Internet Mental Health

BORDERLINE PERSONALITY DISORDER




Diagnostic Features of Borderline (Emotionally Unstable) Personality Disorder

SYMPTOM DEFINITION SELF-DESCRIPTION
EMOTIONAL DISTRESS
Emotional Instability Unstable emotions that are easily aroused, intense, and / or out of proportion to events "I get emotional easily, often for very little reason."
Unstable Self-Image Having unstable self-image (“who-am-I”) or self-direction (instability in values or career plans) "I often wonder who I am or what is the meaning or purpose of my life."
Social Instability Having a pattern of unstable and intense social relationships "My social relationships are intense and unstable."
Separation Anxiety Feeling uncomfortable or helpless when alone or when separated from caretakers "I fear being alone in life more than anything else."
Depressed Mood Feeling down, depressed, or hopeless "I often feel down, depressed, or hopeless."
Self-Harm Having thoughts of deliberate self-harm or suicide OR showing severe self-neglect "Sometimes I feel like hurting or killing myself."
ANTAGONISM
Hostility Using threats or force against others; being verbally abusive, bullying, mean, or vengeful "I argue or fight when people try to stop me from doing what I want."
DISINHIBITION
Impulsivity Acting suddenly or rashly without a plan or consideration of the consequences "I feel like I act totally on impulse." "I'm not good at planning ahead."
Reckless risk taking Doing unnecessary, risky, dangerous activities, without regard for self-damaging consequences "People would describe me as reckless."
IMPAIRED INTELLECT
Transient Dissociative States Having odd or unusual perceptions e.g. feeling unreal, things looking unreal, out-of-body feeling "I often 'zone out' and then suddenly come to and realize that a lot of time has passed.

Core Features of Personality Disorders:

The general requirements for the diagnosis of a personality disorder are:

  • a pervasive pattern of maladaptive traits and behaviours

  • beginning in early adult life

    • it usually has its first manifestations in childhood and is clearly evident in adolescence

    • it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood

  • leading to substantial personal distress and/or social dysfunction, and disruption to others

  • is of long duration, typically lasting at least several years

Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

  • Mild Personality Disorder: There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others .

  • Moderate Personality Disorder: There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life .

  • Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The individual's general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life .

Onset:

Typical features of borderline personality disorder are instability (of self-image, personal goals, interpersonal relationships, and emotions), accompanied by impulsivity, risk taking, and/or hostility. Borderline Personality Disorder occurs in between 1.6% to 5.9% of the U.S. population. It's prevalance is 6% in primary care settings, 10% in outpatient mental health clinics, and 20% in psychiatric inpatients.

For this diagnosis to be given, the individual must be at least in early adulthood. This disorder is only diagnosed when these behaviors become persistent and very disabling or harmful to others.

Both Borderline Personality Disorder and Cyclothymic Disorder have marked shifts in mood. If the criteria are met for each disorder, both Borderline Personality Disorder and Cyclothymic Disorder may be diagnosed.

In clinical practice, "personality disorder is seldom diagnosed and accounts for less than 5% of all hospital admissions. Those who are diagnosed are almost always assigned the categories of borderline, antisocial, or not otherwise specified. Those who repeatedly self-harm are automatically given a diagnosis of borderline personality disorder and those who are aggressive and have a history of offending behaviour are given a diagnosis of antisocial personality disorder, irrespective of the complexity of their issues."

Treatment:

There is insufficient (randomized controlled trial) evidence to prove the effectiveness of any medication for adults with this disorder. However, research shows that Dialectical Behaviour Therapy is helpful for people with Borderline Personality Disorder. Effects included a decrease in inappropriate anger, a reduction in self-harm and an improvement in general functioning. 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. There are too few studies to allow firm conclusions to be drawn about other psychological therapies for Borderline Personality Disorder.

Prognosis:

Borderline Personality Disorder can persist for a lifetime. At 7 to 10 years follow-up, half of patients with BPD had achieved a symptomatic remission (i.e., would no longer be diagnosed as having this disorder). Unfortunately, full recovery (having stable relationships and full-time employment - as well as having no symptoms) takes much longer. After 10 years, only about 20% have stable relationships or full-time employment. A 10-year hospital discharge follow-up study of former inpatients with this disorder found that (depending on the follow-up year) 41% to 52% were receiving social security disability income (SSDI).

At 16-year follow-up of this same group, 78%-99% had achieved a symptomatic remission, but only 40%-60% were assessed as fully recovered.

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 ... 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%."

Individuals with this disorder often have substance use disorders, mood disorders, anxiety disorders, and other personality disorders.

Morbidity and Mortality:

"People with personality disorder have far higher morbidity and mortality than do those without. Life expectancy at birth is shorter by 19 years for women and 18 years for men than it is in the general UK population. Increased mortality can be explained partly by increased incidence of suicide and homicide in people with personality disorder. However, increased mortality from cardiovascular and respiratory diseases suggest that other factors are also important. Difficulties in interpersonal relationships, which lie at the heart of personality disorder, might have an effect on relationships with health-care professionals, resulting in misunderstandings, miscommunication, and poor quality care. Lifestyle factors are probably also important, with high prevalence of smoking, alcohol, and drug misuse in people with personality disorders."

Physical Illness:

Borderline Personality Disorder is significantly associated with arteriosclerosis or hypertension, hepatic disease, cardiovascular disease, gastrointestinal disease, arthritis, venereal disease, and "any assessed medical condition".

SAPAS Personality Screening Test

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

Most of the time and in most situations:

      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?

Answer "Yes" or "No" to each of these 8 questions.


7-Question Well-Being Screening Test (By P. W. Long MD, 2020

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

      Agreeableness:I was kind and honest. (Instead had hostility)
      Conscientiousness: I was diligent and self-disciplined. (Instead had impulsivity, reckless risk taking)
      Openness/Intellect: I showed good reasoning and learning ability. (Instead had transient, stress-related paranoid ideation and severe dissociative symptoms)
      Sociality: I was gregarious, enthusiastic, and assertive.
      Emotional Stability: I was emotionally stable and calm. (Instead had emotional instability, unstable self-image, social instability, separation anxiety, depressed mood, self-harm)
      Physical Health: I was physically healthy.
      Socio-Occupational Functioning: I functioned well in my social relationships and work. (Instead had significant impairment in social, academic, or occupational functioning.)

