Bachelors Degree in Organizational Behavioral Psychology with a background in Autism, Mental Health, Business Psychology. Sales Management.
Diagnosing Borderline Personality Disorder
DSM-5 Criteria: American Psychiatric Association
To understand possible attributes of causes that lead to the development of Borderline Personality Disorder (BPD) and a diagnosis; we must review the criteria according to the American Psychiatric Association (as written in) Diagnostic and Statistical Manual 5th Edition.
“Moderate or greater impairment in personality functioning” - ( two or more of the following )
- Identity: poorly developed or unstable self-image. May often be characterized or associated with excessive self-criticism; chronic feelings of emptiness; and/or dissociative states.
- Self-direction:Instability in goals, aspirations, values, or career plans.
- Empathy: Compromised ability to recognize the feelings and needs of others that is associated with interpersonal hypersensitivity. (ex: prone to feel insulted); perceptions of others are selectively biased toward negative attributes or vulnerabilities.
- Intimacy: Intense, unstable, and conflicted relationships. Are often mistrust, neediness, and anxious preoccupations with (real or imagined) abandonment; These relationships are viewed in extremes: idealization and devaluation that are alternating between over-involvement and withdrawal.
Four or more of the following seven pathological personality traits must be present:
- Emotional lability: Unstable emotional experiences and frequent mood changes; their emotions are easily aroused and manifest as intense, and/or out of proportion to events and circumstances.
- Anxiousness: Intense feelings of nervousness, tenseness, or panic. They often are in reaction to interpersonal stresses; such as, worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
- Separation insecurity: Fears of rejection by— and/or separation from—significant others, associated with fears of excessive dependency and complete loss of independent self.
- Depressivity: Frequent feelings of being down, miserable, and/or hopeless. Marked difficulty recovering from these moods; have negative thoughts and feelings about the future; shame; feelings of low yo no self-worth; suicidal ideation and suicidal behavior.
- Impulsivity: Acting on the impulse of the moment that’s a response to immediate stimuli. They act on a momentary basis without a plan or consideration of outcomes or consequences. They have difficulty establishing or following plans; have a sense of urgency and self-harming behavior under emotional duress.
- Risk-taking: Engagement in dangerous, risky, and potentially self-damaging behavior Thats unnecessarily and (without regard) to consequences; lack of concern for one’s limitations and denial of the reality of the personal danger.
- Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
The impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations.
The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time with onsets that can be traced back at least to adolescence or early adulthood.
The impairments in personality functioning and the individual’s personality trait expression are not better explained by another mental disorder.
The impairments in personality functioning and the individual’s personality trait expression are not attributable to a substance (e.g., a drug of abuse, medication, exposure to a toxin) or a general medical condition (e.g., severe head trauma).
The impairments in personality functioning and the individual’s personality trait expression are not better understood as normal for the individual’s developmental stage or the socio-cultural environment.
Childhood Emotional Invalidation
Parental Emotional Invalidation In Childhood
Experts believe that one causation factor for development of Borderline Personality Disorder (BPD) in later adulthood; is emotional invalidation in childhood.
An emotionally invalidating environment is one that the child is consistently invalidated (or even punishment) in response to their emotional displays or responses. In fact, the professional that developed DBT Therapy (dialectal behavioral therapy), Marsha Linehan, PHD, clinical psychologist, developed that idea or theory.
In her research, she theorized that children that were genetically predisposed to have strong emotions and emotional responses (biologically), were at higher risk of developing BPD due to such strong emotional responses. Strong emotional reactions are typically invalidated. She explains that the invalidation is not necessarily abuse or neglect; as might be expected.
A child’s responses are measured against that child’s specific environment. Typically, parents are expected to respond to excessive emotional responses of a child as an “over-reaction.” As this reaction isn’t accepted socially; that reaction is discouraged.
What is not typically understood with a majority of parents; is if a child is predisposed to those emotional “overreactions” then the discouragement has the opposite effect than intended. It actually makes the child’s reactions more intensified in the emotional responses.
When the child has a pattern of feeling invalidated; they are more likely missing opportunities on how to manage those intense emotions effectively; if at all.
A main and common component of BPD: is marked “emotional dysregulation.” The inability to regulate even the basic of emotions.
