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Expanded Quality of Life Scale For Borderline Personality Disorder

Internet Mental Health Quality of Life Scale

Big 5 Factors Of Mental Illness And Code For This Disorder
(The "6th Big Factor" of Mental Health, "Physical Health", Is Coded Normal or Green)

• Individuals with Borderline (Emotionally Unstable) Personality Disorder are emotionally unstable and overreact to stress with extremes of sadness, anxiety, and anger; they have intense and chaotic social relationships, and are impulsive and often self-destructive (e.g., self-mutilation, attempted suicide).


• Is the most prevalent personality disorder in clinical settings and is associated with severe functional impairment, substantial treatment utilization, and high rates of mortality by suicide.


• Is strongly associated with substance use disorders, mood disorders, anxiety disorders, and other personality disorders.


• Is not due to a medical or substance use disorder.

Prediction

Can last for years or be lifelong

Problems

Occupational-Economic Problems:

• Causes significant impairment in academic or occupational functioning (interrupted education; sudden shifts in vocational aspirations; recurrent job losses). A 10-year hospital discharge follow-up study of former inpatients with this disorder found that 41% to 52% (depending on the follow-up year) were receiving social security disability income (SSDI). At 16-year follow-up of this same group, 78%-99% had achieved a symptomatic remission (i.e., would no longer be diagnosed as having this disorder), but only 40%-60% were assessed as recovered (i.e., having adequate social and occupational functioning - regardless of diagnosis).

Critical, Quarrelsome (Antagonism):

• Inappropriate, intense anger or difficulty controlling anger


• Transient, stress-related paranoid ideation

Impulsive, Disorderly (Disinhibition):

• Impulsive irresponsibility at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

Distressed, Easily Upset (Negative Emotion):

Emotional Instability:


• Emotional instability due to a marked reactivity of mood


• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior


• Chronic feelings of emptiness


• Transient, stress-related severe dissociative symptoms

Social Instability:


• Unstable, intense, chaotic interpersonal relationships characterized by alternating between extremes of idealization and devaluation


• Unstable self-image or sense of self


• Frantic efforts to avoid real or imagined abandonment

Physical Illness:

• Significantly associated with arteriosclerosis or hypertension, hepatic disease, cardiovascular disease, gastrointestinal disease, arthritis, venereal disease, and "any assessed medical condition"

Explanation Of Terms And Symbols

Internet Mental Health Quality of Life Scale

SAPAS Personality Screening Test

Individuals with this disorder would answer "Yes" to the red questions:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people?
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

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Click Here For Free Diagnosis

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Borderline Personality Disorder 301.83

This diagnosis is based on the following findings:

• Frantic efforts to avoid real or imagined abandonment (still present)


• Unstable and intense 'love-hate' relationships (still present)


• Identity disturbance: markedly and persistently unstable self-image or sense of self (still present)


• Impulsivity in at least two areas that are potentially self-damaging (still present)


• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (still present)


• Rapidly shifting emotions (still present)


• Chronic feelings of emptiness (still present)


• Inappropriate, intense anger or difficulty controlling anger (still present)


• Transient, stress-related paranoid ideation or severe dissociative symptoms (still present)

Treatment Goals:

• Goal: overcome fear of abandonment.
  If this problem persists: She will continue to show frantic efforts to avoid real or imagined abandonment. Her frantic efforts to avoid abandonment might include impulsive actions such as self-mutilating or suicidal behaviors.


• Goal: have less unstable and intense "love-hate" relationships.
  If this problem persists: She will continue to show a pattern of unstable and intense relationships. She will switch quickly from idealizing other people to devaluing them. She will see things in terms of extremes, either all good or all bad.


• Goal: develop a positive, stable self-image or sense of self.
  If this problem persists: Her self-image ("who-am-I?") will continue to be very unstable. There will be sudden and dramatic shifts in her self-image, characterized by shifting goals, values, and vocational aspirations. She will see herself as a "victim" (taking little responsibility for any problem).


• Goal: stop impulsive, self-damaging behavior.
  If this problem persists: She will continue to show impulsivity in at least two areas that are potentially self-damaging (i.e., gambling, spending money irresponsibly, binge eating, abusing substances, engaging in unsafe sex, driving recklessly, or being impulsively suicidal).


• Goal: stop self-mutilating or suicidal behavior.
  If this problem persists: She will continue to have recurrent suicidal gestures such as wrist cutting, overdosing, or self-mutilation. Her self-destructive acts will be precipitated by threats of separation or rejection.


• Goal: stop over-reacting to stress.
  If this problem persists: She will continue to have rapidly shifting moods due to extreme reactivity to interpersonal stress (e.g., intense unhappiness, anger, or anxiety usually lasting a few hours and only rarely more than a few days).


• Goal: discover a meaning or purpose to life.
  If this problem persists: She will continue to have chronic feelings of emptiness. She will be easily bored and constantly seeking something to do.


• Goal: better control anger.
  If this problem persists: She will continue to be inappropriately angry. Her anger will be triggered when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning.


• Goal: stop becoming paranoid or dissociating under stress.
  If this problem persists: During periods of extreme stress, she will continue to have transient paranoid ideation or dissociative symptoms (e.g., depersonalization). This will occur most frequently in response to a real or imagined abandonment.

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Emotionally Unstable [Borderline] Personality Disorder F60.3 - ICD10 Description, World Health Organization

Emotionally unstable [borderline] personality disorder is characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behavior, including suicide gestures and attempts.

ICD-10 International Personality Disorder Examination Screening Questions

Emotionally Unstable Personality Disorder: Borderline Subtype

• I can't decide what kind of person I want to be.


• I go to extremes to try to keep people from leaving me.


• I get into very intense relationships that don't last.


• I've never threatened suicide or injured myself on purpose (False).


• I often feel "empty" inside.

Emotionally Unstable Personality Disorder: Impulsive Subtype

• I argue or fight when people try to stop me from doing what I want.


• I don't stick with a plan if I don't get results right away.


• Sometimes I get so angry I break or smash things.


• I'm very moody.


• I take chances and do reckless things.

ICD-10 Diagnostic Criteria (For Research)

A. The general criteria of personality disorder must be met:


• Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').


• The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).


• There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.


• There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.


• The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.


• Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.


Impulsive Subtype:

A. The general criteria of personality disorder (above) must be met:

B. Quarrelsome behavior:


• A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized.
  
  (E.g., "I argue or fight when people try to stop me from doing what I want.")

C. At least two of the following must be present:


• A marked tendency to act unexpectedly and without consideration of the consequences.
  
  (E.g., "I take chances and do reckless things.")


• Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions.
  
  (E.g., "Sometimes I get so angry I break or smash things.")


• Difficulty in maintaining any course of action that offers no immediate reward.
  
  (E.g., "I don't stick with a plan if I don't get results right away.")


• Unstable and capricious mood.
  
  (E.g., "I'm very moody.")


Borderline Subtype:

A. The general criteria of personality disorder (above) must be met:

B. At least three of the following must be present:


• A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized.
  
  (E.g., "I argue or fight when people try to stop me from doing what I want.")


• A marked tendency to act unexpectedly and without consideration of the consequences.
  
  (E.g., "I take chances and do reckless things.")


• Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions.
  
  (E.g., "Sometimes I get so angry I break or smash things.")


• Difficulty in maintaining any course of action that offers no immediate reward.
  
  (E.g., "I don't stick with a plan if I don't get results right away.")


• Unstable and capricious mood.
  
  (E.g., "I'm very moody.")

C. At least two of the following must be present:



• Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual).
  
  (E.g., "I can't decide what kind of person I want to be.")


• Liability to become involved in intense and unstable relationships, often leading to emotional crises.
  
  (E.g., "I get into very intense relationships that don't last.")


• Excessive efforts to avoid abandonment.
  
  (E.g., "I go to extremes to try to keep people from leaving me.")


• Recurrent threats or acts of self-harm.
  
  (E.g., "A number of times, I've threatened suicide or injured myself on purpose.")


• Chronic feelings of emptiness.
  
  (E.g., "I often feel empty inside.")

Borderline Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with borderline personality disorder needs to show at least 5 of the following criteria:

• Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior here.)


• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.


• Identity disturbance: 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). (Note: Do not include suicidal or self-mutilating behavior here.)


• 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, recurrent physical fights).


• transient, stress-related paranoid ideation or severe dissociative symptoms.

This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Proposed New Diagnostic Criteria:

Typical features of borderline personality disorder are instability of self-image, personal goals, interpersonal relationships, and affects, accompanied by impulsiveity, risk taking, and/or hostility. The individual is at least 18 years of age.

A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas:

• Identity:
  Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness; dissociative states under stress.


• Self-direction:
  Instability in goals; aspirations, values, or career plans.


• Empathy:
  Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.


• Intimacy:
  Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between overinvolvement and withdrawal.

B. Four or more of the following seven pathological personality traits, at least one of which must be impulsivity, risk taking, or hostility.

Antagonism


• Hostility:
  Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

Disinhibition


• Reckless Risk Taking:
  Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; lack of concern for one's limitations and denial of the reality of personal danger.


• 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; a sense of urgency and self-harming behavior under emotional distress.

Negative Emotion


• Emotional Instability:
  Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.


• Anxiety:
  Intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of embarrassment; fears of falling apart or losing control.


• Separation Anxiety:
  Fears of rejection by - and/or separation from - significant others, associated with fears of excessive dependency and complete loss of autonomy.


• Depressed Mood:
  Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame, feelings of inferior self-worth; thoughts of suicide and suicidal behavior.

Empirically Derived Taxonomy for Personality Diagnosis: Borderline Personality Disorder

(This section uses an alternative classification system to that of the ICD-10 or the American Psychiatric Association.)

These individuals:

• Are emotionally unstable, and overreact to stress with extremes of sadness, anxiety, and anger. Their emotions tend to change rapidly and unpredictably.


• Feel unhappy, depressed, or despondent; feel life has no meaning; are preoccupied with death and dying; feel empty; and find little or no pleasure, satisfaction, or enjoyment in life’s activities.


• Are angry or hostile, and feel misunderstood, mistreated, or victimized.


• Feel like an outcast or outsider; feel inadequate, inferior, or a failure; are overly needy or dependent.


• May act on self-destructive impulses, including self-mutilating behavior, "cry for help" suicidal threats or gestures, and genuine suicidality, especially when an attachment relationship is disrupted or threatened.


• "Catastrophize," seeing problems as disastrous or unsolvable, and are often unable to soothe or comfort themselves without the help of another person.


• Become irrational when strong emotions are stirred up, showing a significant decline from their usual level of functioning.


• Lack a stable sense of self. Their attitudes, values, goals, and feelings about themselves may seem unstable or ever-changing.


• Have difficulty maintaining stable, balanced views of others. When upset, they see others in extreme, black-or-white terms. Consequently, their relationships tend to be unstable, chaotic, and rapidly changing.


• Fear rejection and abandonment, fear being alone, and tend to become attached quickly and intensely.