How often in the past week did you do each of these 7 behaviors:


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Diagnose Borderline (Emotionally Unstable) Personality Disorder

Diagnose All Personality Disorders

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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Diagnostic Features

"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 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" (ICD10). It is "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts" (DSM-5)

In terms of the "Big-6" Dimensions of Mental Health this disorder is characterized by emotional distress (emotional instability, depressed mood, separation anxiety, self-harm, unstable self-image, and social instability), antagonism (hostility), disinhibition (impulsivity, reckless risk taking), and impaired intellect (transient dissociative states). This leads to substantial personal distress and/or social dysfunction, and disruption to others.

This is not diagnosed before early adulthood because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood. This disorder is of long duration, typically lasting at least several years.

The diagnosis requires having 5 (or more) of the following:

  • 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.

Like all personality disorders, Borderline (Emotionally Unstable) Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

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 shifts, impulsivity, and hostility are normal in childhood and early adolescence, but disappear with maturity. However, in Borderline Personality Disorder, rapid mood shifts, impulsivity, and hostility intensifies in adolescence and persists into adulthood. 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.

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).

Course

By 7 to 10 years' follow-up, half of patients with BPD had achieved a symptomatic remission (i.e., would no longer be diagnosed as having this disorder). Unfortunately, full recovery (having stable relationships and full-time employment - as well as having no symptoms) takes much longer. After 10 years, only about 20% have stable relationships or full-time employment. 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, but only 40%-60% were assessed as fully recovered. 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 ... 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.

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.

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.

Trustworthy Research (PubMed.gov)



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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.


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(USE SLIDER ON RIGHT SIDE OF THE ABOVE PAGE TO SEE FULL CHECKLIST)



This disorder is characterized by pathological personality traits in the following domains:

  • Antagonism , characterized by:

    • Hostility:
      Having angry outbursts; being verbally abusive; having mean, bullying, or vengeful behavior.
      Question: "Has your temper gotten you into trouble? Do you insult people? Do you argue or fight when people try to stop you from doing what you want?"
      • "Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)." (DSM-5)
      • "Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions." (ICD-10)
      • "A marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized." (ICD-10)

  • Disinhibition , characterized by:

    • Impulsivity and Reckless Risk Taking:
      Acting suddenly or rashly without a plan or consideration of the consequences.
      Question: "Do you like doing things that are risky or dangerous? Do you often disregard your safety or that of others? Are you easily distracted so you don't carry out your plans? Do you ofen get into trouble because you act without thinking ahead? Do you have problems with impulsive behavior - like over-spending, risky sexual behavior, substance abuse, reckless driving, or binge eating?"
      • "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.)" (DSM-5)
      • "A marked tendency to act unexpectedly and without consideration of the consequences." (ICD-10)

  • Impaired Intellect , characterized by:

    • Perceptual Dysregulation:
      Having odd or unusual perceptions e.g. feeling unreal, things looking unreal, out-of-body feeling.
      Question: "Do you often feel empty inside? Do you sometimes feel paranoid or like you are losing touch with reality?"
      • "Transient, stress-related paranoid ideation or severe dissociative symptoms." (DSM-5)
      • "Chronic feelings of emptiness." (DSM-5 and ICD-10)
      • Stress-related dissociative states, including depersonalization, derealization, analgesia, and emotional numbing, are a clinical hallmark of borderline personality disorder (BPD), occurring in about 75–80% of patients." Functional neuroimaging studies have shown this is associated with altered functioning in the fronto-limbic regions and temporoparietal areas of the brain.

  • Emotional Distress , characterized by:

    • Emotional Instability:
      Having unstable emotions with frequent mood changes; over-reacting with intense emotions.
      Question: "Are you very moody? Do minor events cause major shifts in moods? Do you have severe mood swings several times a day?"
      • "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)." (DSM-5)
      • "Unstable and capricious mood." (ICD-10)

    • Unstable Self-Image:
      Having unstable: self-image (“who-am-I”), core personal values, life goals and career plans.
      Question: "Can you not decide what kind of person you want to be? Do you have extreme changes in how you see yourself - like shifting from feeling confident about who you are to feeling like you are evil or that you don’t even exist?"
      • "Identity disturbance: markedly and persistently unstable self-image or sense of self." (DSM-5)
      • "Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual)." (ICD-10)
      • "Difficulty in maintaining any course of action that offers no immediate reward." (ICD-10)

    • Social Instability:
      Having a pattern of unstable and intense social relationships.
      Question: "Do you get into very intense relationships that don't last? Do you have major shifts in your opinions about others such as switching from believing someone is a loyal friend or partner to believing the person is untrustworthy and hurtful?"
      • "A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation." (DSM-5)
      • "Liability to become involved in intense and unstable relationships, often leading to emotional crises." (ICD-10)

    • Separation anxiety:
      Finding it difficult to handle separation or rejection from significant others.
      Question: "Do you worry a lot that someone important in your life is tired of you or is planning to leave you? Do you go to extremes to try to keep someone from leaving you?"
      • "Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior here.)" (DSM-5)
      • "Excessive efforts to avoid abandonment." (ICD-10)

    • Depressed Mood and Self-Harm:
      Having thoughts of deliberate self-harm or suicide OR showing severe self-neglect.
      Question: "Do you ever feel suicidal? Have you ever threatened suicide or injured yourself on purpose?"
      • "Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior." (DSM-5)
      • "Recurrent threats or acts of self-harm." (ICD-10)



(Note: Recovery = symptomatic remission + full-time gainful employment + weekly contact with friends)




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 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

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

  • 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 Narcissistic, Borderline and Antisocial 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.

    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 Narcissistic, Borderline and Antisocial 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 Narcissistic, Borderline and Antisocial 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 Having 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.

    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

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    • 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

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    • 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

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    • 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

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    • I suffered from voices and noises from inside or outside my head

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    • 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.

    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

    An Anxious, Emotionally Unstable Life (Emotional Distress)

    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 emotional distress personality disorders have marked anxiety or emotional instability. (This table uses ICD-10 diagnostic criteria.)

    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."

    A Emotionally Stable Life (Emotional Stability)

    How does one live a 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 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 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: Sociality:
    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
    Impulsivity: Caution:
    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


    Back to top



    Treatment

    Major Depressive Disorder Must Be Ruled Out






    Borderline (Emotionally Unstable) Personality Disorder can present with suicidal behavior; hence the following treatment protocal for suicide is important.







    The following are general principles applicable to the treatment of every disorder.











    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.

    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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    Videos

    Borderline Personality Disorder Self-Help Resources

    Depression Self-Help Resources Relevant to Borderline Personality Disorder

    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.

    • Sociality 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.