Emotional invalidation is not to be “blamed” for “causing” a diagnosis of BPD. Only that it is a “risk factor” or a “contributing factor“ to later diagnosis. Studies have shown; however, that childhood mistreatment has a strong connection to developing BPD. Childhood mistreatment can include; but is not limited too, emotional abuse, physical abuse, emotional neglect.
It is difficult to have a more definite and conclusive answer to the question if that invalidation is a causation. This is due to the fact that research is based on questioning a patient with BPD and reflecting on their childhood. Answering the professionals questions. Correlation has been identified but not the cause.
Exploring Emotional Dysregulation: Biology and Environment
A study by Hughes, AE; et al, emphasized the role that a lack of social proximity or responsiveness played in BPD. In relation to any caregiver that was a consistent entity in the child’s daily life and parenting. Further, how it did or did not impair emotional regulation of the child’s emotions in relation to a norm.
Affect regulation difficulties were also theorized to be correlated in the relationship between childhood trauma and BPD Diagnosis later in life. In fact, when comparing many studies that have been done, there is anywhere between a 30-90% correlation of childhood trauma involved. Emotional dysregulation shows a common theme of correlation to later diagnosis.
What IS emotional dysregulation?
The inability to regulate emotions manifests as an emotional reactivity where an individual experiences heightened (above normal range of the average person) emotions that are longer in frequency, longer in duration, and lack the skills and ability to regulate it.
By not having the ability to control (or regulate) average emotions; they find unhealthy ways that are effective in dealing with these emotions. Which can lead to suicidal ideation, self-harm behaviors, non-suicidal but self injury behaviors, even substance abuse. It’s similar to the idea of self-medicating.
These coping strategies and behaviors are what may alleviate or bring control to the emotions. At least lowering any distress they were feeling.
There are symptoms of emotional dysregulation that often might lead to wrong diagnoses (we will explore later.)
- Severe depression
- High levels of shame and anger
- Excessive substance use
- High-risk sexual behaviors
- Extreme perfectionism
- Highly conflictual interpersonal relationships
- Disordered eating
- Suicidal thoughts or attempts
Is Invalidation Child Abuse?
Invalidation is not the same as child abuse. Just as an invalidating environment is not the same as an abusive one; however, an abusive environment is definitely an invalidating one.
Invalidation may be subtle; a general way of interacting in an interpersonal dynamic.
The most common explanation is that any display of emotions are not tolerated. Typically due to the extreme reactions that come with it.
In early childhood, there are particular time frames in development where children learn from their parents (primary caregivers) on the proper ways to cope with emotions. Where they do so without the guidance or support from their parents. They start to understand how to process those internally.
The theory proposes that in those years; they fail to learn these coping strategies that are expected. By failing to learn this; they don’t learn how to endure certain emotions, process them, and react in an expected or “normal” way.
They start to distrust their own emotional responses or reactions; that they aren’t appropriate or “right.” This becomes confusing to the child as they grow and get to adolescence, puberty, than adulthood.
What Ways May Invalidation Manifest?
There are a multitude of ways a form of invalidation in childhood may manifest in that environment.
- Praise: This is not the same as validation. When you praise a person; you are giving them a compliment. When you validate another individual; you are acknowledging them. Validating a child’s emotions is acknowledging the emotion, why they have that emotion, and that it is okay to feel that way. Even if you do not agree with it or understand it. When a parent (for example) praises a child for a behavior without acknowledging the feelings behind it or in spite of it? That’s invalidation. This leads to a child (and later adult) to feel dismissed. That their feelings or emotions aren’t important.
- An example of this: where praise is used and invalidation actually occurs - A child is visibly upset that they have to go into their first day of school. There may be tears or visible signs of extreme emotions. Her father walks her to the gate and waves her into school. No comfort or acknowledgment of the emotions; waving and smiles. When she goes into the classroom; she’s later praised, “Great job!”
Praise WITH Validation would be,” You were SO brave today going in to class by yourself! I know you were scared. I’m proud of you!”
- Another problem that is not often understood is its not praise WITH validation (instead anything BUT validation.) If you say, “Great Job! Don’t you feel silly now for being scared?” This makes the child doubt their emotions and they begin to feel that what they feel is wrong.