• May repeatedly re-experience or re-live a past traumatic event (e.g., having intrusive memories or recurring dreams of the event, or becoming startled or terrified by present events that resemble or symbolize the past event).


• Can play the role of "victim", often eliciting intense emotions in other people who they manipulate into playing the role of "villan" or "rescuer".


• Stir up conflict or animosity between other people.


• Act impulsively.


• Their work life or living arrangements may be chaotic and unstable.

(Editor's Note: Many of these behaviors would be considered normal in 14-year-olds going through the emotionally turbulent phase of adolescence. Most adolescents mature out of their personality disorders within 2 years. Thus the question is: what factors prevent individuals with this disorder from maturing and losing these adolescent borderline features?)

How Antisocial, Borderline and Narcissistic Personality Disorder Overlap

In the DSM-4 and DSM-5, there are certain diagnostic criteria for Antisocial, Borderline and Narcissistic Personality Disorder that overlap, and can't differentiate between these disorders. The following table lists which diagnostic criteria poorly differentiate between these 3 personality disorders.

DIAGNOSTIC CRITERIA	NARCISSISTIC PERSONALITY	BORDERLINE PERSONALITY	ANTISOCIAL PERSONALITY
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating.)	Present	Present	Present
Irritability and aggressiveness, as indicated by repeated physical fights or assaults.	Present	Present	Present
Reckless disregard for safety of self or others.	Present	Present	Present
Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.	Present	Present	Present
Is often envious of others or believes that others are envious of him or her.	Present	Present	Present
Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.	Present	.	Present
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.	.	Present	Present
Transient, stress-related paranoid ideation or severe dissociative symptoms.	Present	Present	.
Fantic efforts to avoid real or imagined abandonment.	Present	Present	.
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.	Present	Present	.

The significant overlap of symptoms in Narcissistic, Borderline, and Antisocial Personality Disorder illustrates how similar these personality disorders are. It could be argued that these overlapping symptoms are the core features of the Narcissistic, Borderline, and Antisocial cluster of Personality Disorders. One way to remember these core features is the acronym "PEACE FAIRS" (Paranoid, Exploitative, Aggressive, Callous, Envious, Fantasies, Abandonment, Impulsive, Reckless, Suicidal).

Although these disruptive behaviors slowly disappear as the individual ages; these maladaptive behaviors may cause decades of unemployment or be very damaging to social relationships.

Where Do Antisocial, Borderline and Narcissistic Personality Disorder Not Overlap?

In the DSM-4 and DSM-5, there are certain diagnostic criteria for Antisocial, Borderline and Narcissistic Personality Disorder that don't overlap, and thus differentiate between these disorders. The following table lists which diagnostic criteria statistically differentiate between these 3 personality disorders.

DIAGNOSTIC CRITERIA	NARCISSISTIC PERSONALITY	BORDERLINE PERSONALITY	ANTISOCIAL PERSONALITY
Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)	Present	.	.
Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)	Present	.	.
Requires excessive admiration	Present	.	.
Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations	Present	.	.
Shows arrogant, haughty behaviors or attitudes	Present	.	.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation	.	Present	.
Identity disturbance: markedly and persistently unstable self-image or sense of self	.	Present	.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lastig a few hours and only rarely more than a few days)	.	Present	.
Chronic feelings of emptiness	.	Present	.
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest	.	.	Present
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure	.	.	Present
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations	.	.	Present
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another	.	.	Present

What Is The Opposite Of The Antisocial, Borderline and Narcissistic Personality Disorders?

The following lists the unhealthy core features of Antisocial, Borderline and Narcissistic Personality Disorders. Opposite each unhealthy core behavior is listed its healthy alternative.

UNHEALTHY CORE FEATURES OF ANTISOCIAL, BORDERLINE, AND NARCISSISTIC PERSONALITY DISORDERS	HEALTHY ALTERNATIVE
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating.)	Self-Control
Irritability and aggressiveness, as indicated by repeated physical fights or assaults.	Peacefulness
Reckless disregard for safety of self or others.	Caution
Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.	Generosity
Is often envious of others or believes that others are envious of him or her.	Contentment
Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.	Kindness
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.	Life Purpose and Meaning
Transient, stress-related paranoid ideation or severe dissociative symptoms.	Trust
Fantic efforts to avoid real or imagined abandonment.	Confidence
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.	Being Realistic

This suggests that effective treatment for Antisocial, Borderline, and Narcissistic Personality Disorder should concentrate on increasing these healthy alternative behaviors.

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Diagnostic Features

Borderline Personality Disorder is a condition characterized by rapid mood shift, impulsivity, hostility and chaotic social relationships. People with borderline personality disorder usually go from one emotional crisis to another.

This disorder appears to consist of acute symptoms superimposed on chronic symptoms. The acute symptoms resolve the most quickly. These acute symptoms are impulsivity (e.g., self-mutilation and suicide efforts) and active attempts to manage interpersonal difficulties (e.g., problems with demandingness/entitlement and serious treatment regressions). The chronic symptoms can persist for a decade or more. These chronic symptoms are affective symptoms reflecting areas of chronic dysphoria (e.g., anger and loneliness/emptiness) and interpersonal symptoms reflecting abandonment and dependency issues (e.g., intolerance of aloneness and counterdependency problems).

In the general population, rapid mood shift, impulsivity, and hostility are normal in childhood and early adolescence, but disappear with maturity. However, in Borderline Personality Disorder, rapid mood shift, impulsivity, and hostility intensifies in adolescence and persists into adulthood. In early adulthood, individuals with this disorder have highly changeable moods and intense anger. Fortunately, in their 30's and 40's, the majority develop emotional stability and adequate coping skills.

Borderline Personality Disorder is quite different from Bipolar I Disorder. The mood swings seen in Borderline Personality Disorder seldom last more than one day; whereas mood swings in Bipolar I Disorder last much longer. Borderline Personality Disorder doesn't exhibit the prolonged episodes of decreased need for sleep, hyperactivity, pressured speech, reckless over-involvement, and grandiosity that are characteristic of Bipolar I Disorder.

The core features of this disorder are: (1) negative emotion (emotional instability, anxiety, separation insecurity, depression, suicidal behavior), (2) antagonism (hostility), and (3) disinhibition (impulsivity, risk taking). Self harm and repeated, impulsive suicide attempts are seen in the more severely ill individuals with Borderline Personality Disorder. This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder should not be diagnosed if its symptoms can be better explained as due to another mental disorder, Substance Use Disorder, or another medical condition (e.g., head trauma).

Disturbed interpersonal relationships: "There is a strong association between BPD and insecure attachment ... individuals demonstrate a longing for intimacy and - at the same time - concern about dependency and rejection." Individuals with this disorder often form "love-hate" relationships that alternate between extremes of idealization and devaluation. They may make frantic efforts to avoid real or imagined abandonment. Frequently they feel that their life is empty and lacking in meaning and purpose. Many don't have a clear sense of "who they are" and "where they are going in life" (i.e., identity and goal confusion).

Negative Emotion

Emotions spiral out of control, leading to extremes of anxiety, sadness, rage, etc. Has extreme reactions to perceived slights or criticism (e.g. may react with rage, humiliation, etc.). Expresses emotion in exaggerated and theatrical ways. Emotions change rapidly and unpredictably. Feels unhappy, depressed, or despondent.

Antagonism (Similar To Antisocial Personality Disorder)

Intense anger, out of proportion to the situation at hand (e.g. has rage episodes). Often angry or hostile.

Disinhibition (Similar To Antisocial Personality Disorder)

Need for stimulation/proneness to boredom Impulsivity Promiscuous sexual behavior Irresponsibility

Like all personality disorders, Borderline Personality Disorder is a deeply ingrained and enduring behavior pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behavior pattern tends to be stable. It causes significant distress/disability.

Course

The course of Borderline Personality Disorder (BPD) is quite variable. "By 7 to 10 years' follow-up, half of patients with BPD will be characterized as remitted." Unfortunately, the impairment in adaptive functioning takes much longer to remit. After 10 years, only about 20% have stable relationships or full-time employment. "Fifteen- and 27-year follow-up studies of patients with borderline personality disorder show that most of them no longer meet full criteria for the disorder by age 40 ... Affective instability is slower to change than impulsivity. Suicide rates in patients with this disorder are close to 10%, with most completions occurring late in the course of illness; early mortality from all causes exceeds 18%."

Complications

Completed suicide occurs in 8%-10% of individuals with Borderline Personality Disorder. Self-mutilation (e.g., cutting or burning), suicide threats and attempts are very common. Recurrent job losses, interrupted education, and broken marriages are common.

Comorbidity

Personality disorders are an overlooked and underappreciated source of psychiatric morbidity. Comorbid personality disorders may, in fact, account for much of the morbidity attributed to axis I disorders in research and clinical practice. "High percentages of patients with schizotypal (98.8%), borderline (98.3%), avoidant (96.2%), and obsessive-compulsive (87.6%) personality disorder and major depressive disorder (92.8%) exhibited moderate (or worse) impairment or poor (or worse) functioning in at least one area." Men with borderline personality disorder are more likely to evidence substance use disorders, antisocial personality disorder and intermittent explosive disorder; whereas women are more likely to evidence eating, mood, anxiety, and posttraumatic stress disorders.

"After adjusting for sociodemographic variables, common Axis I mental disorders, and Axis II personality disorders, the presence of borderline personality disorder was significantly associated with arteriosclerosis or hypertension, hepatic disease, cardiovascular disease, gastrointestinal disease, arthritis, venereal disease, and "any assessed medical condition" (adjusted odds ratios, range 1.46-2.80). In the most stringent adjusted model, diabetes, stroke, and obesity were not associated with borderline personality disorder."

Some other disorders frequently occur with this disorder.

Non-Personality Disorders

      Mood Disorders (males 68.7%-82% vs. females 80.2%-94%):
• Major depressive disorder (32.1%-60%)
• Persistent depressive disorder (9.7%)
• Bipolar I disorder (31.8%)
• Bipolar II disorder (7.7%)
• % of individuals with BPD having affective instability (males 82% vs. females 94%)
• % of individuals with BPD having intense anger (males 74% vs. females 49%)
      Anxiety Disorders (male 66.1%-80%, female 81.1%-92%):
• Panic disorder with agoraphobia (11.5%)
• Panic disorder without agoraphobia (18.8%)
• Social anxiety disorder (29.3%)
• Specific phobia (37.5%)
• PTSD (39.2%)
• Generalized anxiety disorder (35.1%)
• Obsessive-compulsive disorder (15.6%)
      Feeding and Eating Disorders: (males 18%-20.5% vs. females 35%-62.2%)
• Anorexia Nervosa (males 4%-7% vs. females 21%-25%)
• Bulimia nervosa (overall 25%-25.6%; males 10%, females 30%)
      Substance-Related and Addictive Disorders:
• Any alcohol use disorder (males 65%-71.2%, females 43%-45.6%)
• Any drug use disorder (males 44.0%, females 29.8%)
      Neurocognitive Disorders:
• Attention-deficit/hyperactivity disorder

Personality Disorders

      Antisocial personality disorder (males 57% vs. females 26%)

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

The prevalence of Borderline Personality Disorder is about 1.6% of the general population. It is seen in 20% of psychiatric inpatients. This disorder is equally prevalent among men and women.