    Monitoring Your Progress

    NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

    The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



    Life Satisfaction Scale (5-Minute Video)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

    This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



    Desiderata (5-Minute Video)



    The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



    The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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      "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

      Lord Kelvin (1824 – 1907)


    • 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!

    • Economist in grim battle against deceptive scholarship

    • List of Predatory Journals and Publishers

    • The power of asking "what if?"

    • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

    • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn'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? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

        For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

        Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

        When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

        When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

        The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

          Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

        The statistical summary 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.

        • 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


    • Cochrane Collaboration - the best evidence-based, standardized reviews available

    Research Topics

    Borderline Personality Disorder - Core Clinical Journals

    Borderline Personality - All Journals

    Borderline Personality - Review Articles - Core Clinical Journals

    Borderline Personality - Review Articles - All Journals

    Borderline Personality Disorder - Treatment - Core Clinical Journals

    Borderline Personality Disorder - Treatment - All Journals

    Recommended Free Full Text Articles


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    Normal Distribution Of Human Attributes

    Regression to the Mean (Or Why Scientific Experiments Require A Control Group)

    The "Big 6" Dimensions of Mental Health

    Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

    This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

    The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    Which "Big 6" Dimensions of Mental Health are Impaired in Borderline Personality Disorder?

    THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THIS DISORDER
    Agreeableness
    Being kind and honest.
    Antagonism
    Being unkind or dishonest.
          Antagonism
    Conscientiousness
    Being diligent and self-disciplined.
    Disinhibition
    Being distractible, impulsive, or undisciplined.
          Disinhibition
    Openness/Intellect
    Showing good reasoning or learning ability.
    Impaired Intellect
    Showing poor reasoning or learning ability.
          Impaired Intellect
    Extraversion
    Being gregarious, assertive and enthusiastic.
    Detachment
    Being detached, unassertive, and unenthusiastic.
    Emotional Stability
    Being emotionally stable and calm.
    Emotional Distress
    Being emotionally unstable/distressed.
          Emotional Distress
    Physical Health
    Being physically fit and healthy.
    Physical Symptoms
    Being physically unfit or ill.






    The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder

    The problems that are characteristic of this disorder are highlighted with this pink background color.


    AGREEABLENESS VS. ANTAGONISM

    AGREEABLENESS (Helping Others)
    Description: Agreeableness is synonymous with compassion and politeness. Compassion reflects empathy, sympathy, and caring for others. Politeness reflects respect for others. Individuals with high Agreeableness do not hold grudges, are lenient in judging others, are willing to compromise and cooperate with others, and can easily control their temper. The Agreeableness dimension measures the behaviors that are central to the concept of JUSTICE and equality (fair, honest, and helpful behavior - living in harmony with others, neither harming nor allowing harm). Basic human rights are enshrined in the UN Universal Declaration of Human Rights. Individuals with high Agreeableness avoid manipulating others for personal gain, feel little temptation to break rules, are uninterested in lavish wealth and luxuries, and feel no special entitlement to elevated social status. High Agreeableness is associated with better: longevity, helping others, giving to charity, job [team] performance, and marital success. (This dimension appears to measure the behaviors that differentiate friend from foe.)
    Descriptors: Honest, humble, compassionate, polite, cooperative, nonaggressive.
    • Compassion:
      • Forgiving nature
      • Considerate and kind
      • Feel other's emotions
      • Inquire about others’ well-being
      • Sympathize with others’ feelings
      • Take an interest in other people’s lives
      • Like to do things for others
    • Politeness:
      • Seldom rude
      • Respect authority
      • Hate to seem pushy
      • Avoid imposing my will on others
      • Rarely put people under pressure
    • From International Personality Item Pool:
      • Would never cheat on taxes
      • Sympathize with the homeless
      • Trust others
      • Make people feel welcome
      • Am easy to satisfy
      • Dislike being the center of attention
    Chimpanzees: The Agreeableness-Antagonism dimension of human behavior can be traced back to our chimpanzee ancestory. Chimpanzee communities, like every social species, organize themselves according to status (video). In such status hierarchies, the dominant members actively protect their privileged status within the community by using domineering, antagonistic behavior towards subordinate members. This antagonistic, competitive behavior by high-status dominant members of the community is in contrast to the agreeable, cooperative behavior of the low-status, subordinant members. In humans, this same antagonistic behavior is used by those seeking to dominate others.
    Evolution: The brains of social species evolved to allow cooperation and altruism which require coordinating one’s goals with those of others. The core features of Agreeableness are empathy and fairness. In more intelligent species, there appears to be an almost instinctual sense of empathy and fairness (video).
    Language Characteristics: Pleasure talk, agreement, compliments, empathy, few personal attacks, few commands or global rejections, many self-references, few negations, few swear words, few threats, many insight words.
    Research: Higher scores on Agreeableness are associated with deeper relationships. Are you a giver or taker? (video). *MRI research found that 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."
    ANTAGONISM (Harming Others)
    Description: Antagonism is synonymous with being very self-centered and lacking empathy. They find it hard to forgive, are critical of others' shortcomings, are stubborn in defending their point of view, and readily feel anger when provoked. They will flatter others to get what they want, break rules for personal profit, and feel a strong sense of self-importance.
    ICD-11 Description: The core feature of the Antagonism (or Dissociality) trait domain is disregard for the rights and feelings of others. Common manifestations of Antagonism (or Dissociality) include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviors, selfishness); and lack of empathy (i.e., indifference to whether one’s actions hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals).
    Descriptors: Dishonest, arrogant, callous, rude, manipulative, aggressive, irresponsible.
    • Callousness:
      • Am not interested in other people’s problems
      • Can’t be bothered with other’s needs
      • Am indifferent to the feelings of others
      • Take no time for others
      • Don’t have a soft side
    • Manipulativeness:
      • Insult people
      • Believe that I am better than others
      • Take advantage of others
      • Seek conflict
      • Love a good fight
      • Am out for my own personal gain
    • From International Personality Item Pool:
      • Use flattery to get ahead
      • Believe in eye for eye
      • Distrust people
      • Look down on others
      • Have a sharp tongue
      • Think highly of myself
    Language Characteristics: Problem talk, dissatisfaction, little empathy, many personal attacks, many commands or global rejections, few self-references, many negations, many swear words, many threats, little politeness, few insight words.
    Video Example: Here is an example of a very antagonistic person - President Trump at a Mississippi political rally.
    Screening Questions:
    • "It’s no big deal if I hurt other peoples’ feelings."
    • "I crave attention."
    • "I often have to deal with people who are less important than me."
    • "I use people to get what I want."
    • "It is easy for me to take advantage of others."
    • "Others see me as irresponsible."
    * Hostility:
    "It makes me really angry when people insult me in even a minor way."
    "I argue or fight when people try to stop me from doing what I want."
    "I am usually pretty hostile."
    "I can be mean when I need to be."
    "I resent being told what to do, even by people in charge."
    "I always make sure I get back at people who wrong me."
    ("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) [More Information]
    *MRI Research:
    Testing predictions from personality neuroscience. Brain structure and the big five.


