Question

How does one know if he/she has borderline personality disorder when diagnosed by a psychiatrist for the first time, especially in childhood/adolescence?

Answer 1

A diagnosis of Borderline Personality Disorder (BPD) is typically made by a mental health professional such as a psychiatrist or a psychologist, who will use a comprehensive diagnostic evaluation to make the determination. This evaluation generally includes an in-depth interview, observations of the patient's behavior, and may also include input from friends and family. They may also utilize specific clinical inventories or diagnostic tests.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th Edition), BPD is characterized by pervasive patterns of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Some symptoms include:

1. Fear of abandonment. People with BPD are often terrified of being abandoned or left alone.
2. Unstable relationships. People with BPD may idealize someone one moment and then suddenly believe the person doesn't care enough or is cruel.
3. Unclear or shifting self-image. When you have BPD, your sense of self can often be unstable. You might view yourself as evil or bad, or feel like you don't exist at all.
4. Impulsive, self-destructive behaviors. These might include things like substance abuse, unsafe sex, gambling, or binge eating.
5. Self-harm. This might include cutting or burning, and in severe cases, can lead to suicide attempts.
6. Mood swings. Emotional instability can manifest as mood swings that are intense but usually short-lived.
7. Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there's a hole or a void inside them.

It's important to note that diagnosing BPD, particularly in children and adolescents, can be challenging. The personality of children and adolescents is still developing, so the traits that might cause a healthcare provider to consider a diagnosis of BPD may also be part of normal developmental stages. Therefore, many professionals are cautious about diagnosing personality disorders, including BPD, in children and adolescents.

However, a careful and thorough evaluation can lead to appropriate diagnosis and treatment, which is crucial because untreated BPD can cause significant distress and impairment in social, occupational, or other important areas of functioning. If you or a loved one is experiencing these symptoms, it's important to reach out to a mental health professional. Treatments such as dialectical behavior therapy, cognitive-behavioral therapy, and medications can help manage symptoms.