Outcome

After about 10 years, about half of individuals with this disorder no longer meet the full criteria for Borderline Personality Disorder. For those individuals that have this disorder severe enough to require hospitalization, after six years 75% recover. Once recovered, recurrences are rare, perhaps only 10% over six years.

Familial Pattern

If individuals have Borderline Personality Disorder; their first-degree biological relatives are 5 times more likely to have this disorder. These relatives also have an increased risk of having Substance Use Disorders, Antisocial Personality Disorder, and Depressive or Bipolar Disorders.

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Psychotherapy

Dialectical Behavior Therapy is helpful for people with borderline personality disorder in decreasing their inappropriate anger and self-harm, and in increasing their general functioning. There are generally too few studies to allow firm conclusions to be drawn about the value of all the other kinds of psychotherapeutic interventions. Overall, none of the psychotherapies for this disorder have a very robust evidence base. Dialectical behavior therapy and general psychiatric management have been shown to be equally effective. Individuals with this disorder usually suffer from 2 or more psychiatric disorders. Two years after therapy, even though two-thirds achieve diagnostic remission and significant improvement in quality of life, 53% are neither employed nor in school, and 39% are still receiving psychiatric disability financial support. Research has shown that individuals with this disorder need long-term therapy that teaches less emotional, aggressive and impulsive ways of coping.

Individuals with this disorder need to have a long-term therapist or mentor to establish a stable, supportive relationship in which clear and consistent boundaries are established. This therapist or mentor must have the patience and strength to withstand the patient's many crises and limit-testing episodes. Communication should always be clear, honest, optimistic and directed towards teaching more mature coping skills.

Pharmacotherapy

There are currently no medications approved by the FDA to treat this disorder. Antidepressants are not helpful for treatment of this disorder, but may be helpful in the presence of comorbid conditions. Total severity of this disorder was not significantly influenced by any drug. Vitamins, nutritional supplements, and special diets are all ineffective for all Personality Disorders.

A Dangerous Cult

• The Secret Life of L Ron Hubbard


• The Secrets of Scientology


• Weird Belief of Scientology


• Ex-Scientologist Leah Remini reveals the most shocking alleged secrets of the church

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Videos

• What Is Borderline Personality Disorder - Mental Health Guru


• Back From The Edge: Borderline Personality Disorder


• Borderline Personality Disorder: A Treatable Disorder


• Borderline Personality Disorder: A Good Prognosis

• Borderline Personality Disorder - Google


• Borderline Personality Disorder - Epocrates Online


• Borderline Personality Disorder - NIMH


• Borderline Personality Disorder - PubMed Health


• Borderline Personality Disorder - Wikipedia


• Borderline Personality Disorder Clinician Resource Center - UBC Department of Psychiatry


• Is the borderline personality disorder a complex post-traumatic stress disorder? - Nervenarzt 2002


• The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events - American Journal Of Psychiatry 2003


• Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls - Psychiatry Research 2005


• Axis I diagnostic comorbidity and borderline personality disorder - Comprehensive Psychiatry 1999


• Associated diagnoses (comorbidity) in patients with borderline personality disorder - Psychiatric Journal Of The University Of Ottawa 1990


• Personality Disorders (In Dogs And Humans) - Internet Mental Health


• Big Five personality traits - Wikipedia


• A police officer who went undercover as a prisoner says the inmates shared this troubling trait - Why many individuals with borderline personality disorder are so easily led by narcissistic-paranoid-psychopathic individuals

Stories

• Borderline Personality Disorder Stories


• Borderline Personality Disorder Stories - YouTube


• Borderline Personality Disorder documentaries - YouTube


• Depression - www.facetheissue.com


• Self-Esteem - www.facetheissue.com


• Self-Injury - www.facetheissue.com


• Living with borderline personality disorder - BBC

Rating Scales

• Borderline Disorder Rating Scales


• The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. - Psychopathology. 2009


• Borderline Symptom List 23 (BSL-23)


• Rosenberg's Self-Esteem Scale

Which Behavioral Dimensions Are Involved?

Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions of personality.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", but our discussion will focus on the first 5 major dimensions.)

These 5 major dimensions of human behavior seem to represent 5 major dimensions whereby our early ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, enthusiastic, and calm.

Which Dimensions of Human Behavior are Impaired in Borderline Personality Disorder?

THE POSITIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS	THE NEGATIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS	DESCRIPTION (Where red = this disorder)
Agreeableness	Antagonism	Sympathetic, Kind vs. Critical, Quarrelsome
Conscientiousness	Disinhibition	Industrious, Orderly vs. Impulsive, Disorderly
Openness To Experience	Impaired Intellect	Open-Minded, Creative vs. Closed-Minded, Uncreative
Sociability (Extraversion)	Detachment	Enthusiastic, Assertive vs. Reserved, Quiet
Emotional Stability	Negative Emotion	Calm, Emotionally Stable vs. Distressed, Easily Upset

The 5 Major Dimensions of Mental Illness

Our website uses the "Big 5 Factors" of personality as major dimensions of mental illness. Each of these 5 dimensions has a healthy side and an unhealthy side. The Big 5 Factors are: Agreeableness, Conscientiousness, Openness to Experience, Sociability (Extraversion), and Emotional Stability. Our website adds an additional factor, Well-Being (composed of health, happiness, and prosperity). However, our discussion will primarily focus on the traditional "Big 5 Factors".

AGREEABLENESS VS. ANTAGONISM

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Agreeableness (Sympathetic, Kind)

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Description: Agreeableness is synonymous with cooperation and social harmony; whereas Antagonism is synonymous with competition and aggression. The Agreeableness dimension measures the "friend vs. foe" behaviors that are central to the concept of JUSTICE (good vs. bad behavior). Descriptors: Sympathetic, kind, appreciative, affectionate, soft-hearted, warm, generous, trusting, helpful, forgiving, pleasant, good-natured, friendly, cooperative, gentle, unselfish, praising, sensitive Ask yourself: "How will I show LOVE and JUSTICE? How will I live in harmony with others?" MRI Research*: Agreeableness was associated with increased volume in regions that process information about the intentions and mental states of other individuals.

"I am helpful and unselfish with others."

"I have a forgiving nature."

"I am generally trusting."

"I am considerate and kind to almost everyone."

"I like to cooperate with others."

"I don't find fault with others."

"I don't start quarrels with others."

"I am not cold and aloof."

"I am not rude to others."

"I feel other's emotions."

"I inquire about others' well-being."

"I sympathize with others' feelings."

"I take an interest in other people's lives."

"I like to do things for others."

"I respect authority."

"I hate to seem pushy."

"I avoid imposing my will on others."

"I rarely put people under pressure."

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Antagonism (Critical, Quarrelsome)

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* Callousness:

"It's no big deal if I hurt other people's feelings."

"Being rude and unfriendly is just a part of who I am."

"I often get into physical fights."

"I enjoy making people in control look stupid."

"I am not interested in other people's problems."

"I can't be bothered with other's needs."

"I am indifferent to the feelings of others."

"I don't have a soft side."

"I take no time for others."

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* Deceitfulness:

"I don't hesitate to cheat if it gets me ahead."

"Lying comes easily to me."

"I use people to get what I want."

"People don't realize that I'm flattering them to get something."

.

* Manipulativeness:

"I use people to get what I want."

"It is easy for me to take advantage of others."

"I'm good at conning people."

"I am out for my own personal gain."

.

* Grandiosity:

"I'm better than almost everyone else."

"I often have to deal with people who are less important than me."

"To be honest, I'm just more important than other people."

"I deserve special treatment."

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* Suspiciousness:

"It seems like I'm always getting a “raw deal” from others."

"I suspect that even my so-called 'friends' betray me a lot."

"Others would take advantage of me if they could."

"Plenty of people are out to get me."

"I'm always on my guard for someone trying to trick or harm me."

.

* Hostility:

"I am easily angered."

"I get irritated easily by all sorts of things."

"I am usually pretty hostile."

"I always make sure I get back at people who wrong me."

"I resent being told what to do, even by people in charge."

"I insult people."

"I seek conflict."

"I love a good fight."

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("Agreeableness vs. Antagonism" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

CONSCIENTIOUSNESS VS. DISINHIBITION

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Conscientiousness (Industrious, Orderly)

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Description: Conscientiousness is synonymous with being industrious and orderly; whereas Disinhibition is synonymous with being impulsive and disorderly. The Conscientiousness dimension measures the "self-controlled vs. disinhibited" behaviors that are central to the concept of SELF-CONTROL. Descriptors: Self-disciplined, achievement-oriented, industrious, competent, reliable, responsible, orderly, deliberate, decisive Ask yourself: "How will I show SELF-CONTROL? How will I show moderation in all things?" MRI Research*: Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.

"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."

"I am careful."

"I am a reliable hard-worker."

"I am organized. I follow a schedule and always know what I am doing."

"I like order. I keep things tidy."

"I see that rules are observed."

"I do things efficiently. I get things done quickly."

"I carry out my plans and finish what I start."

"I am not easily distracted."

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Rigid Perfectionism (Excessive Conscientiousness)

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"Even though it drives other people crazy, I insist on absolute perfection in everything I do."

"I simply won't put up with things being out of their proper places."

"People complain about my need to have everything all arranged."

"People tell me that I focus too much on minor details."

"I have a strict way of doing things."

"I postpone decisions."

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Disinhibition (Impulsive, Disorderly)

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* Irresponsibility:

"I've skipped town to avoid responsibilities."

"I just skip appointments or meetings if I'm not in the mood."

"I'm often pretty careless with my own and others' things."

"Others see me as irresponsible."

"I make promises that I don't really intend to keep."

"I often forget to pay my bills."

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* Impulsivity:

"I usually do things on impulse without thinking about what might happen as a result."

"Even though I know better, I can't stop making rash decisions."

"I feel like I act totally on impulse."

"I'm not good at planning ahead."

.

* Distractibility:

"I can't focus on things for very long."

"I am easily distracted."

"I have trouble pursuing specific goals even for short periods of time."

"I can't achieve goals because other things capture my attention."

"I often make mistakes because I don't pay close attention."

"I waste my time ."

"I find it difficult to get down to work."

"I mess things up."

"I don't put my mind on the task at hand."

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* Risk Taking:

"I like to take risks."

"I have no limits when it comes to doing dangerous things."

"People would describe me as reckless."

"I don't think about getting hurt when I'm doing things that might be dangerous."

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* Hyperactivity:

"I move excessively (e.g., can't sit still; restless; always on the go)."

"I'm starting lots more projects than usual or doing more risky things than usual."

