- Research has shown that about 75% of people with BPD will make at least one suicide attempt in their lifetime, and many will make multiple suicide attempts.
- BPD is associated with very intense negative emotional experiences. These experiences are so painful that many people with BPD report that they want to find a way to escape.
   - Different strategies to try to reduce their emotional pain include deliberate self-harm, substance use, and even suicide.

University of Minnesota - Twin Cities

In order to be diagnosed with BPD, an individual must exhibit at least 5 of the following 9 criteria:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- 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)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, or recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms

BPD Diagnostic Criteria

A fear of abandonment is a complex phenomenon that can stem from a variety of developmental experiences, including loss or trauma. This is by no means an exhaustive list, but the resulting behaviors can include the ability to attach quickly—even to unavailable partners or relationships—or to stay in relationships no matter how unhealthy they are, have difficulty experiencing emotional intimacy, feel insecure and unworthy of love, find it hard to trust people, experience intense feelings of separation anxiety, and are hypersensitive to criticism.

Fear of Abandonment

- Devaluation and idealization are defense mechanisms that help a person manage their anxiety as well as internal or external stresses.
- Idealization occurs when an individual attributes overly positive qualities to another person or thing, whereas devaluation occurs when an individual attributes themselves, an object, or another person as completely flawed, worthless, or as having exaggerated negative qualities.
- In BPD, devaluation often alternates with idealization.
   - For instance, a person with BPD may shift from great admiration for a loved one (idealization of that person) to an intense anger or dislike towards that person (devaluation of that person).

Idealization and Devaluation

- Identity disturbance is a term used to describe incoherence, or inconsistency, in an individual's sense of identity.
   - This could mean that an individual's goals, beliefs, and actions are constantly changing.
   - It could also be that the individual takes on personality traits of people around them, as they struggle to have and maintain their own identity.

Identity Disturbance

- Impulsivity, or an impulsive behavior, is broadly defined as actions without foresight that are poorly conceived, prematurely expressed, unnecessarily risky, and inappropriate to the situation. 
- Impulsivity is associated with undesirable, rather than desirable, outcomes.
- Individuals who are impulsive are commonly described as hot-headed, rash, unpredictable, and unstable.

Impulsivity

Suicidality in BPD

Affective instability refers to frequent and drastic changes in emotions characterized by high affect intensity, rapid emotion rise times, slow rates of return to emotional baseline, and excessive reactivity to psychosocial cues. Affective instability is a form of emotional dysregulation and may be a key etiological and sustaining factor of BPD.

Affective Instability

Chronic emptiness is understood as a component of unstable self-identity alongside self-criticism and dissociative experiences. Theoretical models have linked the experience of chronic emptiness to deficits in self- and object representations, resulting in a diffuse or unstable identity and disconnection from other people.

Chronic Emptiness

The reason anger in BPD is considered inappropriate is because the level of anger seems to be more intense than is warranted by the situation or event that triggered it. For example, a person with BPD may react to an event that may seem small or unimportant to someone else, such as a misunderstanding, with very strong and unhealthy expressions of anger, including physical violence, sarcasm, and/or yelling.

Inappropriate Anger in BPD

People with BPD often struggle with paranoia or suspicious thoughts about others’ motives. When under stress, they may even lose touch with reality—an experience known as dissociation. They may feel foggy, spaced out, or as if they are outside their own body.

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