A Cluster B personality disorder, Borderline Personality Disorder (BPD) first of all features high drama, emotions, and erratic behavior. What distinguishes this patient from others in Cluster B is the tumultuousness of her life. That is, the pattern characteristic of Cluster B is punctuated by stormy, unstable relationships, suicidal threats and/or attempts, incidents of self-mutilation, and turbulent emotional outbursts. She romanticizes about “ideal love.” Criteria for diagnosis of BPD are the following:
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pervasive pattern of instability
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marked impulsivity, including self-dangerous impulsivity (e.g., substance abuse, sex, reckless driving, gambling, spending, binge eating/drinking)
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frantic efforts to avoid real and imagined abandonment
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pattern of unstable and intense interpersonal relationships
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identity disturbance or diffusion
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persistently unstable self-image or sense of self
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recurrent suicidal behavior, gestures, or threats; self-mutilation
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emotional instability
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intense episodes of dysphoria, irritability, or anxiety
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chronic feelings of boredom and emptiness
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inappropriate and intense anger; difficulty controlling anger
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transient stress-related paranoia or severe dissociative symptoms
These individuals do seek treatment, unlike some of the other Cluster B personalities. There has been some success found in treating these patients with a cognitive behavioral therapy (CBT) protocol called dialectical behavior therapy (DBT) whereby a “first things first” approach is used. They initially work on behaviors related to self-harm, then move on to those involved with non-compliance (with therapy), and finally those associated with the patient’s quality of life.