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* Over-Talkativeness:

"I talk excessively (e.g., I butt into conversations; I complete people's sentences)."

"Often I talk constantly and cannot be interrupted."

.

* Elation:

"I feel much more happy, cheerful, or self-confident than usual."

"I'm sleeping a lot less than usual, but I still have a lot of energy."

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("Conscientiousness vs. Disinhibition" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

OPENNESS TO EXPERIENCE vs. IMPAIRED INTELLECT

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Open To Experience (Open-Minded, Creative)

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Description: Open to Experience is synonymous with being open-minded and creative; whereas Closed to Experience is synonymous with being closed-minded and uncreative. The Openness to Experience dimension measures the "open-minded vs. closed-minded" behaviors that are central to the concept of WISDOM. Descriptors: Wide interests, imaginative, intelligent, original, insightful, curious, sophisticated, artistic, clever, inventive, sharp-witted, wise Ask yourself: "How will I show WISDOM? How will I act wisely and learn from my mistakes?" MRI Research*: Openness To Experience did not have any significant correlation with the volume of any brain structures. (This could suggest that "Openness To Experience", as defined here, is more a function of culture rather than of brain neurobiology.)

"I am original, and come up with new ideas."

"I am curious about many different things."

"I am quick to understand things."

"I can handle a lot of information."

"I like to solve complex problems."

"I have a rich vocabulary."

"I think quickly and formulate ideas clearly."

"I enjoy the beauty of nature."

"I believe in the importance of art."

"I love to reflect on things."

"I get deeply immersed in music."

"I see beauty in things that others might not notice."

"I need a creative outlet."

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Closed To Experience (Closed-Minded, Uncreative)

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"I prefer work that is routine."

"I have difficulty understanding abstract ideas."

"I avoid philosophical discussions."

"I avoid difficult reading material."

"I learn things slowly."

"I have few artistic interests."

"I seldom notice the emotional aspects of paintings and pictures."

"I do not like poetry."

"I seldom get lost in thought."

"I seldom daydream."

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Cognitive Impairment

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* Memory Impairment:

"I have difficulty learning new things, or remembering things that happened a few days ago."

"I often forget a conversation I had the day before."

"I often forget to take my medications, or to keep my appointments."

.

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* Impaired Reasoning or Problem-Solving:

"My judgment, planning, or problem-solving isn't good."

"I lack creativity or curiosity."

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Psychoticism

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* Eccentricity:

"I often have thoughts that make sense to me but that other people say are strange."

"Others seem to think I'm quite odd or unusual."

"My thoughts are strange and unpredictable."

"My thoughts often don’t make sense to others."

"Other people seem to think my behavior is weird."

"I have several habits that others find eccentric or strange."

"My thoughts often go off in odd or unusual directions."

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* Unusual Beliefs and Experiences:

"I often have unusual experiences, such as sensing the presence of someone who isn't actually there."

"I've had some really weird experiences that are very difficult to explain."

"I have seen things that weren’t really there."

"I have some unusual abilities, like sometimes knowing exactly what someone is thinking."

"I sometimes have heard things that others couldn’t hear."

"Sometimes I can influence other people just by sending my thoughts to them."

"I often see unusual connections between things that most people miss."

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* Perceptual Dysregulation:

"Things around me often feel unreal, or more real than usual."

"Sometimes I get this weird feeling that parts of my body feel like they're dead or not really me."

"It's weird, but sometimes ordinary objects seem to be a different shape than usual."

"Sometimes I feel 'controlled' by thoughts that belong to someone else."

"Sometimes I think someone else is removing thoughts from my head."

"I have periods in which I feel disconnected from the world or from myself."

"I can have trouble telling the difference between dreams and waking life."

"I often 'zone out' and then suddenly come to and realize that a lot of time has passed."

"Sometimes when I look at a familiar object, it's somehow like I'm seeing it for the first time."

"People often talk about me doing things I don't remember at all."

"I often can't control what I think about."

"I often see vivid dream-like images when I’m falling asleep or waking up."

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("OPENNESS TO EXPERIENCE vs. BEING CLOSED TO EXPERIENCE" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

SOCIABILITY (EXTRAVERSION) vs. DETACHMENT

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Sociability (Enthusiastic, Assertive)

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Description: Sociability is synonymous with being outgoing, enthusiastic and assertive; whereas Detachment is synonymous with being reserved and quiet. The Sociability (Extraversion) dimension measures the "approach vs. avoidance" behaviors that are central to the concept of SOCIABILITY and LEADERSHIP. Descriptors: Enthusiastic, assertive, active, energetic, outgoing, outspoken, dominant, forceful, show-off, sociable, spunky, adventurous, noisy, bossy Ask yourself: "How will I be outgoing and SOCIABLE? How will I be assertive and share my enthusiasm?" MRI Research*: Sociability (extraversion) was associated with increased volume of medial orbitofrontal cortex, a region involved in processing reward information.

"I'm talkative"

"I'm not reserved."

"I'm full of energy."

"I generate a lot of enthusiasm."

"I'm not quiet."

"I have an assertive personality."

"I'm not shy or inhibited."

"I am outgoing and sociable."

"I make friends easily."

"I warm up quickly to others."

"I show my feelings when I'm happy."

"I have a lot of fun."

"I laugh a lot."

"I take charge."

"I have a strong personality."

"I know how to captivate people."

"I see myself as a good leader."

"I can talk others into doing things."

"I am the first to act."

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Attention Seeking (Excessive Sociability)

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"I like to draw attention to myself."

"I crave attention."

"I do things to make sure people notice me."

"I do things so that people just have to admire me."

"My behavior is often bold and grabs peoples' attention."

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Detachment (Reserved, Quiet)

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* Social Withdrawal:

"I don’t like to get too close to people."

"I don't deal with people unless I have to."

"I'm not interested in making friends."

"I don’t like spending time with others."

"I say as little as possible when dealing with people."

"I keep to myself."

"I am hard to get to know."

"I reveal little about myself."

"I do not have an assertive personality."

"I lack the talent for influencing people."

"I wait for others to lead the way."

"I hold back my opinions."

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* Intimacy Avoidance:

"I steer clear of romantic relationships."

"I prefer to keep romance out of my life."

"I prefer being alone to having a close romantic partner."

"I'm just not very interested in having sexual relationships."

"II break off relationships if they start to get close."

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* Anhedonia (Lack of Pleasure):

"I often feel like nothing I do really matters."

"I almost never enjoy life."

"Nothing seems to make me feel good."

"Nothing seems to interest me very much."

"I almost never feel happy about my day-to-day activities."

"I rarely get enthusiastic about anything."

"I don't get as much pleasure out of things as others seem to."

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* Restricted Affectivity:

"I don't show emotions strongly."

"I don't get emotional."

"I never show emotions to others."

"I don't have very long-lasting emotional reactions to things."

"People tell me it's difficult to know what I'm feeling."

"I am not a very enthusiastic person."

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("Sociability vs. Detachment" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

EMOTIONAL STABILITY VS. NEGATIVE EMOTION

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Emotional Stability (Calm, Emotionally Stable)

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Description: Emotional Stability is synonymous with being calm and emotionally stable; whereas Negative Emotion is synonymous with being distressed and easily upset. The Emotional Stability dimension measures the "safety vs. danger" behaviors that are central to the concept of COURAGE. Descriptors: Stable, calm, relaxed, contented Ask yourself: "How will I show COURAGE? How will I remain calm and emotionally stable in the face of adversity?"

"I am relaxed, and I handle stress well."

"I am emotionally stable, and not easily upset."

"I remain calm in tense situations."

"I rarely get irritated."

"I keep my emotions under control."

"I rarely lose my composure."

"I am not easily annoyed."

"I seldom feel blue."

"I feel comfortable with myself."

"I rarely feel depressed."

"I am not embarrassed easily."

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Negative Emotion (Distressed, Easily Upset)

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Description: Degree to which people experience persistent negative emotions (anxiety, anger, or depression) and are easily upset. (This could be thought of as high threat sensitivity or low stress tolerance.) Descriptors: Emotional instability, anxiety, irritability, depression, rumination-compulsiveness, self-consciousness, vulnerability MRI Research*: Negative Emotion was associated with increased volume of brain regions associated with threat, punishment, and negative emotions.

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* Emotional Instability:

"I get emotional easily, often for very little reason."

"I get emotional over every little thing."

"My emotions are unpredictable."

"I never know where my emotions will go from moment to moment."

"I am a highly emotional person."

"I have much stronger emotional reactions than almost everyone else."

"My emotions sometimes change for no good reason."

"I get angry easily."

"I get upset easily."

"I change my mood a lot."

"I am a person whose moods go up and down easily."

"I get easily agitated."

"I can be stirred up easily."

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* Anxiousness:

"I worry about almost everything."

"I'm always fearful or on edge about bad things that might happen."

"I always expect the worst to happen."

"I am a very anxious person."

"I get very nervous when I think about the future."

"I often worry that something bad will happen due to mistakes I made in the past."

"I am filled with doubts about things."

"I feel threatened easily."

"I am afraid of many things."

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* Separation Insecurity:

"I fear being alone in life more than anything else."

"I can't stand being left alone, even for a few hours."

"I’d rather be in a bad relationship than be alone."

"I'll do just about anything to keep someone from abandoning me."

"I dread being without someone to love me."

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* Submissiveness:

"I usually do what others think I should do."

"I do what other people tell me to do."

"I change what I do depending on what others want."

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* Perseveration:

"I get stuck on one way of doing things, even when it's clear it won't work."

"I get stuck on things a lot."

"It is hard for me to shift from one activity to another."

"I get fixated on certain things and can’t stop."

"I feel compelled to go on with things even when it makes little sense to do so."

"I keep approaching things the same way, even when it isn’t working."

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* Depression:

"I have no worth as a person."

"Everything seems pointless to me."

"I often feel like a failure."

"The world would be better off if I were dead."

"The future looks really hopeless to me."

"I often feel just miserable."

"I'm very dissatisfied with myself."

"I often feel like nothing I do really matters."

"I know I'll commit suicide sooner or later."

"I talk about suicide a lot."

"I feel guilty much of the time."

"I'm so ashamed by how I've let people down in lots of little ways."

"I am easily discouraged."

"I become overwhelmed by events."

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("Emotional Stability vs. Negative Emotion" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

The Blueprint For Virtue Is Built Into Your DNA

More than 2,300 years ago, ancient Greek philosophers taught that the best way to live was to live a life of virtue. They believed that these virtues were in keeping with the laws of nature.

The main virtues, they believed, were justice, moderation, wisdom, sociability, courage, and physical health.

Psychological research now has shown that these virtues do predict success and good health. It can be argued that these virtues represent basic evolutionary principles that are evident at every level of our existence: physiological, psychological, and social.

DNA, The Basis of Life

First let's examine the chemical basis of life - the DNA molecule.