    CONSCIENTIOUSNESS VS. DISINHIBITION

    CONSCIENTIOUSNESS (Self-Control)
    Description: Conscientiousness is synonymous with being industrious and orderly. The Conscientiousness dimension measures the behaviors that are central to the concept of SELF-CONTROL - organizing and controlling one's behavior in order to achieve one's goals. This involves traits like paying attention, controlling impulses, and delaying gratification. Individuals with high Conscientious work hard to achieve goals, pursue accuracy and perfection, show prudent, careful decision making, and are orderly with things and time. High Conscientiousness is associated with better: longevity, health, school and job performance. (This dimension appears to measure the behaviors that differentiate industriousness from distractibility [or order from chaos]).
    Descriptors: Cautious, self-disciplined, industrious, efficient, organized.
    • From Between facets and domains: 10 aspects of the Big Five
      • Industriousness:
        • Do a thorough job
        • Do things efficiently
        • Not lazy
        • Carry out my plans
        • Finish what I start
        • Get things done quickly
        • Always know what I am doing
      • Orderliness:
        • Like order
        • Keep things tidy
        • Follow a schedule
        • Want everything to be “just right”
        • See that rules are observed
        • Want every detail taken care of
    • From International Personality Item Pool:
      • Avoid mistakes
      • Follow the rules
      • Get chores done right away
      • Work hard
      • Complete tasks successfully
      • Like order
    Chimpanzees: The Conscientious-Disinhibited dimension of human behavior is also evident in chimpanzees. Chimpanzees can plan for the future and control their impulses (video). Goal-directed behavior requires good impulse control, otherwise it becomes distracted and disorganized.
    Evolution: The brains of sentient species evolved to allow the pursuit of non-immediate goals, keeping behavior on track by orienting attention away from distractions and toward goal-relevant stimuli.
    Language Characteristics: Many positive emotion words (e.g. happy, good), few emotional distress words (e.g. hate, bad), more perspective, careful to check that information is conveyed correctly, straight to the point, formal, few negations, few swear words, few references to friends, few disfluencies or filler words, many insight words, not impulsive.
    Research: Higher scores on Conscientiousness predict greater success in school and at work. *MRI research found that Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
    Video Example: Here is an example of a very conscientious person - President Obama discussing the Iranian nuclear treaty.
    "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."
    DISINHIBITION (Impaired Self-Control)
    Description: Disinhibition is synonymous with Being distractible, impulsive or undisciplined. Individuals with high Disinhibition avoid difficult tasks or challenging goals, don't mind incompleteness or inaccurracy, act without thinking of the consequences, have disorganized surroundings and schedules.
    ICD-11 Description: The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences. Common manifestations of Disinhibition include: impulsivity; distractibility; recklessness; and lack of planning.
    Descriptors: Impulsive, uncontrolled, distractible, inefficient, disorganized.
    • From Between facets and domains: 10 aspects of the Big Five
      • Distractibility:
        • Waste my time
        • Find it difficult to get down to work
        • Mess things up
        • Don’t put my mind on the task at hand
        • Postpone decisions
        • Am easily distracted
      • Disorderliness:
        • Leave my belongings around
        • Am not bothered by messy people
        • Am not bothered by disorder
        • Dislike routine
    • From International Personality Item Pool:
      • Rush into things
      • Break rules
      • Waste my time
      • Do just enough to get by
      • Misjudge situations
      • Leave a mess
    Language Characteristics: Few positive emotion words, many emotional distress words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.Few positive emotion words, many emotional distress words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.
    Screening Questions:
    • "People would describe me as reckless."
    • "I feel like I act totally on impulse."
    • "Even though I know better, I can’t stop making rash decisions."
    • "I’m not good at planning ahead."
    * 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."
    * Reckless 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."
    ("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) [More Information]
    *MRI Research:
    Testing predictions from personality neuroscience. Brain structure and the big five.


    EMOTIONAL STABILITY VS. EMOTIONAL DISTRESS

    EMOTIONAL STABILITY (Stability)
    Description: Emotional Stability is synonymous with stability and calm. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. Individuals with high Emotional Stability are relatively tough, brave, and insensitive to physical pain, feel little worry even in stressful situations, and have little need to share their concerns with others. High Emotional Stability is associated with better: longevity, leadership, job [team] performance, and marital success. (This dimension appears to measure the behaviors that differentiate safety from danger.)
    Descriptors: Calm, rarely angry, rarely depressed or moody, rarely anxious or embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Stability:
        • Rarely get irritated
        • Keep my emotions under control
        • Rarely lose my composure
        • Am not easily annoyed
      • Calm:
        • Relaxed, handle stress well
        • Feel comfortable with myself
        • Am not embarrassed easily
        • Seldom feel blue
        • Rarely feel depressed
    • From International Personality Item Pool:
      • Remain calm under pressure
      • Rarely get irritated
      • Feel comfortable with myself
      • Relaxed most of the time
      • Am not embarrassed easily
    Language Characteristics: Pleasure talk, agreement, compliment, low verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less frustration, low concreteness.
    "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."
    EMOTIONAL DISTRESS (Impaired Stability)
    Description: Emotional Distress is synonymous with emotional volatility and negative emotion. Individuals with high emotional volatility are easily upset or angered. They often are very moody and emotionally labile. Individuals that have high negative emotion exhibit over-sensitivity to threat or stress. They exhibit excessive fear, anxiety, depression, or irritability.
    ICD-11 Description: The core feature of the Emotional Distress (or Negative Affectivity) trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Emotional Distress include: experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness.
    Descriptors: Easily upset, angry, depressed, moody, anxious, embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Emotional Instability:
        • Get angry or upset easily
        • Change my mood a lot
        • Am a person whose moods go up and down easily
        • Get easily agitated
        • Can be stirred up easily
      • Negative Emotion:
        • Worry a lot
        • Get nervous easily
        • Am filled with doubts about things
        • Feel threatened easily
        • Am easily discouraged
        • Become overwhelmed by events
        • Am afraid of many things
    • From International Personality Item Pool:
      • Panic easily
      • Get angry easily
      • Often feel blue
      • Worry about things
      • Am easily intimidated
    Evolution: All animals have evolved a "fight or flight" response to threat to ensure their survival. Mammals went one step further and evolved a "fight, flight, or freeze" response to threat. In humans, this mammalian "freeze" response to threat involves inhibition of behavior in response to threat, punishment, and emotional distress. This threat response of "freezing", shutting down or passively avoiding is commonly seen in human anxiety or depression (e.g., freezing with fear or being immobilized by indecision, worry or depression).
    Language Characteristics: Problem talk, dissatisfaction, high verbal productivity, many repetitions, polarised content, stressed, many self-references, few short silent pauses, many long silent pauses, few tentative words, more aquiescence, many self references, exaggeration, frustration, high concreteness.
    Screening Questions:
    • "I worry about almost everything."
    • "I get emotional easily, often for very little reason."
    • "I fear being alone in life more than anything else."
    • "I get stuck on one way of doing things, even when it’s clear it won’t work."
    • "I get irritated easily by all sorts of things."
    Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Emotional Distress or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and emotional distress.
    * 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."
    * Irritability:
    "I get irritated easily by all sorts of things."
    "I am easily angered."
    "I have a very short temper."
    "I snap at people when they do little things that irritate me."
    * Separation Anxiety:
    "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."
    * Depressed Mood:
    "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."
    ("Emotional Stability vs. Emotional Distress" 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) [More Information]
    *MRI Research:
    Testing predictions from personality neuroscience. Brain structure and the big five.





