Reichl, C., & Kaess, M. (2021). Self-harm in the context of borderline personality disorder. Current Opinion in Psychology, 37, 139–144. https://doi.org/10.1016/j.copsyc.2020.12.007 

 Self-harm in the context of borderline personality disorder

Individuals with Borderline Personality Disorder are at a high risk of suicidal ideations, non-suicidal self-injury, suicidal self-injury, binge eating, fights, substance abuse. Moreover, individuals with BPD have impaired impulse control and emotional regulation and carry a negative self-image, resulting in self-damaging behavior becoming a frequent result of this instability. 

Self-Defeating Behavior in BPD

Gunderson, J. G. (2007). Disturbed relationships as a phenotype for borderline personality disorder. American Journal of Psychiatry, 164(11), 1637–1640. https://doi.org/10.1176/appi.ajp.2007.07071125 

Disturbed relationships as a phenotype for borderline personality disorder

The DSM-IV criteria for borderline personality disorder describe their interpersonal relationship styles as intense and unstable. The relational style for individuals with BPD emphasizes the “preoccupied” attachment style (clingy behavior; insecurity; seeking attention) and the “fearful” attachment style (denial, fear, confusion).

Intense and Unstable Relationships in BPD

Herpertz, S. C., Dietrich, T. M., Wenning, B., Krings, T., Erberich, S. G., Willmes, K., Thron, A., & Sass, H. (2001). Evidence of abnormal amygdala functioning in borderline personality disorder: A functional MRI study. Biological Psychiatry, 50(4), 292–298. https://doi.org/10.1016/s0006-3223(01)01075-7 

Evidence of abnormal amygdala functioning in borderline personality disorder

Biskin, R. S., & Paris, J. (2012). Diagnosing borderline personality disorder. Canadian Medical Association Journal, 184(16), 1789–1794. https://doi.org/10.1503/cmaj.090618

Diagnosing borderline personality disorder

Mood shifts for BPD are described as intense emotional shifts between different moods or mental states. Research suggests that individuals with BPD have enhanced amygdala activations and larger ventral temporal regions, leading to an increased focus and attention on emotional stimuli.

Shifting Moods in BPD

Klonsky, E. D. (2008). What is emptiness? clarifying the 7th criterion for borderline personality disorder. Journal of Personality Disorders, 22(4), 418–426. https://doi.org/10.1521/pedi.2008.22.4.418 

What is emptiness? clarifying the 7th criterion for borderline personality disorder

Feelings of emptiness are the 7th criterion for diagnosing BPD and correlate highly with depressive and anxiety symptoms. In addition, chronic feelings of emptiness are related to feelings of loneliness and hopelessness, a risk factor for self-isolation, suicidal ideation, and self-injury. 

Boredom and Emptiness in BPD

Selby, E. A., & Joiner, T. E. (2013). Emotional cascades as prospective predictors of dysregulated behaviors in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 4(2), 168–174. https://doi.org/10.1037/a0029933 

Emotional cascades as prospective predictors of dysregulated behaviors in borderline personality disorder

It can be described as self-sabotaging behavior concerning goals, accomplishments, diet, etc. Rumination, dysregulated emotions, impulsivity, and negative emotions are the leading causes of self-defeating behavior. 

Self-Damaging Behavior in BPD

Dammann, G., Hügli, C., Selinger, J., Gremaud-Heitz, D., Sollberger, D., Wiesbeck, G. A., Küchenhoff, J., & Walter, M. (2011). The self-image in borderline personality disorder: An in-depth qualitative research study. Journal of Personality Disorders, 25(4), 517–527. https://doi.org/10.1521/pedi.2011.25.4.517 

The self-image in borderline personality disorder: An in-depth qualitative research study

Individuals with BPD suffer from identity disturbances resulting in an insecure self-image and feelings of shame. Individuals with BPD integrate situations in which they've felt isolated or excluded into their self-image. 

