The Nine Diagnostic Criteria, Explained

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  1. they may be hypersensitive to anything that might be seen as abandonment, rejection or being left alone. This can be as simple as someone walking away after an argument or carers going on a holiday and leaving the family member.
  2. they may have unstable relationships with family and friends. They elevate a person to an impossible standard and then devalue them when they don’t live up to those standards.
  3. they may have trouble knowing who they are and what is important to them. They have an unstable self image. They do, however, believe they are unworthy and have a deep sense of shame.
  4. they may act impulsively, which often can lead to behaviour which is self destructive. This means at times of stress they can’t sit and wait to think things through, but may take drugs, drink to excess, run away, overdose, drive recklessly, binge eat, spend money they don’t have, or have risky sex etc, to relieve their distress.
  5. they may self harm by harming their body. This may be cutting, burning, head banging, pulling out hair. Self harm is usually not an attempt to die, but a form of distraction from the emotional pain they are experiencing. 60% of people who self harm report they do not feel pain when they cut or burn themselves, but feel a sense of relief (Valerie Porr).
  6. they may have mood swings or emotions that change quickly, often with seemingly no reason. These emotions are unpredictable and can change in an instant. ‘Rapid mood swings are a core feature of BPD that Marsha Linehan describes as emotional dysregulation’ (Valerie Porr)
  7. they may feel empty and need others to make them whole. They don’t know what they want or who they are. However they struggle with feeling that they deserve this emptiness. Once again a symptom of their overwhelming shame.
  8. they may have excessive anger or sometimes intense rage.
  9. they can numb out, go blank, have amnesic experience or feel detached, as if they are observing their body from the outside. It is often a coping mechanism to tolerate stress. At times of stress they may also become overly suspicious or have paranoid thinking.


A word on Shame-

Shame is often the main emotion in people with BPD. It is an overall sense of being worthless, bad, unlovable — a loser!

Shame is enemy number one for people with BPD. They feel bad almost all the time. It is the emotion  which most often drives most BPD responses to most situations. Shame is strongly linked to chronic suicidality, self harm and anger.

It is important for carers to remember that the person they care for lives constantly with this shame. If you want to help her/him it is vital that you have compassion for this constant pain.

Judy Burke, Sanctuary, 30 Mar 2016
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This website is produced by members of the Sanctuary Support Group. We are not mental health professionals nor clinicians.  We are ordinary people who care for someone with BPD. This website is a collection of information that we have found helpful or of interest in the context of our own lived experiences. The content of this website is not a substitute for independent professional advice, diagnosis or treatment.

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