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    The "Five Factor Model of Personality" as Shown In Dogs

    All animals have personalities - that is, consistent individual differences in behavior. Within virtually any population, some individuals are consistently more active, more aggressive, or are more willing to engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality found in humans can be found in dogs.



    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.

    OPEN-MINDEDNESS / INTELLECT VS. CLOSED-MINDEDNESS / IMPAIRED INTELLECT
    Intellect
    Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
    Impaired Intellect
    Dog is slow to respond to corrections.
    Dog ignores commands.
    Dog is slow to learn new tricks or tasks.

    EXTRAVERSION VS. DETACHMENT
    Sociality ("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. EMOTIONAL DISTRESS
    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.
    Emotional Distress ("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

    The "Five Factor Model of Personality" In A Social Species

    The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociality" ], (4) decide whether to proceed in a self-controlled or disinhibited manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness to Experience" ].

    Spider Personalities

    All animals have personalities (defined as consistent behavioral differences among individuals). Animals can consistently differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk taking), (3) Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and (5) Emotional Stability (e.g., calmness).

    Some social spiders live in colonies of up to several hundred individuals, and exhibit cooperative behaviours such as prey capture and maternal care. Researchers have found that spider personalities differ in aggressiveness:
    • Aggressive spiders are more likely to attack their mirror image than are shy spiders who are more likely to run away.
    • In a spider colony, individual spiders differ in degree of boldness (aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack prey and to resume movement after a disturbance.] Hunting prey for these social spiders is a collective effort. The presence of a bold spider causes the shy spiders to become bolder which increases the effectiveness of their collective hunting effort. A positive feedback loop is established whereby hunting success increases spider boldness which increases future collective hunting success. However, when researchers removed these bold "leader" spiders, the collective hunting by the remaining spiders became less successful. The bold "leader" spiders thus were shown to have a disproportionately large impact on the group, and so were named "keystone individuals". Because of their special personality characteristic (boldness) the "leader" spiders performed a vital function (making the shy spiders bolder) which fascilitated collective social action.

      This research made the very important finding that the spiders modified each other's personalities. The bold spiders became bolder because of their hunting success. However their hunting success was entirely dependent upon gaining the collective support of the shy spiders. Likewise, the shy spiders owed their hunting success to being made bolder by association with the bold spider. Thus for more successful collective action, the bold "leader" spider needed to have followers, and the shy "follower" spiders needed to have a "leader". To make their collective social action more successful, the different spider personalities had to bring out the "best" in each other.



    The "Five Factor Model of Personality" and Personality Disorders

    The following diagram shows the relationship between the "Five Factor Model 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.


    Enlarge Image


    3D Models of How the Personality Disorders Are Correlated



    The DSM-IV personality disorders in the National Comorbidity Survey Replication study determined how personality disorders statistically correlated with each other. The above 3D model was created (by P.W. Long MD) from this correlational data.

      Note: Due to their low prevalence in this study, Histrionic and Narcissistic Personality Disorder were not included. However, these 2 missing personality disorders were inserted into the 3D model (by PWL) where other research suggested they should occur.


    This statistical model shows that all of the personality disorders are highly correlated - they are overlapping entities that blend into each other with no clear boundaries. This 3D model groups personality disorders into two highly interrelated large clusters (named "greed" and "fear" by PWL).

    The fact that these personality disorders are so highly interrelated suggests that it is common for individuals to have multiple personality disorders.



    Section III of the DSM-5 presents an alternative model for personality disorders. Based on research findings, this model drops four personality disorders: Schizoid, Paranoid, Dependent, and Histrionic.

    The above 3D model shows the statistical correlations between personality disorders in this alternative DSM-5 model.

      Note: Borderline Personality Disorder plays a central role in this model. It is correlated to all of the other major personality disorders (except Schizotypal Personality Disorder). It could be argued that Borderline Personality Disorder may not be a true personality disorder. Instead, it may more represent chaotic instability - an advanced stage in which a previous stable personality disorder becomes unstable and goes from order into chaos. This would explain why Borderline Personality Disorder is usually diagnosed in combination with another personality disorder.

      Thus, it is argued, instead of diagnosing someone as having both "Antisocial and Borderline Personality Disorders"; it would be more correct to diagnose "Antisocial Personality Disorder with Emotionally Unstable Traits".

      Chaos theory states that balanced systems under stress can be pushed into instability. Specifically, as stress on a stable system is increased, a "tipping point" is reached wherein the system quickly goes from stability to instability. The following animated graphs illustrate this mathematical principle. The vertical (y) axis represents the stress level. As the stress level increases, a tipping point is reached whereafter the system becomes more unstable. (These animations recycle.)

      Logistic map animation.gif
      By Snaily CC BY-SA 3.0, The "tipping point" between stability and instability



      According to chaos theory, these animations could represent what happens when a personality disorder is under increasing stress. Initially, the personality disorder remains stable; then under increasing stress a tipping point is reached wherein the previously stable personality disorder becomes chaotic. Any further stress makes the personality disorder even more unstable.