- Hidden Invalidation: When children grow up with praise disguising any validation (or lack there of) they may have issues distinguishing when it’s legitimate praise and validation from when it’s the opposite. Worse for the child? The adults in other aspects of their lives are seeing and hearing the praise. The words that seem to be encouraging and positive. So the child has no one to differentiate for them between the two; nor realize the actual damage being done to the child.
- Perception: Ever heard “perception is the reality?” Well, we all experience interactions and Interpersonal relationships differently. They affect us in good or bad ways; differently. In a two child household; one child may be experiencing a healthy environment and the other may be impacted by the invalidation negatively instead. Causing one child to grow up and not have the emotional dysregulation issues that their sibling might end up dealing with.
- It is important to remember; when we are talking about a significant impact on a child that would cause them to develop BPD; that we aren’t talking about isolated or occasional incidences. This is an ongoing and pervasive pattern in the entire childhood that has shaped the dysfunctional emotional regulation causing BPD development or symptoms.
Additional Relationship Struggles with a Borderline
Above we discussed two very big components in the instability of relationships when with an i individual with BPD. Rage and Unstable Emotions are common struggles and key elements of unstable relationships with Borderlines. We touched briefly on extreme fear of abandonment that many professionals believe stems from childhood and other trauma in life span. Before we dive into more detail on how parenting in childhood may affect an individual, putting them at high risk for BPD, there are a few more facets in the unstable relationship to mention.
- Fear Of Rejection
- Assumption of malicious Intent
- Intense and short lived romance
- Unstable self image
- More likely to befriend or date abusive partners
- Idealization - Discard Cycle
Emotional Instability in Interpersonal Relationships
In a notable capacity; individuals with BPD struggle to identify any given emotion. The emotions of themselves and also, in others around them.
In studies done on wether those with BPD are more inclined to be overly sensitive to others emotions; or the opposite, and can not interpret or identify at all, is a mixed finding.
This has lead to two different Borderlines.
Those with too much empathy. Or those that seem to lack empathy.
Being able to identify emotions in others or ourselves is a marked trait of emotional regulation. When an individual lacks that ability; naturally it can (and most often does) lead to unstable interpersonal emotional relationships.
There is no specific reason found that individuals with BPD lack this ability. There are several theories that have been commonly researched and studied that seem to have a causal link.
In early childhood; typically, the skill learned early on in development is identifying people’s emotions. One role that is very important as a parent/caregiver.
Deficit’s in development of this skill can be attributed to a neglectful parent. One that didn’t respond to an infant or toddlers basic emotions and needs.
Invalidating environment, where they couldn’t learn to differentiate emotions because they were not allowed to be displayed; so they never saw those emotions displayed.
In relationships; the BPD individual may have ”too much” empathy. However, they are being perceived as having none. This is primarily due to the issue of their own emotions being overly intense that it almost drowns out the others emotions around them.
Think of it as you are drowning and trying to gasp for air and battle to get yourself to the surface. Lungs about to burst and you know they are also in crisis around you. However, you can’t help them to the surface because all you keep seeing and feeling and doing is trying not to drown and take gallons of water into your lungs to die.
That is pretty much what the Borderline feels when dealing with intense emotions.
Other real issues with maintaining relationships is the random, impulsive aggression and/or rage that is a 180 out of nowhere. There are many reasons that it could be triggered. One common reason; fear of abandonment. This may also stem out of childhood. This fear can be real or imagined; but, it’s an intense fear. Compare to a phobia in, all honesty, to those that struggle with BPD.
There are many ways that can manifest Inwardly (self-harm) or outwardly towards others (rage, verbal abuse, even domestic violence.) The Borderline doesn’t have the calculated intent to harm another as abuse goes; but rather they have an internal fight (tug of war) with logic and emotions.
“I knew rationally I was screaming and crying. I rationally knew that it was an over reaction to absolutely nothing. That it was my imagined fear that took over. I knew I needed to stop hitting him. But I couldn’t stop. (Anonymous Interviewee.)”
