the following nine criteria to be diagnosed with borderline personality disorder.2

  1. Fear of abandonment
  2. Unstable or changing relationships
  3. Unstable self-image; struggles with identity or sense of self
  4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
  5. Suicidal behavior or self-injury
  6. Varied or random mood swings
  7. Constant feelings of worthlessness or sadness
  8. Problems with anger, including frequent loss of temper or physical fights
  9. Stress-related paranoia or loss of contact with reality

Somatoform Disorders

Somatoform disorders are a group of mental health conditions centering on the development of medical symptoms that seem excessive for an individual’s actual physical condition. In 2013, the APA discontinued use of the terms somatization disorder, hypochondriasis, pain disorder and undifferentiated somatoform disorder and reclassified all of these conditions under somatic symptom disorder (SSD). However, the term somatoform disorder can still be found in some published studies. In the previous diagnostic manual, medically unexplained symptoms were a key feature of many disorders within this classification. Now, a person can be diagnosed with SSD even if symptoms are associated with a medical condition.4

Somatoform Disorder Symptoms

A person focuses significantly on physical symptoms including pain, weakness or shortness of breath, resulting in major distress and/or problems functioning. People with this disorder who do not have medical conditions often refuse to believe symptoms are the result of mental or emotional problems and insist there is a physical condition to blame. Others with actual medical problems such as heart disease or cancer have disproportionate and excessive thoughts, feelings and behaviors related to their illness.3

Diagnostic Criteria

According to the APA Diagnostic and Statistical Manual of Mental Disorders, at least one symptom must be persistent, typically for more than six months. However, symptoms may vary and come and go.3

  • Disproportionate and ongoing thoughts about the seriousness of symptoms
  • Ongoing high level of anxiety about health or symptoms
  • Excessive time and energy spent on the symptoms or health concerns

BPD and Somatoform Disorders: A Comparison

Findings from a team of Dutch and American researchers indicate that people with BPD have symptoms that partially overlap with somatoform disorders, although there are key differences. The study, published in the March 2015 issue of Borderline Personality Disorder and Emotional Dysregulation, compared emotional and relationship stability problems in people with BPD versus people with somatoform disorders.5

Of 472 adult participants, an estimated 25% were diagnosed with BPD and about 33% were diagnosed with a somatoform disorder. An additional 25% had a combined diagnosis of BPD and a somatoform disorder, while the remaining individuals had mental health problems unrelated to BPD or somatoform disorders. The goal of the study was to assess whether emotional control and relationship stability problems linked to both or either disorder were associated with any degree of poor bonding attachment during childhood and the formation of anxiety-based or avoidance-based relationships in adulthood.5

After analyzing the participant subgroups, researchers concluded that attachment difficulties play a role, although the nature of that role varies between BPD and somatoform disorders. People with BPD express their attachment distress through “hyperactive” loss of emotional control that excessively activates the bonding urge. Those with somatoform disorders express their distress through an “underactive” loss of emotional control that essentially deactivates the bonding urge. People affected by both disorders shift in a disorganized manner from hyperactive bonding urges to underactive bonding urges.5

  1. An Overview of BPD. NEA.BPD website. Accessed October 25, 2016.
  2. Diagnosis. NEA.BPD website. Accessed October 25, 2016.
  3. What Is Somatic Symptom Disorder? American Psychiatric Association website. Updated January 2016. Accessed October 25, 2016.
  4. Somatic Symptom Disorder – DSM-5. website. Accessed October 25, 2016.
  5. Van Dijke A, Ford JD. Adult attachment and emotion dysregulation in borderline personality and somatoform disorders. Borderline Personal Disord Emot Dysregul. 2015;2:6. doi:10.1186/s40479-015-0026-9.

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