      Thus the emotional instability, chaotic social functioning, and self-harming behavior of Borderline Personality Disorder could represent a chaotic, unstable state of a previously stable personality disorder.


    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-paranoid-narcissistic-histrionic-borderline 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 emotional distress (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 schizoid-schizotypal cluster of personality disorders.


    The Blueprint For Virtue Is Built Into Your DNA

    More than 2,300 years ago, the ancient Greek philosopher, Aristotle (384–322 BC), said: " What is the essence of life? To serve others and to do good. " Aristotle taught that "doing good" was synonymous with living a life of virtue. He believed these virtues were in keeping with the laws of nature.

    Aristotle and other ancient Greek philosophers believed that the main virtues were justice, self-control/moderation, wisdom, sociality, 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.

    • Proteins are built as chains of amino acids, which then fold into unique three-dimensional shapes that have different functions. Proteins compose structural and motor elements in the cell, and they serve as the catalysts for virtually every biochemical reaction that occurs in living things.

    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.

    Virtues Manifested at The Physiological, Psychological, and Social Levels

    • Justice:

    • In terms of survival, it is better that members of a species cooperate. With one's own species, cooperation requires that an individual neither harms nor allows harm (which is the definition of justice). Justice requires mutually beneficial interaction in which no party gains an unfair advantage. It ensures service to the common good - not just good for the privileged few.

      • Physiological Level:

        [Evolutionary Principle] The Most Adaptable Survive

        Evolution isn't survival of the fittest; it is survival of the most adaptable.


        In evolution, it is not the strongest or smartest organism that survives - it is the organism that can best adapt to its changing environment.

        [Evolutionary Principle] Live In Harmony

        An organism must be able to flourish 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 uncontrollable growth which kills the organism and itself.

        [Evolutionary Principle] No Species Escapes Extinction

        Nothing lives forever; nearly all species that ever lived are now extinct. They did not survive the sudden climate changes that caused mass extinctions of nearly all life on earth. Fortunately, a few species did survive the last mass extinction.


        There have been five mass extinction events in Earth's history. In the worst one, 250 million years ago, 96 percent of marine species and 70 percent of land species died off. Humans almost went extinct 60,000 years ago when only approximately 1,000 humans survived a global drought. Nowadays, many scientists are predicting that we're on track for a sixth mass extinction due to human destruction of the environment. This human-caused mass extinction of life on earth is the greatest injustice that humanity has ever created.

      • Psychological Level:

        Justice means neither harming nor allowing harm.

        Injustice is more than just being deceitful (e.g., lying, stealing, cheating). Justice requires that we neither harm nor allow harm to others and our environment. Justice is the public manifestation of love.

      • Social Level:

        Social injustice occurs when one group unfairly harms another. Social justice requires that we treat others the way we want them to treat us.

        Evolution doesn't care if we are beautiful, strong, intelligent, or happy. Evolution only cares if we can flourish by living in harmony with others and our environment.

        Injustice occurs when groups or nations harmfully violate the rights of others. Once there is a breakdown in the rule of law, it is just a matter of time until the group or nation degenerates into corruption and a violent struggle for power.

        Humanity's survival now depends upon whether love, brotherhood, and peace can overcome hate, nationalism, and war.

    • Self-Control:

    • To survive, all organisms have homeostatic mechanisms that strive to balance their functioning at an optimal level between excess and deficiency. Some organisms have strong homeostatic mechanisms; hence their functioning is highly regulated and orderly. Other organisms have weak homeostatic mechanisms; hence their functioning is weakly regulated and disorderly or chaotic. [Golden Mean: The Greek poet Hesiod (c.700 bc) said that "moderation is best in all things'. Ancient Greek philosophers taught that self-control or moderation is about finding the Golden Mean or balance between two extremes, excess and deficiency.]

      • Physiological Level:

        [Evolutionary Principle] Maintain Stability By Self-Regulation (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).

        [Evolutionary Principle] Certain Vices Shorten Life

        Certain excesses (smoking, obesity, and alcohol) damage DNA; hence must be seen as vices.


        "A major cause of aging is 'oxidative stress.' It is the damage to DNA, proteins, and lipids (fats) caused by oxidants, which are highly reactive substances containing oxygen. These oxidants are produced normally when we breathe, and also result from inflammation, infection, and consumption of alcohol and cigarettes. In one study, scientists exposed worms to two substances that neutralize oxidants, and the worms' lifespan increased an average 44%.

        Another factor in aging is 'glycation.' It happens when glucose, the main sugar we use as energy, binds to some of our DNA, proteins, and lipids, leaving them unable to do their jobs. The problem becomes worse as we get older, causing body tissues to malfunction, resulting in disease and death. Glycation may explain why studies in laboratory animals indicate that restricting calorie intake extends lifespan." [reference]

      • Psychological Level:

        Self-control and moderation in all things (i.e., good behavioral homeostasis) is the core feature of conscientiousness.

        Conscientious individuals have good homeostatic control of their behavior - it is neither excessively inhibited nor disinhibited. They are careful, responsible, hard-working, cautious, focused, and organized. In contrast, individuals lacking conscientiousness are careless, irresponsible, impulsive, easily distracted, and disorganized.

      • Social Level:

        Vices (behavioral excesses or deficiencies) must be controlled or they will destroy a group or nation.

        When a group or nation is overcome by its excesses (e.g. alcoholism, drug abuse, or corruption) or deficiencies (e.g. injustice or massive poverty); it withers and dies.

    • Wisdom:

    • Learning requires attention, reasoning, and memory. Of the 21 different hominids that have existed; 20 are now extinct. Only our species, homo sapiens, has survived. It appears evolution has favored our species, compared to the extinct hominids, because of our superior adaptability and ability to learn. [Our Attention May Blind Us: The biggest problem with learning is that our selective attention may blind us to much of what we see. We create our own reality - seeing only what we are interested in seeing. Thus we are blinded by our desires and biases.].

      • Physiological Level:

        [Evolutionary Principle] Experiment To Improve Adaptation

        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. Sometimes the rung of one DNA molecule breaks off and attaches itself to another DNA molecule. 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] Replicate Experiments

        Evolution uses the scientific experimental method to discover the truth.