In those with BPD; the rational side loses. The emotions are so intense that they can not hold them back. An average individual on a scale of 1-10 would feel the emotion at an 8. They would have a struggle with logic and emotion and logic primarily wins. Someone with BPD feels that same emotion at 100. Its an uncontrollable tidelwave. This can be indicative of Intermittent Rage Disorder.
When you are the one in the relationship with the Borderline; it’s often that because of these episodes of rage, anger, and abusive traits that it’s difficult for them to form a trusting and close emotionally, bond between them. Trust is difficult to form when you never know when that rage will come down on you. There may not often be a rhyme or reason to the episodes. No identifiable triggers to avoid.
Its a belief in some who are professionals in the field; as well as those who suffer from BPD, that it’s important to realize that they are not that abusive monster. That it’s not the typical abuser scenario and that with proper therapy, it can be overcome. The motivation and intent behind it isn’t that of control, not to humiliate or harm, it’s the inability to control emotion regulation and when taught strategies; can turn around a relationship that can be a healthy one.
This is not in any capacity to say that anyone should tolerate abusive behaviors in a relationship. In ideal situations and circumstances; however, it is manageable if the Borderline truly wants to become non-abusive.
Attachment In Childhood Development
In the first two years, a child exhibits attention and attachment-seeking behaviors from their parents/caregivers. Studies have proved that, if as an infant, the child received nurturing, in tune and available parent, that they develop a healthy sense of safety. That sense of safety, they than develop trust.
When a parent responds accordingly to an infants cries and needs consistently, the child begins to be able to comfort themselves because they know the parent will provide their need.
If a parent neglects to provide a consistent pattern than over that same time, the child internalizes that they don’t always have someone to provide that need. This can lead to a lack of developing Object Constancy.
Object Constancy consists of the development of an emotional bond to that parent or caregiver they can not immediately see. This idea stems from the developmental concept of Object Permanence (skill typically squirted between 2-3 years old.) Piaget initially founded the idea of Object Constancy as a developmental milestone. The Object Constancy psychodynamic concept is viewed to be an emotional equivalence to Object Permanence.
When a child is neglected in early childhood to a degree that the child fails to develop a healthy concept of Object Constancy; then in adulthood a continued issue remains. When most people aren’t in the physical presence of their partner; that they still have a close bond. Even when that person isn’t present, didn’t answer their phone call, unread text message etc. None of these actions would be perceived as rejection or abandonment.
When you struggle with Borderline Personality; you never developed that Object Constancy, even though you developed Object Permanence. The higher severity in this dimension; didn’t just lack that ability to attachment-secure a caregiver, but most likely experienced many traumas in those years before being verbally communicative (Scientific Advisory Board, 2018.).
Most specifically “attachment trauma.” These individual’s most likely experienced inconsistent and/or emotionally unavailable parents. Had formative childhood and adolescent years in highly chaotic environments that stunted the growth emotionally in critical years.
In reality; when you really dissect the attributes that make up this personality disorder, Object Constancy is at the middle or center of Borderline traits.
Individuals that are triggered, many wouldn’t understand what the huge problem may be and the excessive reactions or behaviors exhibited. In reality, any distance (no matter how small) can trigger emotions of abandonment, loneliness, being dismissed, and sometimes even the feelings of the disdain of the caregiver.
It’s not a conscious reaction, and survival “mode” is triggered without realization in the moment of protecting oneself from current emotions that will hurt them.
In reality, these fight/flight responses are not healthy. In fact, they are even self-sabotaging.
”I am so positive they won’t stay; because everyone leaves, that I self-sabotage. I am so positive I fulfill my self-fulfilling prophecy (Abigail K.)”
These self-sabotage scenarios are very common and it creates a scenario that they sabotage the relationship in order to avoid future (and convinced imminent) rejection and abandonment.
They also lack the ability to decipher continuity in their partner; shifting constantly between good and bad. This lack of ability is primarily due to the non-developed Object Constancy concept. It leads to intense (even child like behaviors and reactions) when a person isn’t physically present. This to most of my readers, (most likely) will have trouble trying to even process that idea.
Worse is when that intense phobia-like fear of abandonment manifests, nearly always (close after) the Borderline will experience deep emotions of guilt and shame. They will turn any blame on themselves. In reality; these emotions are valid and manifested from real events and aspects of development not met in youth but to the borderline (because it’s not conscious) they will feel they didn’t have a reasonable reaction, or they responded immaturely.
