Borderline Personality Disorder: Assessment and Diagnosis

Reader’s Question

I know that no one can diagnose me over the internet. But I’m beginning to wonder if I might have Borderline Personality Disorder.

I am a 19-year-old male college student. For at least the past five years, I have been a very emotionally volatile person. Close friends have thought I might be bipolar, but I know I do not because my mood changes hour by hour, not week by week. Furthermore, it is triggered by external causes. I have a very unstable self-image. Some days I think very highly of myself and feel great, other days I feel that I have nothing to be proud of and I am an utter failure. Sometimes I become extremely angry to the point of breaking things. I have never actually injured someone, although I’ve scared plenty of friends, who tell me I yell and scream like I’m possessed by some demon when I’m angry. I have a very addictive personality, but I have never been addicted to anything harmful simply because I have pretty high morals and don’t try dangerous things (never tried drinking, etc.). My addictions (or impulses) over the past few years have included video games, soft porn, the internet, and listening to music (I am always wearing headphones).

I prefer to have a smaller number of very close friends rather than a larger number of loose friends. I DON’T feel abandoned by them very often. However, I have very few friends of the opposite sex. I have always been in love, unrequitedly, with someone since I was 11; by this I mean that at every point since that age, I have had very obsessive “crushes” (I hate that word, but what else am I going to call it?) on some girl, generally who I am friends with but in a non-romantic way, which lasts three or four years and does not end until a new one begins. I feel very abandoned by the opposite sex in general, but not by my family or friends. I also feel very abandoned by God, and even after having lost all belief, I still, paradoxically, feel abandoned and angry at a God I don’t even believe in. Now that I am a freshman in college, I don’t have many friends in college, and feel abandoned by the students at my university in general (i.e., not by any particular person). At many points during my first year here in college, I have felt utterly miserable and worthless. Nobody I know would describe me as a manipulative person, and this seems to be half the point of BPD. No one I know would tell me that I take them on guilt trips. When I feel very sad, I just sulk in solitude; I don’t drag anyone under with me. Neither do I think that people are all good or all bad. When I read about this facet of BPD online, I can’t imagine myself thinking this way.
Still, I feel mentally ill, and BPD sounds the closest to what I have out of anything I’ve read about. Although I think I do technically qualify as BPD under the DSM criteria, can I really have BPD if I do NOT feel that my friends abandon me and no one I know ever considers me manipulative?

Psychologist’s Reply

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You are correct to say that it’s truly impossible to offer an accurate diagnosis online. Given your stated discontent, it certainly appears essential that you afford yourself the opportunity to visit with a duly trained mental health professional and secure a thorough assessment. You might be pleasantly surprised by what you can learn about yourself and how much support and help is available to you.

Some words about Borderline Personality Disorder appear in order, however, as it is an often misunderstood phenomenon. In late teen years and early adulthood, it is not that uncommon for some individuals to have a great deal of inner turmoil about their own identity and their ability to relate to others, and to struggle with less than optimal self-regulation of their mood. The DSM specifically cautions against applying the borderline label to younger individuals who may be undergoing a fairly intense identity disturbance. But when disturbances of personal identity, a marked lack of personality integration, and deficient emotional self-regulation persist into later adulthood, they can indicate borderline personality, even though not everyone with borderline traits will develop the full disorder. Moreover, it is the nature of borderline personality that the features presented will vary considerably based on what other dominant personality traits a person has (e.g., not all such persons would therefore be considered “manipulative”).

It’s also not uncommon for individuals who have mood regulation problems to have difficulty solidifying a sense of self. Such difficulties don’t always arise from the classic symptom patterns of bipolar disorder, mania, or depression. So, the very best way to gain some peace of mind is to share all your concerns with a professional who can more objectively examine the whole picture and offer you the support you need to develop a self-image you not only can live with but can embrace.

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