        Evolution is constantly experimenting - comparing the adaptive success of new DNA mutations against the success of their original DNA. As in science, evolution requires that the findings of its experiments be repeatedly replicated. This requirement for repeated replication of success eliminates unstable mutant DNA which can't successfully replicate its initial adaptive success.

        [Evolutionary Principle] Share Information

        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] Have 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.

        [Evolutionary Principle] Use A Standardized Language To Share Information

        Every living cell stores all of the adaptive information that evolution has taught it by using the same "4 letter chemical code" (4 base pairs repeated billions of times) in its DNA.


        Without using this universal, standardized language to store information, evolution could not pass on adaptive information within the body or between generations.

        [Evolutionary Principle] Chance Directs Evolution

        Evolution is not guided by any plan; the direction it takes is determined solely by chance events.


        In evolution, there is no evidence of a grand plan, and that everything happened for a reason according to this universal plan. Instead, each organism's evolution was solely determined by random DNA mutation and natural selection.

        For example, our hominid lineage diverged from the ape lineage 7 to 8 million years ago. There were 21 hominid species - and 20 became extinct. Thus evolution tried 21 different experiments in creating hominids, and all proved to be evolutionary dead-ends - except our species, Homo sapiens. Our species has existed for about 100,000 years, and now we could be on the verge of extinction due to nuclear war or climate change.


      • [Evolutionary Principle] Expect Unexpected Consequences

        Making a small change in a complex system will often cause major unintended consequences.


        For example, when nature causes a DNA mutation or humans engineer a genetic modification, the unintended consequence can be: (1) a positive unexpected benefit (e.g. a recent spontaneous mutation in crayfish has produced a "super crayfish" that clones itself), or (2) a negative unexpected detriment (e.g. Monsanto genetically engineered its plants to make them resistant to the most used herbicide, Roundup [glyphosate], in order to help their plants survive during weed spraying. Monsanto's plants did become resistant to this herbicide, but this promoted the development of the same resistance in several weed species and insects. Now millions of acres of U.S. farmland have been destroyed by these pesticide resistent "superweeds" and insects.)

        [Evolutionary Principle] Nature Constantly Changes

        Everything in nature cycles and eventually dies.


        DNA has a built-in time bomb (shortening of its telomeres with each reproduction) that causes it to age. Old DNA doesn't divide: thus all organisms eventually die.

        Cancer occurs when DNA fails to age and keeps dividing until the resulting unchecked cell growth destroys the organism. Thus, nature prevents continuous growth; hence "no tree grows to heaven". Similarly, the competing forces in nature ensure that nothing remains the same - everything cycles.


      • Psychological Level:

        Humans are rational animals that evolution has given the ability to reason and learn. Wise, open-minded individuals that ask "why?" consistently outperform close-minded individuals that never question "why?". The hallmark of open-minded individuals is their curiosity and willingness to logically experiment and make mistakes in order 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 relevant information 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. The most efficient record keeping involves using: (1) standardized language to avoid confusion, and (2) mathematically quantified data.

      • Social Level:

        War is the greatest threat to civilization and the accumulation of knowledge. Those that start wars never foresee war's unexpected consequences.

        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.

    • Sociality:

    • In a social species, social networking is vital for survival since it permits cooperation and sharing of information. Single celled organisms banded together to form multicellular organisms because of the additional survival benefits that such multicellular cooperation bestowed upon them.

      • Physiological Level:

        [Evolutionary Principle] Combine Forces

        Sharing of genetic diversity speeds up evolution.


        The genetic sharing of DNA during sexual reproduction increases genetic diversity, which speeds up evolution. Even single-celled organisms, like bacteria, survive better in diverse communal groups (where they can exchange their DNA), rather than surviving as solitary organisms.

      • Psychological Level:

        Sociality increases one's chances for survival.

        Individual humans are too weak to survive solo; human survival requires that individuals cooperate for mutual benefit. Socially outgoing individuals, compared to solitary individuals, are more likely to acquire adaptive information from others in a social group. Also socially outgoing individuals belong to more social networks; hence are more likely to receive social support in times of need.

      • Social Level:

        Like all social species, humans form dominance hierarchies ("pecking orders").

        Humans survive better living in social groups. These groups permit specialization of labor which dramatically increases the group's productivity - hence its chances for survival.

        All social species, including humans, organize their social groups in terms of dominance hierarchies ("pecking orders"). Such dominance hierarchies unequally distribute power and wealth within the group. For humans, a child on the bottom of our dominance hierarchy is often chronically hungry, unsafe, or neglected.

        Nature establishes social dominance hierarchies as a cruel survival strategy which maximizes the adaptive advantages for those at the top of the dominance hierarchy at the expense of those at the bottom. This is often a matter of life and death because, when the social group is stressed by famine or disease, it is those at the bottom of a social dominance hierarchy who are most likely to starve or die.

        Social groups and nations that freely share adaptive information are the most likely to succeed.

        Nations that freely share information 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:

    • An organism's primary objective is to stay alive; hence it must be able to differentiate safety from danger. Courage, like everything else, must be exercised in moderation. Too little courage results in cowardice, and too much courage results in foolish recklessness. [Fight-Flight-Freeze-Fantasize: There are three main coping strategies that all animals use: (1) "Fight" or angry attack, (2) "Flight" or fearful retreat, and (3) "Freeze" or depressive immobilization. Humans uniquely have a fourth main coping strategy, "Fantasize", in which they respond to stress by creating comforting delusions or false beliefs which are strongly held against all evidence to the contrary.]

      • Physiological Level:

        [Evolutionary Principle] Remain Stable

        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, and humans have spread to every continent.

      • Psychological Level:

        Courage involves remaining calm and emotionally stable in the face of adversity.

        Courage doesn't mean rushing headlong into danger. The courageous person will assess the situation, and take the appropriate "fight/flight/freeze/fantasize" response that best solves the problem. There is no one response that is always right. Individuals must remain calm and emotionally stable while facing adversity - otherwise strong emotion can severely impair their problem-solving ability.

      • Social Level:

        Leaders must instill courage in their followers in order to maintain morale.

        Once a group loses its courage, and its morale is broken, it quickly becomes dysfunctional.

    • Physical Health:

    • In order to stay alive; an organism must maintain its physical health.

      • Physiological Level:

        [Evolutionary Principle] Evolution's Only Goal Is Survival

        Evolution selects for traits that help organisms survive, but doesn’t necessarily find optimal solutions.


        The goal of evolution is to create living organisms - even if they aren't perfect. 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). 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.

        [Evolutionary Principle] Avoid Extremes

        Nature hates extremes and rewards moderation.


