Borderline Personality: Does a BPD Diagnosis Imply Raging?

Borderline Personality Disorder usually conjures up images of a raging woman or explosive man whose attacks cause great suffering for their spouse, boy/girlfriend, and/or children, marriage problems and a need for intensive counseling help.

While this image does fit for some people who suffer with this disorder, many individuals with a bpd diagnosis in fact are highly sensitive persons who experience more intense fear and depression than they do anger. Raging may NOT be the central feature of this disorder.

The video in this link explains the fear and depression that a young man suffering with a bpd diagnosis experiecd. Alas, help came too late for this likable young man who last year took his life. Thank you so much to his friend who forwarded the video link to me in a Comment in response to one of my earlier posts on bpd. The nine-minute video is well worth watching to the end.

My professional colleague H.O. suffers with a borderline personality disorder. H.O. therefore has both a professional and personal understanding of bpd diagnosis. She has corresponded with me recently to share her perspectives about bpd. I am pleased that H.O. has given me permission to share her writing with my readers.

This article is the third in the series I have been publishing of H.O.’s insights. The first explained the term borderline personality sufferer and the second addressed the stigma attached to the term bpd from its association with terms like drama queen for women and abusive for men.


Dear Dr. Heitler:

The question of the diagnostic label for people with what we usually call bpd is very complex. For a long time there have been controversies about dropping the term “borderline” as misleading and stigmatizing.

Concerns have been raised also about putting BPD in the PD (Personality Disorders) cluster. There seems to be significant biological overlap between BPD and bipolar disorder for example, which the psychiatry establishment considers to be biological as opposed to “bad”. And many of the most negative features that people often associate with bpd may actually stem from malignant narcissism (impulses to hurt people combined with hearing only one’s own desires).

When I diagnose a client with the term Borderline Personality Disorder I base it on two aspects of DSM 5 diagnosis

a) the general criteria for all of the Personality Disorders, that is, impairment and its continuity in time/across situations an

b) the specific criteria for BPD

What are the specific DSM 5 criteria for borderline personality disorder?

-Significant impairments in personality functioning

-Impairments in interpersonal functioning

-Pathological “personality” traits i.e. affective negativity and which consists of: lability of affect, anxiousness, separation anxiety, depressivity.



Stigmatizing and Blame

The term pathological personality traits is especially unfortunate. This term conveys stigmatizing and blame. Now not only is the client unhappy but it is his or her fault too. That’s a term that would benefit from deletion.

The DSM also unfortunately fails to clarify that affective negativity (lots of hurt, angry, depression and other negative feelings) is a function of vulnerability. Because people with bpd have high emotional sensitivity combined with low resilience (ability to bounce back from negative feelings), negative emotions tend to take up more of their time, energies and relationships.

What is a more helpful perspective for understanding ptsd?

Negative feelings are triggered more frequently for people with bpd at least in part because their amygdala, a part of the brain which controls emotional reactions, is set too sensitively. That is, their amygdala reads “Danger!” where others would see none. And their amygdala launches intense fight or flight reactions where others would calmly deal with the situation.

This mood hyper-reactivity/hyper-intensity may stem from ptsd from traumatic childhood experiences including childhood emotional and/or physical abuse, often by a borderline parent. Those traumatic incidents raise amygdala reactivity. Subsequently, a person who has been traumatized in childhood functions much like military personnel with PTSD from having experienced extremely emotionally painful negative events in war situations.


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