To those who are trying to understand and have a relationship in many capacities with a borderline; a great way to think of it is if a toddler is left alone or has very inconsistent parents or caregivers, the rage and tantrums and fears would make sense right?
Well that’s what the borderline STILL experiences; just in an adult world in a society that dictates the “norm” so appears to be a ridiculous response. When in reality, they are at that same stage developmentally because it never grew.
Real-life Experience and Situation Detailed by a Borderline: Share Your Story
“Kori Anne” was in her late thirties and had been diagnosed with BPD at the age of 25.
She was raised by a mother who was emotionally detached and neglectful; consistently ignoring her newborns needs and ignored her when she was suffering from chronic colic.
Her “only savior“ that was the most consistent, was her father. Her father did everything he could to pick up the extra parental responsibility of caring for her (especially after their You her daughter was born.). Mom would dote on the baby and still ignore and dismiss Kori Anne.
Dad even admitted years into her adulthood he probably over compensated.
There was a significant issue that prevented him from being consistent throughout her childhood and critical development stages. The issue was that her father was an officer in the military. His career required that he left at no notice, he never knew when he’d return or how long he’d stay. So nine months could go by with Kori Anne non existent to her mother and wanting the father. On top of this; she was in a chaotic environment (in general) because he was transferring duty stations (on average) every couple of years. “Kori Anne“ even lacked the stability and consistency of a childhood home, with stability in one school, never had consistent friendships.
Not only did moving around so frequently create chaos; twice they had relocated to another country. By the age of 6 years old; “Kori Anne” had lived in Japan and England. She identified in early childhood as an English kid. Even spoke Scottish and English fluently.
Fear of abandonment began at birth. For her family, it was not an intentional environment they were putting their children in that would dramatically affect their later identity issues and development of mental illness.
The one and only caregiver who never let her down. But, he was literally never there.
When her parents divorced, she had spent her first 6 years of life also witnessing a very verbally abuse environment. Her attachment to her mom was damaging and the one to her father was extreme. The trauma of moving back to the States, to live with her mother deeply affected her emotionally.
“Kori Anne” was young and had no understanding of custody issues and child support etc. All that she remembers that was obsessively overwhelming her around age 8 to 11. By age 12; circumstances arose and she demanded to move in with her father.
I was born healthy. I was not born with a predisposition that my brain was a ticking time bomb; and would go haywire in early adulthood creating drastic chemical imbalances. I was MADE to be this way. You can’t “fix“ me. You can’t go to the shrink an get medication that will make me normal. My medication? It takes my symptoms from an intense and unable to manage; to a lower Intensity. My father recently (no longer speaking last five years)stated I needed to utilize modern medicine and fix it. I said I can’t be fixed. I can not take a magic pill. That he needed to accept me for what I am because he’s one of the people who broke me. I can’t fix what you broke. - *Kori Anne
Narcissist Vs Borderline
A parent that is a narcissist has lasting impacts on their children. They affect their partner in their relationship. When a narcissist parent is covert; a child’s outcry may be to no avail. How can this affect children so severely? Did you know the serious impact it could have? Do you know the signs of a narcissistic parent?
These questions are on first glance “duh” questions. Well how could I not notice?
Than you learn the “truth” and you could be surprised to know you would never have guessed. You’d never have realized. Let me explain than give you another real life “share your story.”
Let me first state that narcissist parents may not be openly abusive. I’d argue that the more covert the narcissist, the less likely they’d come to anyone’s radar of being anything but a great parent.
Let me say though, one article said it the best as these parents are “emotionally tone deaf.” Part of that is these parents are so much more concerned about their own feelings (or what I’d rather say is their own concerns) they don’t become in tune with the child’s emotions. Especially pain.
Children that have narc parents can’t just go find a family that will be in tune with their over sensitivity. So Instead, they sacrifice their self-esteem. Without realizing what they are doing or even why.
”Kori Anne” states it best in our interview. That she felt that she was the problem. If she didn’t get so hurt easily...if she didn’t struggle so much in school...if she wasn’t so loud...