The Self-Image of People with BPD

Although contentious, one proposed classification of BPD highlights five different subcategories that vary by symptom presentation:
1. Affective: Mood-related symptoms such as depression and anxiety.
2. Impulsive: Characterized by impulsive and often self-injurious behavior.
3. Aggressive: Temperamental symptoms characterized by inappropriate levels of rage and irratibility.
4. Dependent: Characterized by an ntolerance of being alone and fear of abandonment.
5. Empty: Characterized by an instable self-identity and a sense of inner emptiness.

Subtypes of Borderline Personality Disorder

Rebok, F., Teti, G. L., Fantini, A. P., Cárdenas-Delgado, C., Rojas, S. M., Derito, M. N., &amp; Daray, F. M. (2014). Types of borderline personality disorder (BPD) in patients admitted for suicide-related behavior. Psychiatric Quarterly, 86(1), 49–60. https://doi.org/10.1007/s11126-014-9317-3 

Types of Borderline Personality Disorder (BPD) in Patients Admitted for Suicide-Related Behavior

Although an individual cannot be diagnosed with Borderline Personality Disorder, or any other personality disorder, until the age of 18,  there are many behaviors and signs that can appear throughout childhood and adolescence, that may be precursors to the development of BPD later on in life. Longitudinal studies have suggested that this precursors can be seen beginning in very early childhood and throughout adolescence.  One example of this may be a child's regulation and expression of their emotions, particularly negative ones such as anger and sadness. 

Developmental Trajectories of Borderline Personality Disorder in Childhood and Adolescence 

Mainali, P., Rai, T., & Rutkofsky, I. H. (2020). From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: Exploring the Neuromorphological and Epigenetic Pathway. Cureus, 12(7), e9474. https://doi.org/10.7759/cureus.9474 

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- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder

Cluster B Personality Disorders

American Psychological Association. (n.d.). Clinical psychology. American Psychological Association. https://www.apa.org/ed/graduate/specialize/clinical 

American Psychological Association: Clinical Psychology

A chronic and pervasive disposition to disregard and violate the rights of others. Manifestations include:
- Repeated violations of the law
- Exploitation of others
- Deceitfulness
- Impulsivity
- Aggressiveness
- Reckless disregard for the safety of self and others
- Irresponsibility
- A lack of guilt, remorse, and empathy.

Antisocial Personality Disorder

Histrionic Personality Disorder (often abbreviated as HPD) is a personality disorder characterized by extreme emotional patterns and attention-seeking. People with Histrionic Personality Disorder display several or more of the following characteristics in ways that hinder social and workplace functioning: 

This Could be a separate relation child node: 

- Discomfort with situations in which they are not the center of attention 
- Tendency to interact with others in excessively provocative or sexually seductive ways 
- Speech style that is overly impressionistic and lacking in detail 
- Exaggerated and rapidly shifting expression of emotions 
- Tendency to consider themselves closer to others than they actually are 

Histrionic Personality Disorder

Narcissistic Personality Disorder (often abbreviated as NPD) is a personality disorder characterized by extreme grandiosity, need for admiration, and lack of empathy. People with Narcissistic Personality Disorder display several or more of the following characteristics in ways that hinder social and workplace functioning: 

- Grandiose sense of self-importance, such as exaggerating talents and achievements 
- Preoccupation with unrealistic fantasies of success 
- Unwilling to associate with those they consider to be less important than they are 
- Sense of entitlement 
- Lack of empathy for others 
- Envy of others or belief that others are envious of them 

Narcissistic Personality Disorder

van der Wal, S. J., O. Bienvenu, J.,  Romanoski, A. J., Eaton, W. E., Nestadt, G.,  Samuels, J. Longitudinal relationships between personality disorder dimensions and depression in a community sample, Neurology, Psychiatry and Brain Research, Volume 30, 2018, Pages 56-61, ISSN 0941-9500, https://doi.org/10.1016/j.npbr.2018.05.005.
(https://www.sciencedirect.com/science/article/pii/S0941950018300836)

Longitudinal relationships between personality disorder dimensions and depression in a community sample

Histrionic personality disorder: Causes, symptoms &amp; treatment. Cleveland Clinic. (n.d.). Retrieved July 31, 2022, from https://my.clevelandclinic.org/health/diseases/9743-histrionic-personality-disorder 

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