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 ex- perience intense abandonment fears and inappropriate anger even when faced with a real- istic 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 or fury when some- one 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 re- lated 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 sui- cidal 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, or 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 alternatively be seen as beneficent supports or as cruelly punitive.
Such shifts often reﬂect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.
stable 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 that of 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 a meaningful relationship, nurturing, and support. These in- dividuals may show worse performance in unstructured work or school situations.
Individuals with borderline personality disorder display impulsivity in at least two areas that are potentially self—damaging (Criterion 4). They may gamble, spend money irrespon- sibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with this disorder display recurrent suicidal behavior, gestures, or threats, or self—mutilat- ing 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 the individual assumes 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.