• The DNA molecule is the foundation of all life on earth. DNA is a double helix molecule that is like a spiral ladder with rungs. Each rung on this ladder consists of 2 base pairs; altogether there are 4 bases used by DNA. These four bases are abbreviated A, T, C, and G. These 4 bases form the "4 letter chemical code" in DNA which stores all the chemical information necessary for life.


• The DNA molecule's spiral ladder has millions of rungs (base pairs). Part of DNA's chemical code is read by messenger RNA (which takes it out of the cell nucleus to the nearby ribosomes who use this code to create proteins). All the DNA chemical code in our 46 chromosomes is estimated to be about 3.2 billion base pairs long.

DNA Replication

• The mutual attraction between opposite bases (G-C and A-T) allows for DNA replication, since the DNA molecule can divide lengthwise into two halves. Then each half can attract the necessary opposite bases to create a complementary new strand of DNA.


• This chemical replication only works because of the mutual attraction between opposite base pairs. This is somewhat like sexual reproduction, which only works because of the mutual attraction between opposite sexes.

Virtues Manifested at The Physiological, Psychological, and Social Levels

• Justice:


• Physiological Level:
  
  Evolutionary principle of adaptation (living in harmony):
  
  In evolution, it is not the smartest or strongest organism that survives; it is the most adaptable. An organism must be able to live in harmony with its environment.
  
  For example, all the cells in a healthy body grow in harmony. Cancer represents the harmful breakdown in these harmonious cellular relationships. Cancer results from mutated DNA that is self-destructive because it causes chaotic, uncontrollable growth which kills the organism and itself.


• Psychological Level:
  
  Social harmony breaks down when individuals act unjustly. Their injustice consists of unfair and harmful violation of the rights of others.
  
  Injustice is more than just being deceitful (e.g., lying, stealing, cheating). Injustice also includes callousness, manipulativeness, hostility, unfounded suspiciousness, and grandiosity (feeling that others are inferior, and thus can be abused/exploited).


• Social Level:
  
  Social injustice occurs when one group unfairly harms another.
  
  Injustice occurs when groups or nations unfairly and harmfully violate the rights of others (e.g., violating human rights, unfair inequality, harmful prejudice, exploitative colonialism, ethnic cleansing, genocide, or initiating war).


• Moderation:


• Physiological Level:
  
  Evolutionary principle of homeostasis:
  
  Life involves constant change, and all organisms evolve ways to moderate these changes to maintain their stability (i.e., homeostasis). The goal of this homeostasis is to maintain optimal conditions for life (i.e., to avoid deficiency or excess).
  
  For example, DNA is self-controlling; it moderates its functioning by turning itself on or off depending upon its environment. Thus, by moderating its own functioning, DNA can better survive environmental change. However, there is a limit to how much change organisms can withstand (e.g., a fish out of water).


• Psychological Level:
  
  Self-control and moderation in all things is the core feature of conscientiousness.
  
  Conscientious individuals have more occupational and social success. They are careful, responsible, hard-working, cautious, focused, and organized. Individuals that are careless, irresponsible, sporadically employed/unemployed, impulsive, easily distracted, and disorganized have much less success in life.


• Social Level:
  
  When a social group or nation loses its self-discipline and moderation, it becomes more politically polarized and disorganized.
  
  This erodes its social cohesiveness. Its leadership becomes irresponsible, careless, indecisive, and impulsive - and eventually the group or nation fails.


• Wisdom:


• Physiological Level:
  
  Evolutionary principle of experimentation and evaluation:
  
  Evolution creates better adapted organisms by using mutation and natural selection.
  
  The sugar-phosphate backbone of DNA preserves the specific order of the rungs on the DNA ladder. Chance mutation causes deletion (or multiplication) of these rungs. Natural selection then determines if the mutated DNA survives better than the original DNA. If so, this mutated DNA creates a more adaptable organism. Without this constant experimentation and evaluation (mutation and natural selection), evolution would stop.
  
  Evolutionary principle of information sharing:
  
  Organisms survive because they genetically share adaptive information from one generation to the next.
  
  For example, all the information needed to create an elephant is coded in its 56 chromosomes. This also includes all the elephant's instinctual behaviors. That's an incredible amount of adaptive information passed by DNA from one generation to the next.
  
  Evolutionary principle of contingency plans:
  
  In evolution, most of the information stored in DNA is contingency plans.
  
  Only a tiny amount of the information stored in DNA's base pairs tells how to make proteins. Far more of the information stored in DNA determines when and where these proteins are to be produced. Thus, DNA stores more information on contingency plans for "when" and "where" to do a task (e.g., produce protein) than it stores information on "how" to do it.
  
  
  From a computer programming viewpoint, DNA stores far more (contingency or conditional) "if ... then ..." commands than it stores "print" (i.e., produce protein) commands. It also appears that DNA stores backup plans ("if ... then ... else ...." commands). It is incredible that one information storing molecule can be so sophisticated!
  
  Evolutionary principle of backup copies:
  
  There is a surprising amount of information on DNA that is stored in duplicate or triplicate.
  
  It is as if the DNA molecule archives important information by storing copies of it on the same molecule.


• Psychological Level:
  
  Wise, open-minded individuals that ask "why?" consistently outperform close-minded individuals that never question "why?". The hallmark of open-minded individuals is their willingness to experiment and make mistakes to learn.
  
  Throughout human history, open-minded, inventive, quick learning individuals prospered better than close-minded, uncreative, and slow learning individuals. Open-minded individuals are more likely to gather intelligence and create contingency plans before they act.
  
  Wise individuals that keep a record of their progress (in diaries, business records, etc.) outperform those individuals that don't keep such records.
  
  Such records allow individuals to look back over the years to analyze their successes and failures. Otherwise, without these backup records, individuals must rely on their notoriously faulty memories.


• Social Level:
  
  War is the greatest threat to civilization and the accumulation of knowledge.
  
  History's Dark Ages occur when wars cause a collapse of civilization. The worst Dark Age occurred at the end of the Bronze Age around 1200 BC. For 40-50 years, war destroyed all the ancient Mediterranean civilizations (except Egypt's, which came close to collapsing). Almost every significant city in the eastern Mediterranean world was destroyed. These cultures (except Egypt) lost their literacy, political organization, and ability to build cities or conduct international trade. Their people barely survived and were forced to return to simple, small village life.


• Sociability:


• Physiological Level:
  
  Evolutionary principle of communal sharing:
  
  Those organisms which communally share adaptive information survive better than solitary organisms.
  
  The genetic sharing of DNA during sexual reproduction increases genetic diversity, which speeds up evolution. Even single-celled organisms, like bacteria, survive better in communal groups (where they can exchange their DNA), rather than surviving as solitary organisms.


• Psychological Level:
  
  Compared to solitary individuals, socially outgoing individuals are more likely to acquire adaptive information from others.
  
  Also, compared to solitary individuals, socially outgoing individuals belong to more social networks; hence are more likely to receive social support in times of need.


• Social Level:
  
  Social groups and nations that freely share adaptive information are the most likely to succeed.
  
  These nations democratically support freedom of speech and of the press, universal education, social equality, social mobility, and social mixing of their members. This social sharing and mixing strengthens the social cohesiveness of these groups and improves their quality of life.


• Courage:


• Physiological Level:
  
  Evolutionary principle of resiliency:
  
  The DNA molecule is extremely stable.
  
  During evolution, natural disasters have caused repeated near-total mass extinctions of all life on earth; yet life has always recovered. Now DNA life forms have spread to virtually every corner of our planet.


• Psychological Level:
  
  Courage involves remaining calm and emotionally stable in the face of adversity.
  
  There is a natural "fight (anger), flight (fear), freeze (depression), or fantasize (delusion)" response in the face of adversity. The individual must adopt the "fight/flight/freeze/fantasize" response that best solves the adversity. Such problem-solving is always enhanced if the individual can remain calm and emotionally stable while facing adversity.


• Social Level:
  
  Historically, "strong man" dictatorial rule has proven to be disastrous because it allowed emotionally unstable leaders to have absolute power.
  
  It is essential that leaders of social groups or nations remain calm and emotionally stable when facing adversity. It is disastrous when leaders base their decisions on personal slight, fear, depression, or delusion. Dictators' idea of courage is to bully their opponents into submission, or to kill them (e.g., the Philippine tyrant, President Rodrigo Duterte, has publicly stated that he has personally killed hundreds of "criminals").


• Physical Health:


• Physiological Level:
  
  Evolutionary principle of requiring survival, but not perfection:
  
  The goal of evolution is to create living organisms - even if they aren't perfect.
  
  Evolution selects for traits that help organisms survive, but doesn’t necessarily find optimal solutions. Thus, evolution has produced many types of organisms - some are in a gray area between living and nonliving (e.g., viruses), the majority are single-celled (e.g., bacteria), and a few are multicellular (e.g., most animals and plants). Evolution's only requirement is that an organism must be able to stay alive and reproduce. It is an error to believe that the sole purpose of evolution is to create more complex or intelligent organisms. In terms of global biomass, single-celled organisms far outweigh multicellular organisms. So, in that sense, evolution has favored single-celled, unintelligent organisms.


• Psychological Level:
  
  Physical health is a good predictor of mental health and longevity.
  
  Often physical exercise and proper diet is just as effective as medication in the treatment of many physical and mental disorders.


• Social Level:
  
  Leading global risks:
  
  The leading global risks for mortality in the world are high blood pressure (responsible for 13% of deaths globally), tobacco use (9%), high blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%).
  
  The leading global risks for burden of disease as measured in disability-adjusted life years (DALYs) are underweight (6% of global DALYs) and unsafe sex (5%), followed by alcohol use (5%) and unsafe water, sanitation, and hygiene (4%).
  
  Thus, proper physical exercise, diet, and self-control (re: tobacco use, alcohol use, and unsafe sex) play a crucial role in decreasing the risk of disability and death.

The "Big 5 Factors" of Personality as Shown In Dogs

The same "Big 5 Factors" of personality found in humans can be found in dogs. This makes sense because dogs, like humans, are a social species.

AGREEABLENESS VS. ANTAGONISM

.

Agreeableness ("Friend")

.

Dog is friendly towards unfamiliar people.

Dog is friendly towards other dogs.

When off leash, dog comes immediately when called.

Dog willingly shares toys with other dogs.

Dog leaves food or objects alone when told to do so.

.

Antagonism ("Foe")

.

Dog is dominant over other dogs.

Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).

Dog behaves aggressively towards unfamiliar people.

Dog shows aggression when nervous or fearful.

Dog aggressively guards coveted items (e.g., stolen item, treats, food bowl).

Dog is quick to sneak out through open doors, gates.

CONSCIENTIOUSNESS VS. DISINHIBITION

.

Conscientiousness ("Self-Controlled")

.

Dog works at tasks (e.g., getting treats out of a dispenser, shredding toys) until entirely finished.

Dog works hard all day herding or pulling a sleigh (if a "working dog" on the farm or in the snow). *

Dog is curious.

.

Disinhibition ("Disinhibited")

.