        The optimal conditions for DNA survival are usually the midpoint between deficiency and excess. For example, DNA thrives at the temperature of liquid water, but is destroyed when water freezes or boils. Organisms flourish when they maintain their functioning in the midpoint between deficiency and excess. Nature punishes those organisms that slip into conditions of deficiency or excess.

      • Psychological Level:

        Our physical vices are leading causes of disability and death.

        Usually virtue is physically helpful; whereas vice is physically harmful. The modern vices of cigarette smoking, alcohol and drug abuse, sedentary lifestyle, obesity, and unsafe sex are leading causes of physical disability and death. Chronic users of cigarettes lose 13% of their expected lifespan, chronic users of alcohol lose 29%, chronic users of cocaine lose 44%, chronic users of methadone lose 49%, chronic users of heroin lose 52%, and chronic users of methamphetamine lose 53% of their expected lifespan.

      • 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%).

        Globally, it appears that "modernization" increases addiction, sedentary lifestyle, obesity, unsafe sex, environmental destruction, and disastrous climate change. Thus, our modern civilization may severely impair our future evolution, or lead to our own extinction. [The Second Law of Thermodynamics: In physics, this law states that, in order to create order in one part of a system, more disorder (entropy) is automatically created in another part of the system. This law would predict that, in order to create and maintain our civilization, we will automatically create greater disorder and chaos in our environment. This is a chilling prediction given what is currently happening with climate change.]



    The "Five Factor Model of Personality" as Shown In Dogs

    All animals have personalities - that is, consistent individual differences in behavior. Within virtually any population, some individuals are consistently more active, more aggressive, or are more willing to engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality found in humans can be found in dogs.



    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.
    OPEN-MINDEDNESS / INTELLECT VS. CLOSED-MINDEDNESS / IMPAIRED INTELLECT
    Intellect
    Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
    Impaired Intellect
    Dog is slow to respond to corrections.
    Dog ignores commands.
    Dog is slow to learn new tricks or tasks.
    EXTRAVERSION VS. DETACHMENT
    Sociality ("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. EMOTIONAL DISTRESS
    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.
    Emotional Distress ("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

    The "Five Factor Model of Personality" In A Social Species

    The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociality" ], (4) decide whether to proceed in a self-controlled or disinhibited manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness to Experience" ].

    Spider Personalities

    All animals have personalities (defined as consistent behavioral differences among individuals). Animals can consistently differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk taking), (3) Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and (5) Emotional Stability (e.g., calmness).

    Some social spiders live in colonies of up to several hundred individuals, and exhibit cooperative behaviours such as prey capture and maternal care. Researchers have found that spider personalities differ in aggressiveness:
    • Aggressive spiders are more likely to attack their mirror image than are shy spiders who are more likely to run away.
    • In a spider colony, individual spiders differ in degree of boldness (aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack prey and to resume movement after a disturbance.] Hunting prey for these social spiders is a collective effort. The presence of a bold spider causes the shy spiders to become bolder which increases the effectiveness of their collective hunting effort. A positive feedback loop is established whereby hunting success increases spider boldness which increases future collective hunting success. However, when researchers removed these bold "leader" spiders, the collective hunting by the remaining spiders became less successful. The bold "leader" spiders thus were shown to have a disproportionately large impact on the group, and so were named "keystone individuals". Because of their special personality characteristic (boldness) the "leader" spiders performed a vital function (making the shy spiders bolder) which fascilitated collective social action.

      This research made the very important finding that the spiders modified each other's personalities. The bold spiders became bolder because of their hunting success. However their hunting success was entirely dependent upon gaining the collective support of the shy spiders. Likewise, the shy spiders owed their hunting success to being made bolder by association with the bold spider. Thus for more successful collective action, the bold "leader" spider needed to have followers, and the shy "follower" spiders needed to have a "leader". To make their collective social action more successful, the different spider personalities had to bring out the "best" in each other.

    The "Five Factor Model of Personality" and Personality Disorders

    The following diagram shows the relationship between the "Five Factor Model 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.



    Enlarge Image





    3D Models of How the Personality Disorders Are Correlated



    The DSM-IV personality disorders in the National Comorbidity Survey Replication study determined how personality disorders statistically correlated with each other. The above 3D model was created (by P.W. Long MD) from this correlational data.

    This statistical model shows that all of the personality disorders are highly correlated - they are overlapping entities that blend into each other with no clear boundaries. This 3D model groups personality disorders into two highly interrelated large clusters (named "greed" and "fear" by PWL).

    The fact that these personality disorders are so highly interrelated suggests that it is common for individuals to have multiple personality disorders.




    Section III of the DSM-5 presents an alternative model for personality disorders. Based on research findings, this model drops four personality disorders: Schizoid, Paranoid, Dependent, and Histrionic.

    The above 3D model shows the statistical correlations between personality disorders in this alternative DSM-5 model.

      Note: Borderline Personality Disorder plays a central role in this model. It is correlated to all of the other major personality disorders (except Schizotypal Personality Disorder). It could be argued that Borderline Personality Disorder may not be a true personality disorder. Instead, it may more represent chaotic instability - an advanced stage in which a previous stable personality disorder becomes unstable and goes from order into chaos. This would explain why Borderline Personality Disorder is usually diagnosed in combination with another personality disorder.

      Thus, it is argued, instead of diagnosing someone as having both "Naricissistic and Borderline Personality Disorders"; it would be more correct to diagnose "Narcissistic Personality Disorder with Emotionally Unstable Traits".

      Chaos theory states that balanced systems under stress can be pushed into instability. Specifically, as stress on a stable system is increased, a "tipping point" is reached wherein the system quickly goes from stability to instability. The following animated graphs illustrate this mathematical principle. The vertical (y) axis represents the stress level. As the stress level increases, a tipping point is reached whereafter the system becomes more unstable. (These animations recycle.)

      Logistic map animation.gif
      By Snaily CC BY-SA 3.0, The "tipping point" between stability and instability



      According to chaos theory, these animations could represent what happens when a personality disorder is under increasing stress. Initially, the personality disorder remains stable; then under increasing stress a tipping point is reached wherein the previously stable personality disorder becomes chaotic. Any further stress makes the personality disorder even more unstable.

      Thus the emotional instability, chaotic social functioning, and self-harming behavior of Borderline Personality Disorder could represent a chaotic, unstable state of a previously stable personality disorder.


    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-paranoid-narcissistic-histrionic-borderline 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 emotional distress (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 schizoid-schizotypal cluster of personality disorders.


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