She felt she’s be more easily loved and accepted if she was not so many things. It wasn’t the criticism. It was that it was constant. About everything.
Narcissism: Does it Breed Narcissism
Narcissistic Parents: “Echoism”
Those children that are more empathetic than average, some think respond with what they labeled “echoism.” They bring this idea from the story of a nymph Echo. Echo was said to have been cursed by always repeating the last words she heard. It talks about how Narcissus fell in love with his own rejection; Echo fell in love with Narcissus.
This is to paint the picture that “echoists” struggle to find their own “voice.“. Narcissist parents leave little room for a sensitive child to have any room to express themselves openly.
Narc Parents: Typical Dynamics
We touched on attachment earlier. To further elaborate: a child with narcissistic parents end up questioning their safety if left in anyone else’s hands. They develop insecure attachment” or “anxious attachment.”
What are the different aspects of these u healthy attachment? The different types that develop can rely depend on the child’s natural temperament. However; ongoing neglect will typically create avoidance where unpredictable attention creates anxiety.
Imagine having a neglectful mother and a father that has unpredictably. The message being given to a child would be an anxiety riddled avoidance. As an adult in that situation I think it’s apparent what the issues might be in how we feel or respond. If a child is raised in that environment, it seems almost obvious the outcome.
Now to go further into this kind of environment; psychology today publication mentions something called ”need-panic.” This means narcissistic parents can create a panic surrounding the child’s actual needs. They develop into interpersonal relationships where they seem to need nothing from the other person.
That is until a situation arises, maybe a crisis, now they have this incessant need for reassurance. To eliminate that need they become exceptionally needy. This can either push others away or the person seeking the reassurance is let down and further hurt by not receiving what’s needed.
What’s interesting is looking at fiercely I dependent outgoing kids. A response to narc parents that’s not overt is abandoning I ti act completely in childhood. They learn early on no one can be trusted and you can only rely on yourself. This isn’t going to sustain throughout life. It may seem healthy or steady in the beginning.
What ends up happening to those kids that are also super sensitive in nature; they become compulsively selfless caretakers. To beat exain this idea is that they give to others what they never had.
Now I want to state these children are probably natural empaths; in some believes gifted empathy. They can develop this ”laser focus” towards one or both of their parents. When they end up adults in relationships that laser focus may switch to the person they are in a relationship with.
The problem this causes is their happiness is organized and reliant in others. They believe that their parents or partners self esteem is dependent on them. They believe that their own needs that are close to erupting are going to upset that person so they suppress it. They are told and later believe that the feelings they have gotten make them selfish. They will grow into adulthood hating the needs they deeply have because of a warped view of selfishness on their part. They see it as a burden so less likely to express it.
Example Of a Narcissistic Father
Narc Parents: If You Can’t Beat Them; Join Them
There are a group of narc parents that are a more select group and maybe not as common. They extreme narcissistic parent. Some children; although extreme empathy may be also extremely outgoing ame naturally aggressive. They are the kids that have the idea “if you can’t beat them; join them.”
When I say this I’m not saying the child tries to match the narc by becoming a narc. More like they won’t fight against the narc, they will just make damn sure to be what that narc wants. If the narc says they will fail, they will do what they can to succeed.. The problem is they end up in a dangerous situation of later becoming narcissistic themselves.
Now coupled with abuse obviously this may lead to Post Traumatic Stress in these children later in life. Kids from these kinds of parents end up just trying to survive. They lose the ability to imagine a future or dream and can only see what’s happening now.
Even when they realize a parent was a narcissist. When they understand their behaviors and why they react and feel how they do? Its not something they easily move past. It has lasting damage that some feel can’t be reversed.
- Borderline personality disorder and childhood trauma: exploring the affected biological systems and
According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experience
- DSM-5 Fact Sheets
Download fact sheets that cover changes in the new edition, updated disorders, and general information about the DSM–5.
- Emotional Invalidation During Childhood May Cause BPD
Chronic emotional invalidation, particularly in childhood shows a correlation with BPD
This content was accurate and true to the best of the author’s knowledge at the time of publication but may be out of date. The information contained in this article may not reflect current policies, laws, technology, or data.
© 2021 Abby Rourk