Dog is boisterous.

Dog seeks constant activity.

Dog is very excitable around other dogs.

OPENNESS TO EXPERIENCE vs. IMPAIRED INTELLECT

.

Open To Experience ("Open-Minded")

.

Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).

.

Closed To Experience ("Closed-Minded")

.

Dog is slow to respond to corrections.

Dog ignores commands.

Dog is slow to learn new tricks or tasks.

SOCIABILITY (EXTRAVERSION) vs. DETACHMENT

.

Sociability ("Approach")

.

Dog is attention seeking (e.g., nuzzling, pawing or jumping up on family members looking for attention and physical contact).*

Dog seeks companionship from people.

Dog is affectionate.

.

Detachment ("Avoidance")

.

Dog is aloof.

Dog gets bored in play quickly.

Dog is lethargic.

EMOTIONAL STABILITY VS. NEGATIVE EMOTION

.

Emotional Stability ("Safety")

.

Dog tends to be calm.

Dog is relaxed when greeting people.

Dog is confident.

Dog adapts easily to new situations and environments.

.

Negative Emotion ("Danger")

.

Dog is anxious.

Dog is shy.

Dog behaves fearfully towards unfamiliar people.

Dog exhibits fearful behaviors when restrained.

Dog avoids other dogs.

Dog behaves fearfully towards other dogs.

Dog behaves submissively (e.g., rolls over, avoids eye contact, licks lips) when greeting other dogs.

.

Modified from Jones, A. C. (2009). Development and validation of a dog personality questionnaire. Ph.D. Thesis. University of Texas, Austin. * New items added by Phillip W. Long MD

Notice the Personality Differences Between Dogs and Humans Dogs and humans are strikingly similar on 4 of the "Big 5 Factors" of personality. However, dogs and humans are quite different on the "Conscientiousness" factor - because the canine brain isn't designed to organize work projects. That's why dogs don't build dog houses. Two of the "Big 5 Factors" of dog personality are clearly a function of dogs being a social species that forms social hierarchies: (1) the "Agreeableness" factor describes "friend vs. foe" behaviors, and (2) the "Sociability" factor describes "approach vs. avoidance" behaviors. The "Openness to Experience" describes the ability to learn from experience. The "Emotional Stability" factor describes "safety vs. danger" behaviors.

The Brain and the "Big-5 Factors" of Human and Dog Personality It could be that the "Big-5 Factors" of personality represent some extremely basic brain functions. For example, when a young man approaches a young woman, she must: (1) decide whether he is friend or foe ["Agreeableness"], (2) decide if this represents safety or danger ["Emotional Stability"], (3) decide whether to approach or avoid him ["Sociability"], (4) decide whether to be self-controlled or disinhibited ["Conscientiousness"], and (5) learn from this experience ["Openness to Experience"].

Symptoms That Are Good Predictors Of Borderline (Emotionally Unstable) Personality Disorder

As well as having unstable emotional functioning and unstable interpersonal functioning; individuals with Borderline Personality Disorder have a poorly developed, or unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness, and dissociative states under stress. Thus the main characteristic of this disorder is its instability.

Borderline Symptoms Which Statistically Best Predict A Diagnosis Of Borderline Personality Disorder

(0.8 Loading) I thought of hurting myself I didn't believe in my right to live I experienced stressful inner tension I hated myself I wanted to punish myself My mood rapidly cycled in terms of anxiety, anger, and depression The idea of death had a certain fascination for me Everything seemed senseless for me I was afraid of losing control (0.7 Loading) It was hard for me to concentrate I felt helpless I was lonely I had images that I was very much afraid of Criticism had a devastating effect on me I felt vulnerable (0.6 Loading) I was absent-minded and unable to remember what I was actually doing I felt disgust I didn't trust other people I suffered from shame I felt disgusted by myself (0.5 Loading) I suffered from voices and noises from inside or outside my head (0.4 Loading) I felt as if I was far away from myself I felt worthless Note: These symptoms suggest that Borderline Personality Disorder is characterized by self-hatred and emotional instability.

Is Borderline Personality Disorder A Developmental Delay?

Borderline personality traits are seen in 10% of male and 18% of female adolescents. In adolescence, abnormal personality traits usually disappear within 2 years. However, 17% of adults display borderline personality traits; thus they did not grow out of their adolescent borderline personality traits. In their twenties, they have the maturity of a young teenager. Thus the question is, what factors prevented these individuals from maturing?

Impulsiveness vs. Conscientiousness

Ozlem Ayduk found that individuals with Borderline Personality Disorder are hypersensitive to rejection and have poor self-control. Their poor self-control was evident on testing even at age 4.

In adulthood, individuals with Borderline Personality Disorder often act like adolescents and do impulsive, harmful activities (e.g., over-spending, reckless sex, substance abuse, reckless driving, binge eating). They want immediate gratification, and act without consideration of future consequences. In personality measurement, reckless impulsiveness is the opposite of conscientiousness. Research has shown that conscientiousness (or "grit") is even more important than intelligence in predicting scholastic and vocational success.

Lack Of Social Skills In Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with Borderline Personality Disorder lack the essential social skills of emotional stability, stable self-image, and social stability. They lack chastity and caution (that are also lacking in individuals with Histrionic Personality Disorder), and lack control of anger (that is also lacking in Antisocial Personality Disorder).

Social Skills That Are Lacking In Borderline Personality Disorder

SOCIAL SKILL	BORDERLINE PERSONALITY	NORMAL
Emotional Stability	Emotional instability (emotions change rapidly and unpredictably)	Having a predictable mood which does not quickly change
Stable Self-Image	Unstable self-image	Being certain about "who-am-I" and "where-am-I-going-in-life"; having meaning & purpose to life
Stable Relationships	Unstable, intense, chaotic relationships	Having a stable and peaceful social life
Chastity	Desire for casual or illicit sex	Avoidance of casual sex ("one night stands") AND absence of intense desire for illicit sex
Caution	Harmful impulsiveness (acting without forethought or concern for consequences)	Thinking carefully before acting or speaking; being cautious
Control of Anger	Hostility (often angry or hostile)	Absence of anger or irritability in response to minor slights; absence of mean or vengeful behavior

Avoidant, borderline, and dependent personality disorders are closely related and can be thought of as forming a "low emotional stability cluster" of personality disorders. On personality testing, these three disorders all have low emotional stability scores.

Social Skills That Are Lacking In The "Low Emotional Stability Cluster" Of Personality Disorders

PERSONALITY DISORDER	LACKING	LACKING	LACKING
Borderline Personality	Emotional Stability (instead has emotional instability)	Stable Self-Image (instead has unstable self-image)	Stable Relationships (instead has intense, chaotic relationships)
Avoidant Personality	Self-Confidence (instead has feeling inferior or shy)	Optimism (instead has pessimism or expecting the worst)	Belonging (instead has fearing rejection by others)
Dependent Personality	Independence (instead has dependence on others)	Extraversion (instead has submissiveness)	Peacemaking (instead has inability to handle conflict)

The "Big 5" Dimensions of Personality and Personality Disorders

There are two free online personality tests that assess your personality in terms of the "Big 5" dimensions of personality. The following diagram shows the relationship between the "Big 5" dimensions of personality and personality disorders. This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G. DeYoung, and Douglas Samuel and Thomas Widiger.

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Personality Disorders Scoring Low On Emotional Stability

In personality testing, individuals with Borderline, Avoidant, or Dependent Personality Disorders often have a low Emotional Stability test score.

Low Emotional Stability test scores are associated with negative emotion (i.e., anxiety, depression and anger). Another name for "low Emotional Stability" is "Negative Emotion".

A Calm, Emotionally Stable Life (Emotional Stability)

How does one live a calm, emotionally stable life?

One approach to answering this question is to study the behavior of individuals who live anxious, emotionally unstable lives. Could the opposite of their maladaptive behavior define how to live a calm, emotionally stable life?

Research has shown that anxiety and emotional instability highly correlates with low scores on the emotional stability personality dimension. The personality disorders that have the lowest scores on the emotional stability personality dimension are the Avoidant, Dependent, and Borderline Personality Disorders.

Could the opposite of the personality traits seen in the Avoidant, Dependent, and Borderline Personality Disorders be a clue as to how to live a calm, emotionally stable life? If so, the right side of the following table would define a calm, emotionally stable life. (This table uses DSM-5 diagnostic criteria.)

Avoidant Personality Disorder	The Opposite Of Avoidant Personality Disorder
Avoidance:	Sociability:
Avoids occupational activities that involve significant interpersonal contact, because of her fear of criticism, disapproval, or rejection	Doesn't avoid occupational activities that involve significant interpersonal contact, because of any fear of criticism, disapproval, or rejection
Is unwilling to get involved with people unless she is certain of being liked	Is willing to get involved with people even if she is uncertain of being liked
Shows restraint within intimate relationships because of her fear of being shamed or ridiculed	Is not reluctant in intimate relationships because of any fear of being shamed or ridiculed
Is preoccupied with being criticized or rejected in social situations	Doesn't worry excessively about being criticized or rejected in social situations
Social Anxiety:	Self-Confidence:
Is inhibited in new interpersonal situations because of her feelings of inadequacy	Is not inhibited in new interpersonal situations because of any feelings of inadequacy
Views herself as socially inept, personally unappealing, or inferior to others	Does not view herself as socially inept, personally unappealing, or inferior to others
Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing	Is not reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
Dependent Personality Disorder	The Opposite Of Dependent Personality Disorder
Dependency:	Independence:
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others	Can make everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of her life	Assumes responsibility for most major areas of her life
Has difficulty expressing disagreement with others because of her fear of loss of support or approval	Can express disagreement with others
Has difficulty initiating projects or doing things on her own	No difficulty initiating projects or doing things on her own
Goes to excessive lengths to obtain nurturance and support from others	Does not go to excessive lengths to obtain nurturance and support from others
Feels uncomfortable or helpless when alone because of her exaggerated fears of being unable to cope	Feels comfortable when alone
Urgently seeks another relationship as a source of care and support when a close relationship ends	Does not urgently seek another relationship as a source of care and support when a close relationship ends
Is unrealistically preoccupied with fears of being left to take care of herself	Is not preoccupied with fears of being left to take care of herself
Borderline (Emotionally Unstable) Personality Disorder	The Opposite Of Borderline Personality Disorder
Emotional Instability:	Emotional Stability:
Rapidly shifting emotions	Stable emotions
Inappropriate, intense anger or difficulty controlling anger	Good anger control
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior	No suicidal behavior, gestures, or threats, or self-mutilating behavior
Chronic feelings of emptiness	Has meaning and purpose to her life
Rule-Breaking:	Rule-Keeping:
Potentially self-damaging impulsivity (e.g., spending, sex, substance abuse, reckless driving, binge eating)	No potentially self-damaging impulsivity
Unstable, Intense, Chaotic Relationships:	Stable Relationships:
Unstable and intense 'love-hate' relationships	Stable, close, long-lasting interpersonal relationships
Frantic efforts to avoid real or imagined abandonment	Can calmly cope with real or imagined abandonment
Markedly and persistently unstable self-image or sense of self	Stable self-image; positive sense of herself

An Anxious, Emotionally Unstable Life (Negative Emotion)

How does one live an anxious, emotionally unstable life?

