Borderline Personality Disorder diagnostic criteria:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:  

  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

  2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 

  3. identity disturbance: markedly and persistently unstable self-image or sense of self. 

  4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 

  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 

  6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 

  7. chronic feelings of emptiness 

  8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 

  9. transient, stress-related paranoid ideation or severe dissociative symptoms

The DSM IV goes on to say:

The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.

Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.

Individuals with Borderline Personality Disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver who nurturing qualities had been idealized or whose rejection or abandonment is expected.

There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging (Criterion 4). They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (Criterion 5). Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection or by expectations that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating the individual’s sense of being evil.

Individuals with Borderline Personality Disorder may display affective instability that is due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) (Criterion 6). The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual’s extreme reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

Associated Features and Disorders

Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnotic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individuals with this disorder, especially in those with co-occurring Mood Disorders or Substance-Related Disorders. Physical handicaps may result from self-inflicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and broken marriages are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder. Common co-occurring Axis I disorders include Mood Disorders, Substance-Related Disorders, Eating Disorders (notably Bulimia), Posttraumatic Stress Disorder, and Attention-Deficit/Hyperactivity Disorder. Borderline Personality Disorder also frequently co-occurs with the other Personality Disorders.

Back to the Archives


Email from Vincent Vandale Smith:  

I know this is probably too little too late.  And I don't really expect at this point for anything to change.  After I hung up with you though, everything really began eating away at me.  I guess not so much because I came to the realization that you are right, though you are, but moreso because I realized that I may very well have just lost a very good friend.  And I didn't lose a friend because of a disagreement or distance or what not, but because I was once again @&%$*!# up everything.  Which automatically kicked in, "well if that is over, no sense in going through all this pondering and thinking and what not"...  But you don't deserve that.  Hell you didn't deserve any of this... and I can't sleep as a result, so I'm going to try and write all this out.  I don't really know what the end result will be.  Certainly don't expect it to change things, and I doubt it will bring any peace of mind.  But you deserve it, so if nothing else, it will be a parting gift of sorts, a thank you for being there for the past five years.  I wish I could have done this earlier tonight on the phone as well, but I think writing it out may help me figure out what went wrong.

Don't really know where to begin with it all.  So much I feel I should try and cover, but no real sense of where any of it fits or falls into.  Feel like looking back of everything, I've dissected my entire life into a puzzle then just scattered up the pieces.  Nothing feels like it lines up...  But going to try.

Guess first I should start with apologizing.  No, I did not have surgery.  Did go to the hospital down in Miami for the headaches, but they preferred I just take lots of painkillers and check back if I kept blacking out rather than go through with surgery. So I guess that brings about the question of why I said I did anyway.  Maybe you were right earlier when you said maybe it was just for attention.  But I don't know... I think it was more an accumulation of issues...  I guess... one of my biggest fears in this world, if not my biggest fear, is being alone.  I have had so many people in my life leave it for one reason or another that were beyond my control.  And at that time... let's see... you were already gone.  Around then was also when I realized me and Crit really were never going to be able to be friends or get back together again.  Spent the whole semester trying and trying to redeem myself, but just realized maybe it was not meant to be.  Nicole was out of the country.  I know there's more... but just... it felt like everyone was drifting away.  Hell maybe that was part of what was causing the headaches to be so bad.  Dunno... but I guess when people seemed to actually be concerned about me when I mentioned that they said I might need surgery... I guess it was the first time in a long time I felt like people actually cared about my wellbeing.  I mean friends always say they care and will be there and such... but I guess at least in my experience, it always seems to be more the proper thing to say and never something that seemed genuine.  And it really meant something to me I guess... Does that justify what I did?  No, not really... but I guess it is as close to understanding it as I can get.  The more I think about it, I think I originally came to the decision because I felt like I was losing Crit.  I guess in a way it seemed like a last ditch effort to see if she really did care.  Only problem was, that meant having to now perpetuate the myth... I didn't know who still talked to who or whatnot, and for some to know and not others would ruin everything.  Wow that's really pathetic of me huh?  Especially considering it didn't work as I didn't hear from her the entire break and things never worked out anyway.  All I ended up doing was hurting you and everyone else in the process.  I guess another part of it could be that I don't feel like my life is never something that anyone takes an interest in.  I'm sooo used to having to only share parts of me because no one can ever accept all of me.  And as a result, talking about my life never seemed the same... and thus felt like no one seemed to really care about it.  The only time people ever seemed to take an interest is if something was wrong with me.  Seemed like the only time where people took an interest in all of me for me, instead of just taking an interest in one side of me.  Maybe I'm wrong in that perception, but that is how I've perceived things to be for a long time actually.

You know, I think I've come to the realization that I have become in essence the epitome of everything I have ever hated in other people.  I've lied to people that care about me, I cut people out of my life for things I've done wrong or just don't feel like dealing with anymore, I've treated people like $#@!... and the entire time, it never really dawned on me that I was just spiraling further and further into my own dark hole.  And you're right... in the end, for "thinking" (in quotes because in hindsight, can't help but ask what the hell was I thinking) it would help, it has only made things worse for me.  I have single-handedly gone against EVERYTHING I have tried to set myself up to be.  Maybe I don't deserve people like you in my life... certainly don't seem to know how to handle it.  I've treated people I can't stand better than people that cared about me.  Wow... really makes me wonder what the hell I've become.  I guess that goes beyond crazy...  And yet for every time I've tried to commit suicide, I have always stopped myself because I've said that it would not be fair to those that did care about me, and it would be nothing but a cop out instead of facing my problems.  But what do I do?  I don't kill myself... then go right back down the hole again... each time just sinking further and further down.  And for as much as I always wanted to point the finger at someone else... in the end, I have no one to blame but myself.  Maybe it is better off that Rena and Crit left me.  Hell maybe it is better off that everyone seems to leave me.  I'm a miserable person to deal with.  I have my good side that I can let hang out on the surface, like my Hat Boy persona if you want to give it a name.  But I guess you don't have to scratch the surface too hard to see the ugly real me beneath.  Then again, who knows if that is even the real me.  Maybe that is just another persona and the real me is somewhere else.  I guess your guess is as good as mine.  Guess that's something or someone I'll have to work on finding.

Don't really know what else to say at this point.  Could apologize over and over again, but that I don't think really helps after a while.  And there really is nothing I think I can do or say that would allow for or even deserve forgiveness.  I've @&%$!# up, and if that has meant losing you as a friend, well then that is the price I have to pay for it.  I guess it is due time I took stock of what I have left of myself, the real me so to speak, and see what I can do with it while there is still anything left.  I am sorry again for what I've done, and I am really grateful that you have been a friend these past five years, even if it was only to a part of me.  You were the oldest friend I had in Miami, and I will look back on the good times with at least half a smile.  Who knows what the future will bring you, but if this is the end, then I wish you the best, because that's all I can do anymore.

V.V.S.
3:26 am

Back to the Archives