I won’t try to sugarcoat it…Borderline Personality Disorder is an ugly thing. The anger, despair, and emotional pain of the sick person is unbearable, and the pain of watching a loved one suffer is equally devastating.

The fact that you are here means you have an idea of what’s going on, but it can be tough finding a professional that will acknowledge a diagnosis. Doing your own research is essential these days if you want to find out what’s really happening in a person who has this disorder.

The first place most people look when they hear “Borderline Personality” is the Diagnostic and Statistical Manual of Mental Disorders (the DSM). This is the “bible” of psychiatry, and contains a list of 9 symptoms, 5 of which are required for someone to qualify for an official diagnosis.

1. For reasons we will explore further in another post, the DSM is sadly short of really describing what BPD looks like on an everyday basis. For instance, fear of abandonment is a blanket term that most people can relate to, but for someone with Borderline it goes much farther than just hoping your loved ones don’t leave you. They can experience obsessive and intrusive thoughts about the person they care for, leading to desperate attempts to keep this person close whether through phone calls, texts, social media, or through actions like pulling away and closing off emotionally, responding with anger or irritation to loved ones, or emotionally engaging the person by pleading, explaining, and offering solutions.

2. Despite the response of the loved one, and even despite their own attempts to not attach themselves to others or behave inappropriately, their desperate measures to keep people close often end up pushing these people away, thus an ongoing struggle with holding close, stable relationships. This fear of abandonment also entails an immense sensitivity to rejection, a view that criticism or disagreement is a significant threat to a relationship, and feelings of shame and self-hatred for feelings and behaviour that feels uncontrollable.

3. Obviously this would have an effect on anyone’s personal relationships with friends, family, coworkers, and significant others. People with BPD often start seeing this at home with parents and guardians at a young age, usually around puberty. They will begin showing signs of anger and depression, unexplained moments of rage and conflict, followed by feelings of shame and embarrassment or heartfelt apologies. This is reflected in relationships with significant others, resulting in frequent break-ups after a quick and intense romance.

4. Blending into this symptom is what some people refer to as black-and-white thinking. Borderline causes a person to think in all-encompassing terms. A person is either a great friend or an enemy. A job is either fantastic or the worst job they’ve ever had. It difficult to see things as a mixture of good and bad. Difficult to remember that the bad week they’ve had was sprinkled with good moments. Difficult to remember that good things have happened when they feel so badly inside. Difficult to see a loved one as a good person with typical flaws, and difficult to balance rationality with emotionality.

5. These struggles with viewpoints and relationships contributes to an overall feeling of instability when one reflects on one’s own identity. Frequent mood and relationship changes make it difficult to identify a solid picture of a person’s personality, likes and dislikes, boundaries, goals, and values. Without a clear picture of who they are, people with BPD will look to others, matching their personalities, language, dress, and activities to match the people they feel represent who they want to be. As the inspiration changes, a person’s appearance and behaviour can change, similar to how adolescents will imitate their role models as they find their unique identities. But for a person with Borderline, this fluctuation can continue for a lifetime, especially because their emotional and behavioural reactions on a daily basis can be so out-of-line with the identity they want to have.

6. The symptom of impulsivity is pretty self-explanatory; spending, sex, drugs, and other behaviour that alleviate the negative emotions of BPD can cause problems just like any risky behaviour. Some people move out of town on a whim, some people have affairs…all in an attempt to lessen the emotional pain of the illness or escape the emptiness that is described as yet another symptom in the DSM.

7. Dissociation is a symptom that similarly serves as a protective defence from intense emotional and psychological pain. Especially in those who have been victims of abuse, shutting down emotionally and even physically is a response to an overload of sensation and/or information like loud noises, pain, anger, shame, and other overwhelming conditions. For a person with BPD, fighting or yelling, positive or negative sexual encounters, stress, trauma, large crowds, tense environments, and myriad other experiences can trigger a shutting down of the mind and body.

8. Probably the most notable of the symptoms are self-injury and suicidal behaviour. Pulling hair, cutting, scratching, burning, stabbing, and banging the head are all examples of self-injurious behaviour. Like dissociation and impulsivity, self-injury is a way to alleviate intense psychological pain. It can work like a drug, producing a response in the body that increases pleasure and feelings of relief. Signs will often be hidden under long sleeves, long pants, or baggy clothes and most of the time will be done in private. These behaviours are not attempts at suicide, but attempts to simply feel better. However, many people with Borderline also have repeated instances of suicide attempts and hospitalisations; ten percent of them will successfully commit suicide.

9. Last but not least, emotional instability and feelings of anger and rage are the symptoms that will likely present themselves most frequently. Moods tend to change rapidly, sometimes with occasion and sometimes with no seeming trigger. Depression, despair, anxiety, and anger can rush in unannounced and unprepared-for; the person experiencing this will understandably react. Extreme rage over seemingly minor issues can be expressed in yelling and physicality, as well as hurtful words. The person will experience extreme shame and guilt for these behaviours once the episode subsides; this is frequently when the self-injury and suicidal behaviour will present itself. The extreme anxiety and feelings of despair will make the person essentially immobile, unable to function in daily activities like school or work. They may avoid people and places and isolate themselves, or they may feel justified in their reactions, even if they know they are ill and responding inappropriately.

We will go more into the brain activity behind these symptoms later, but I hope this somewhat lengthy description of the symptoms of Borderline Personality Disorder has brought a little more understanding to how BPD looks in the life of the person suffering or the loved ones who are concerned for them. Borderline can contribute to a hectic household, but knowing what you are seeing, and being able to distinguish it from the person, is an essential first step in coping with and healing from this devastating illness. So I challenge you now! What symptoms are you seeing? Are there any you don’t recognise? Whatever symptoms you see, when they pop up next time, make sure you remember that this is NOT the person. This is a sign of a deeper problem, an illness that must be identified and treated. Recovery is possible, and healing is meant for YOU and YOUR family. The first step is recognising the illness.