The work
group is recommending that this disorder be reformulated as the Borderline Type.
Individuals
who match this personality disorder type have an extremely fragile self-concept
that is easily disrupted and fragmented under stress and results in the
experience of a lack of identity or chronic feelings of emptiness. As a
result, they have an impoverished and/or unstable self structure and difficulty
maintaining enduring intimate relationships. Self-appraisal is often
associated with self-loathing, rage, and despondency. Individuals with
this disorder experience rapidly changing, intense, unpredictable, and reactive
emotions and can become extremely anxious or depressed. They may also
become angry or hostile, and feel misunderstood, mistreated, or
victimized. They may engage in verbal or physical acts of aggression when
angry. Emotional reactions are typically in response to negative
interpersonal events involving loss or disappointment.
Relationships
are based on the fantasy of the need for others for survival, excessive
dependency, and a fear of rejection and/or abandonment. Dependency
involves both insecure attachment, expressed as difficulty tolerating
aloneness; intense fear of loss, abandonment, or rejection by significant
others; and urgent need for contact with significant others when stressed or
distressed, accompanied sometimes by highly submissive, subservient behavior.
At the same time, intense, intimate involvement with another person often leads
to a fear of loss of an identity as an individual. Thus, interpersonal
relationships are highly unstable and alternate between excessive dependency
and flight from involvement. Empathy for others is severely impaired.
Core
emotional traits and interpersonal behaviors may be associated with cognitive
dysregulation, i.e., cognitive functions may become impaired at times of
interpersonal stress leading to information processing in a concrete, black-and
white, all-or-nothing manner. Quasi-psychotic reactions, including
paranoia and dissociation, may progress to transient psychosis.
Individuals with this type are characteristically impulsive, acting on the spur
of the moment, and frequently engage in activities with potentially negative
consequences. Deliberate acts of self-harm (e.g., cutting, burning),
suicidal ideation, and suicide attempts typically occur in the context of
intense distress and dysphoria, particularly in the context of feelings of
abandonment when an important relationship is disrupted. Intense distress
may also lead to other risky behaviors, including substance misuse, reckless
driving, binge eating, or promiscuous sex.
Instructions
A.
Type rating. Rate the patient’s personality
using the 5-point rating scale shown below. Circle the number that best
describes the patient’s personality.
5
= Very Good Match: patient exemplifies this type
4
= Good Match: patient significantly resembles this type
3
= Moderate Match: patient has prominent features of this type
2
= Slight Match: patient has minor features of this type
1
= No Match: description does not apply
B.
Trait ratings. Rate extent to which the
following traits associated with the Borderline Type are descriptive of
the patient using this four-point scale:
0 =
Very little or not at all descriptive
1
= Mildly descriptive
2
= Moderately descriptive
3
= Extremely descriptive
1. Negative
Emotionality: Emotional Lability
Having
unstable emotional experiences and mood changes; having emotions that are
easily aroused, intense, and/or out of proportion to events and circumstances
2. Negative
Emotionality: Self-harm
Engaging
in thoughts and behaviors related to self-harm (e.g., intentional cutting or
burning) and suicide, including suicidal ideation, threats, gestures, and
attempts
3. Negative
Emotionality: Separation insecurity
Fears of
rejection by, and/or separation from, significant others; distress when
significant others are not present or readily available
4. Negative
Emotionality: Anxiousness
Feelings
of nervousness, tenseness, and/or being on edge; worry about past unpleasant
experiences and future negative possibilities; feeling fearful and threatened
by uncertainty
5. Negative
Emotionality: Low self-esteem
Having a
poor opinion of one’s self and abilities; believing that one is worthless or
useless; disliking or being dissatisfied with one’s self; believing that one
cannot do things or do them well
6. Negative
Emotionality: Depressivity
Having frequent
feelings of being down/ miserable/ depressed/ hopeless; difficulty “bounding
back” from such moods; belief that one is simply a sad/ depressed person
7. Antagonism:
Hostility
Irritability,
hot temperedness; being unfriendly, rude, surly, or nasty; responding angrily
to minor slights and insults
8. Antagonism:
Aggression
Being
mean, cruel, or cold-hearted; verbally, relationally, or physically abusive;
humiliating and demeaning of others; willingly and willfully engaging in acts
of violence against persons and objects; active and open belligerence or
vengefulness; using dominance and intimidation to control others
9. Disinhibition:
Impulsivity
Acting on
the spur of the moment in response to immediate stimuli; acting on a momentary
basis without a plan or consideration of outcomes; difficulty establishing and
following plans; failure to learn from experience
10. Schizotypy:
Dissociation Proneness
Tendency
to experience disruptions in the flow of conscious experience; “losing time,”
(e.g., being unaware of how one got to one’s location); experiencing one’s
surroundings as strange or unreal
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