The following table summarizes the personality traits of individuals with Avoidant, Dependent and Borderline Personality Disorder. Individuals with these low emotional stability personality disorders have marked anxiety or emotional instability. (This table uses ICD-10 diagnostic criteria.)

The Most Anxious and Emotionally Unstable Personality Traits	Examples
Avoidant Personality Traits:
Persistent and pervasive feelings of tension and apprehension.	"I usually feel tense or nervous."
Belief that oneself is socially inept, personally unappealing, or inferior to others.	"I feel awkward or out of place in social situations."
Excessive preoccupation about being criticized or rejected in social situations.	"I worry a lot that people may not like me."
Unwillingness to get involved with people unless certain of being liked.	"I won't get involved with people until I'm certain they like me."
Restrictions in lifestyle because of need of security.	"A lot of things seem dangerous to me that don't bother most people."
Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection.	"I keep to myself even when there are other people around."
Dependent Personality Traits:
Encouraging or allowing others to make most of one's important life decisions.	"I let others make my big decisions for me."
Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes.	"I find it hard to disagree with people if I depend on them a lot."
Unwillingness to make even reasonable demands on the people one depends on.	"I don't ask favors from people that I depend on a lot."
Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself.	"I usually feel uncomfortable or helpless when I'm alone."
Preoccupation with fears of being left to take care of oneself.	"I worry about being left alone and having to care for myself."
Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.	"I often seek advice or reassurance about everyday decisions."
Borderline Personality Traits:
A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized	"I argue or fight when people try to stop me from doing what I want."
A marked tendency to act unexpectedly and without consideration of the consequences	"I take chances and do reckless things."
Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions	"Sometimes I get so angry I break or smash things."
Difficulty in maintaining any course of action that offers no immediate reward	"I don't stick with a plan if I don't get results right away."
Unstable and capricious mood	"I'm very moody."
Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual)	"I can't decide what kind of person I want to be."
Liability to become involved in intense and unstable relationships, often leading to emotional crises	"I get into very intense relationships that don't last."
Excessive efforts to avoid abandonment	"I go to extremes to try to keep people from leaving me."
Recurrent threats or acts of self-harm	"A number of times, I've threatened suicide or injured myself on purpose."
Chronic feelings of emptiness	"I often feel empty inside."

Primate Evolution

There appears to be three different ways in which primates have evolved socially:

• The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.


• In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.


• Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

Questions To Ask When Setting Goals

In The Past Week:

• WHO: was your problem?


• EVENT: what did he/she do?


• RESPONSE: how did you respond to that event?


• OUTCOME: did your response help?


• TRIGGER: what did you do that could have triggered this problem?


• GOAL: what life skill(s) do you have to work on? (from checklist)

Example Of Setting Goals In Interviewing A Person With Borderline Personality Disorder

In The Past Week:

• WHO: was your problem?
  "My husband."


• EVENT: what did he/she do?
  "My husband is always angry at me, and is turning our children against me."


• RESPONSE: how did you respond to that event?
  "I stood my ground and yelled back at him."


• OUTCOME: did your response help?
  "No, my kids can't take all this fighting. I think our marriage is nearly over."


• TRIGGER: what did you do that could have triggered this problem?
  "Ever since my husband found out about my affair; he's been impossible to live with."


• GOAL: what life skill(s) do you have to work on? (from checklist)
  "I want to work on: (1) Social Stability ("having a stable and peaceful social life"), and (2) Stable Self-Image ("being certain about "who-am-I" and "where-am-I-going-in-life"; having meaning & purpose to life")."

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Moderate to Severe Depression Must Be Ruled Out

Medical causation must be ruled out

Suicidal risk must be assessed and treated

Psychosocial treatment

World Health Organization mhGAP Intervention Guide

Treatment Guidelines

• Borderline Disorder Treatment Guidelines


• Borderline personality disorder: treatment and management. - National Institute for Health and Clinical Excellence (NICE); 2009

Treatment

Borderline personality disorder: Treatment and management - Summarized From NICE (UK) Guidelines (2009)

The management of crises

Principles and general management of crises

When a person with borderline personality disorder presents during a crisis, consult the crisis plan and:

• maintain a calm and non-threatening attitude




• try to understand the crisis from the person's point of view




• explore the person's reasons for distress




• use empathic open questioning, including validating statements, to identify the onset and the course of the current problems




• seek to stimulate reflection about solutions




• avoid minimising the person's stated reasons for the crisis




• refrain from offering solutions before receiving full clarification of the problems




• explore other options before considering admission to a crisis unit or inpatient admission




• offer appropriate follow-up within a time frame agreed with the person.

Drug treatment during crises

Short-term use of drug treatments may be helpful for people with borderline personality disorder during a crisis.

Before starting short-term drug treatments for people with borderline personality disorder during a crisis:

• ensure that there is consensus among prescribers and other involved professionals about the drug used and that the primary prescriber is identified




• establish likely risks of prescribing, including alcohol and illicit drug use




• take account of the psychological role of prescribing (both for the individual and for the prescriber) and the impact that prescribing decisions may have on the therapeutic relationship and the overall care plan, including long-term treatment strategies




• ensure that a drug is not used in place of other more appropriate interventions




• use a single drug




• avoid polypharmacy whenever possible.

When prescribing short-term drug treatment for people with borderline personality disorder in a crisis:

• choose a drug (such as a sedative antihistamine^[3]) that has a low side-effect profile, low addictive properties, minimum potential for misuse and relative safety in overdose




• use the minimum effective dose




• prescribe fewer tablets more frequently if there is a significant risk of overdose




• agree with the person the target symptoms, monitoring arrangements and anticipated duration of treatment




• agree with the person a plan for adherence




• discontinue a drug after a trial period if the target symptoms do not improve




• consider alternative treatments, including psychological treatments, if target symptoms do not improve or the level of risk does not diminish




• arrange an appointment to review the overall care plan, including pharmacological and other treatments, after the crisis has subsided.

Follow-up after a crisis

After a crisis has resolved or subsided, ensure that crisis plans, and if necessary the overall care plan, are updated as soon as possible to reflect current concerns and identify which treatment strategies have proved helpful. This should be done in conjunction with the person with borderline personality disorder and their family or carers if possible, and should include:

• a review of the crisis and its antecedents, taking into account environmental, personal and relationship factors




• a review of drug treatment, including benefits, side effects, any safety concerns and role in the overall treatment strategy




• a plan to stop drug treatment begun during a crisis, usually within 1 week




• a review of psychological treatments, including their role in the overall treatment strategy and their possible role in precipitating the crisis.

If drug treatment started during a crisis cannot be stopped within 1 week, there should be a regular review of the drug to monitor effectiveness, side effects, misuse and dependency. The frequency of the review should be agreed with the person and recorded in the overall care plan.

The management of insomnia

Provide people with borderline personality disorder who have sleep problems with general advice about sleep hygiene, including having a bedtime routine, avoiding caffeine, reducing activities likely to defer sleep (such as watching violent or exciting television programmes or films), and employing activities that may encourage sleep.

Be aware of the potential for misuse of many of the drugs used for insomnia and consider other drugs such as sedative antihistamines.

Discharge to primary care

When discharging a person with borderline personality disorder from secondary care to primary care, discuss the process with them and, whenever possible, their family or carers beforehand. Agree a care plan that specifies the steps they can take to try to manage their distress, how to cope with future crises and how to re-engage with community mental health services if needed. Inform the GP.

Inpatient services

Before considering admission to an acute psychiatric inpatient unit for a person with borderline personality disorder, first refer them to a crisis resolution and home treatment team or other locally available alternative to admission.

• the management of crises involving significant risk to self or others that cannot be managed within other services, or




• detention under the Mental Health Act (for any reason).

When considering inpatient care for a person with borderline personality disorder, actively involve them in the decision and:

• ensure the decision is based on an explicit, joint understanding of the potential benefits and likely harm that may result from admission




• agree the length and purpose of the admission in advance




• ensure that when, in extreme circumstances, compulsory treatment is used, management on a voluntary basis is resumed at the earliest opportunity.

Arrange a formal CPA review for people with borderline personality disorder who have been admitted twice or more in the previous 6 months.

Ensure that young people with severe borderline personality disorder have access to tier 4 specialist services if required, which may include:

• inpatient treatment tailored to the needs of young people with borderline personality disorder




• specialist outpatient programmes




• home treatment teams.

• Patients with Borderline Personality Disorder in Emergency Departments - Frontiers In Psychiatry 2017
  For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. The effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.


• Psychosocial interventions for self-harm in adults - Cochrane Database of Systematic Reviews 2016
  Cognitive Behavioral Therapy can result in fewer individuals repeating self-harm; however, the quality of this evidence ranged between moderate and low. Dialectical behaviour therapy for people with multiple episodes of self-harm/probable personality disorder may lead to a reduction in frequency of self-harm, but this finding is based on low quality evidence. Case management and remote contact interventions did not appear to have any benefits in terms of reducing repetition of self-harm. Other therapeutic approaches were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to these interventions is inconclusive.


• Pharmacological interventions for self-harm in adults - Cochrane Database of Systematic Reviews 2015
  Given the low or very low quality of the available evidence, and the small number of trials identified, it is not possible to make firm conclusions regarding pharmacological interventions in self-harm patients.


• Interventions for self-harm in children and adolescents - Cochrane Database of Systematic Reviews 2015
  The quality of evidence was mostly very low. There is little support for the effectiveness of group-based psychotherapy for adolescents with multiple episodes of self-harm based on the results of three trials, the evidence from which was of very low quality. Results for therapeutic assessment, mentalisation, and dialectical behaviour therapy indicated that these approaches warrant further evaluation. Despite the scale of the problem of self-harm in children and adolescents there is a paucity of evidence of effective interventions.


• Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting - Behavior Research and Therapy 2013
  The effectiveness of dialectical behavior therapy was assessed for 1423 consecutively admitted inpatients with Borderline Personality Disorder. At the end of the 3-month inpatient treatment; approximately 15% had a full remission (i.e., showed a symptom level equivalent to that of the general population), 45% had a partial remission, 31% remained unchanged, and 11% deteriorated.


• Psychological therapies for people with borderline personality disorder - Cochrane Database of Systematic Reviews 2012
  There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for borderline personality disorder core pathology and associated general psychopathology. However, none of the treatments has a very robust evidence base.


• Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study - American Journal of Psychiatry 2012
  Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. However, by the time of the 16-year follow-up assessment, both groups had achieved similarly high rates of remission (range for borderline patients: 78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery (40%-60% compared with 75%-85%). In contrast, symptomatic recurrence and loss of recovery occurred more rapidly and at substantially higher rates among borderline patients than axis II comparison subjects (recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared with 9%-28%).


• Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up - American Journal of Psychiatry 2012
  "Both treatment groups showed similar and statistically significant improvements on the majority of outcomes 2 years after discharge. The original effects of treatment did not diminish for any outcome domain, including suicidal and nonsuicidal self-injurious behaviors. Further improvements were seen on measures of depression, interpersonal functioning, and anger. However, even though two-thirds of the participants achieved diagnostic remission and significant increases in quality of life, 53% were neither employed nor in school, and 39% were receiving psychiatric disability support after 36 months."


• Crisis interventions for people with borderline personality disorder - Cochrane Database of Systematic Reviews 2012
  A comprehensive search of the literature showed that currently there is no RCT-based evidence for the management of acute crises in people with BPD and therefore we could not reach any conclusions about the effectiveness of any single crisis intervention.


• Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study - American Journal of Psychiatry 2010
  50% of participants achieved recovery from borderline personality disorder, which was defined as remission of symptoms and having good social and vocational functioning during the previous 2 years. Overall, 93% of participants attained a remission of symptoms lasting at least 2 years, and 86% attained a sustained remission lasting at least 4 years. Of those who achieved recovery, 34% lost their recovery.


• Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling - Journal of Consulting and Clinical Psychology 2010
  Based on 16 studies, the dropout rate was 27.3% pre- to posttreatment.


• Drug treatment for borderline personality disorder - Cochrane Database of Systematic Reviews 2010
  Total borderline personality disorder severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment.


• Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder - Cochrane Database of Systematic Reviews 2006
  Subjects receiving dialectical behavior therapy (DBT) were half as likely to make a suicide attempt, required less hospitalization for suicide ideation, and had lower medical risk across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment and had fewer psychiatric hospitalizations and psychiatric emergency department visits.


• Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years - Journal of Personality Disorders 2005
  The psychosocial functioning of borderline patients improved substantially over time, with the percentage meeting criteria for good overall psychosocial functioning increasing from 26% at baseline to 56% at 6-year followup.


• A 27-year follow-up of patients with borderline personality disorder - Comprehensive Psychiatry 2001
  Of the original 64 patients, only 5 (7.8%) still met the diagnostic criteria for borderline personality disorder, but 10.3% had committed suicide.

Note: One glance at how Antisocial, Borderline and Narcissistic Personality Disorder overlap will illustrate how difficult it is to treat these disorders.

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Videos

• Automatic Thoughts


• Cognitive Behavioral Tools

Borderline Personality Disorder Self-Help Resources

• Borderline Personaity Disorder Self-Help - Google


• Borderline Personality Disorder: Family Guidelines - Multiple Family Group Program at McLean Hospital


• Facing Your Feelings: Overcoming Distress Intolerance - Centre For Clinical Interventions (Australia)


• DBT Self-Help - Dialectal Behavior Therapy self-help website

Depression Self-Help Resources Relevant to Borderline Personality Disorder

• Treatment Information For Consumers - Center for Clinical Interventions - Australia


• Back From The Blues: Coping With Depression - Centre For Clinical Interventions (Australia)


• Improving Self-Esteem: Overcoming Low Self-Esteem - Centre For Clinical Interventions (Australia)


• Antidepressant Skills Workbook: Helping You Deal With Depression - Centre for Applied Research in Mental Health and Addiction (Canada)


• Antidepressant Skills At Work: Dealing with Mood Problems in the Workplace - Simon Fraser University, British Columbia, Canada


• Living Life To The Full - (interactive online course) Scottish Executive Health Department


• Living With Clinical Depression - NHS choices (UK)


• MoodGYM - (10+ hour interactive online course for teens and young adults) Australian National University


• Recognizing the Warning Signs and Symptoms of Depression


• Self-Help and Coping Tips to Overcome Depression

Self-Blaming vs. Self-Compassion

Some individuals are constantly at war with themselves.

They believe: "I am stupid", "I am a failure", "Nothing goes right for me". They constantly analyze themselves and their behavior for flaws. They are cynical and pessimistic. Because of their gloomy, depressed or angry mood, they withdraw and socially isolate themselves. This lack of cooperation with others makes them feel even more hopeless, depressed or angry.

These individuals are at a high risk for developing Persistent Depressive Disorder or Major Depressive Disorder. Healthy people are self-confident, optimistic, sociable, and feel accepted and supported by friends. Individuals suffering from excessive self-blaming are pessimistic, socially withdrawn, and feel rejected by others.

If you suffer from excessive self-blaming; here are ways you can remedy this by learning increased self-compassion and social cooperation:

• Self-Confidence vs. Self-Blaming:
  You must be kind towards yourself, instead of always blaming yourself for everything. Accept and love yourself for who you are - with all your human imperfections. You must strive to have a good opinion of yourself and your abilities, and to be socially confident. Quit constantly comparing yourself to others.


• Optimism vs. Pessimism:
  Strive to replace your unrealistic, pessimistic, negative thinking with more realistic, optimistic, positive thinking.


• Sociability vs. Social Withdrawal:
  In order to feel good, you have to do good. Thus to feel better, you have to get out and help others (and remember to frequently smile).


• Feeling Accepted vs. Feeling Rejected:
  You can not control how other people behave towards you. All you can do is control how you behave towards other people. Much of your life is not under your control; hence you can not change it. You are only responsible for the small part of your life which is under your control - the part you can change. Thus remain friendly and out-going - especially towards people that haven't accepted you.

Improving Positive Behavior

Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

This habit of planning the day in the morning, then assessing these plans in the evening has been shown to increase health and happiness. There is an additional benefit from doing a weekly review of your life satisfaction.

Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.

International Space Station (For Meditation)



Planning My Day (5-Minute Meditation Video)

Planning My Day (Picture)



Reviewing My Day Or Week (5-Minute Meditation Video)



Life Satisfaction Scale (Video)



Healthy Social Behaviors Scale (Video)



Mental Health Scale (Video)



The Philosophy Of Stoicism (5 minute video)

Stoicism 101 (52 minute video)



The Roman emperor and Stoic philosopher Marcus Aurelius ruled from 161 to 180 A.D.

An Example Of Mindfulness Meditation (10 minute video)

In the 5th century BCE, Buddha spent 6 years of his life mastering mindfulness meditation. He then decided to look beyond meditation. Buddha concluded that simply emptying the mind of thought is calming, but otherwise it accomplishes little - since "You return to the same world". Instead, Buddha taught that we should change our world by seeking enlightenment through practicing compassion, and living a calm, peaceful, happy life.

7-Minute Workout Is All You Need To Get Back Into Physical Shape

Click Here For More Self-Help

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• The best summary on bad research is given by Laura Arnold in this Tedx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!


• Criteria For High Quality Research Studies

It is imperative that medical researchers conduct high quality research studies, otherwise the US Food and Drug Administration (FDA) refuses to licence their new drug or therapy. In 2009, the cost of successfully licensing one new drug or therapy under the FDA scheme was estimated to be US$1,000 million. Thus psychiatric research which leads to FDA approval of a new drug or therapy has to be of the highest quality; however the majority of psychological research studies on new therapies fail to reach these high standards for research. This could explain why two-thirds of psychological research studies can't be replicated. High quality research must meet the following criteria:


• Randomized Controlled Trial:
  Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).


• Representative Sample:
  Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).


• Single Blind Trial:
  Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).


• Double Blind Trial (Better Than Single Blind Trial):
  Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.


• Baseline Comparability:
  Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.


• Confounding Factors:
  Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.


• Intervention Integrity:
  Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).


• Statistical analysis:
  Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.
  
  Ask: Are the results both statistically significant and clinically significant? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention). In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).
  
  
  Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.
  
  Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)
  
  Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”
  
  Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.


• Completeness of follow-up data:
  Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.


• Handling of missing data:
  Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.


• Replication of Findings:
  Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).


• Fraud:
  Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size (n), mean (M) and standard deviation (SD) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:
  
  
  • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean (M) is defined as "the sum (Sum) of the values of each observation divided by the total number (n) of observations". So: M = Sum/n. Thus: (Sum) = (M) multiplied by (n). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate (M) multiplied by (n). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean (M) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value, and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)
  
  
  • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible for a (normally distributed) strictly positive variable (because the "cooked" M and SD would mathematically require the strictly positive variable's range of data to include negative numbers). For a normally distributed sample of size of 25-70, this occurs when the SD is greater than one-half of the M; for a sample size of 70+, this occurs when the SD is greater than one-third of the M [using these formulas].
  
  
  • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).
  
  
  • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).
  
  
  • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).
  
  
  • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.
  
  
  • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.
  
  
  • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.
  
  
• Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!


• Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999


• Not All Scientific Studies Are Created Equal - video


• The efficacy of psychological, educational, and behavioral treatment


• Estimating the reproducibility of psychological science


• Psychologists grapple with validity of research


• Industry sponsorship and research outcome (Review) - Cochrane Library


• 'We've been deceived': Many clinical trial results are never published - (text and video)


• Junk science misleading doctors and researchers


• Junk science under spotlight after controversial firm buys Canadian journals


• Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?


• When Evidence Says No, But Doctors Say Yes

Research Topics

Borderline (Emotionally Unstable) Personality Disorder - Latest Research (2016-2017)

• Amitriptyline


• Amphetamine


• Amphetamine (extended release)


• Aripiprazole


• Atomoxetine


• Bupropion


• Carbamazepine


• Citalopram


• Clozapine


• Cognitive Behaviorial Therapy


• Complications


• Combination Therapy


• Crime


• Desipramine


• Dexmethylphenidate


• Dexmethylphenidate (extended release)


• Dextroamphetamine


• Diagnosis


• Diagnostic Criteria


• Doxepin


• Drug Therapy


• Drug Therapy: randomized controlled trial


• Drug Therapy: multicenter randomized controlled trial


• Drug Therapy: placebo-controlled randomized controlled trial


• Economic Impact


• Education


• Electroconvulsive Therapy


• Embryology


• Enzymology


• Epidemiology


• Escitalopram


• Etiology


• Family History


• Fluoxetine


• Fluvoxamine


• Genetics


• Haloperidol


• Imipramine


• Immunology


• Lamotrigine


• Lisdexamfetamine dimesylate


• Lithium


• Metabolism


• Methamphetamine


• Methylphenidate


• Methylphenidate (extended release)


• Methylphenidate (long acting)
Methylphenidate patch

• Microbiology


• Mirtazapine


• Mortality


• Nortriptyline


• Olanzapine


• Paroxetine


• Pathology


• Personality


• Phenytoin


• Physiology


• Psychoeducation


• Psychology


• Quetiapine


• Quality of Life


• Radiography


• Rehabilitation


• Risperidone


• Sertraline


• Stress


• Sulpiride


• Therapy


• Tranylcypromine


• Trazodone


• Trauma


• Valproate, Valproic Acid, Divalproex Sodium


• Venlafaxine


• Virology


• Ziprasidone

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