High-Functioning Borderline Personality Disorder (BPD) Self-Test & Guide
When it comes to mental health disorders, borderline personality disorder (BPD) is often misunderstood. BPD affects 1.6% of the general population and represents 20% of the inpatient psychiatric population5.
Borderline personality disorder (BPD) can be broken into four types. The symptoms are usually overt, but high-functioning borderline personality disorder can be harder to spot. Treatment for BPD can help with daily functioning and the ability to have healthy relationships with others.
High-Functioning Borderline Personality Disorder (BPD) Self-Test
Try this self-assessment based on the criteria outlined by the American Psychiatric Association’s official DSM-5 Borderline Personality Disorder. The test should take less than five minutes.
Your results of this self-assessment are not a replacement for a professional diagnosis, nor is this test meant to be a proper diagnostic tool. Please use it only for educational purposes and talk to your doctor about all your symptoms.
Types of BPD
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), borderline personality disorder is part of a cluster of personality disorders1. Within the cluster of personality disorders, BPD is characterized by dramatic and very eccentric emotional responses.
- Be stable beginning in childhood and lasting through adulthood
- Clash with cultural and societal norms and expectations
- Lead to personal conflicts and issues in society
Petulant
Petulant BPD often is associated with having a desire for control. This desire can manifest in relationships, friendships, and the workplace. Passive-aggressive methods and manipulation are often used to maintain power.
Characteristics of Petulant BPD include:
- Extreme mood swings
- Outbursts of anger
- Unpredictability
- Feelings of being unworthy of love
- Irritability
- Impatience
- Stubbornness
Relationships are an essential aspect of the Petulant BPD sub-type. Feelings of unfulfillment in relationships and using manipulation to attempt to change others are common with this subtype of BPD.
Impulsive
Impulsive BPD looks very different from the other sub-types on the outside. Impulsive borderline personality disorder can have characteristics like charisma, charm, and flirtation.
High levels of impulsivity can occur without consideration of the consequences or other people. Engaging in risky activities and putting themselves or others in danger happen often with this type of BPD.
Impulsive BPD can cause struggles with:
- Thrill-seeking or dangerous activities
- Illegal substance abuse
- Alcoholism
- Self-harm
- Threats or attempts of suicide
Self-Destructive
Self-destructive BPD is inward-facing with struggles of feeling self-hatred and bitterness. Attention seeking from others occurs in order to feel better. Without attention, even more self-hatred and bitterness can occur.
Self-destructive BPD symptoms can include:
- Thrill-seeking or dangerous activities
- Illegal substance abuse
- Alcoholism
- Self-harm
- Threats or attempts of suicide
Open expression of hatred and bitterness may not occur when suffering from self-destructive BPD. Beliefs within this disorder can result in relationships that spiral out of control, a lack of self-care, and unstable emotions.
High-Functioning Borderline Personality Disorder
Discouraged or Quiet BPD is often called high-functioning borderline personality disorder. This subtype of BPD can result in keeping negative emotions hidden.
Characteristics of high-functioning BPD include:
- Perfectionism and the need for control
- Feelings of emptiness and loneliness
- Approval seeking from others
- Alienation and self-isolation
- Self-harm and destructive behavior
- Clingy and needy in relationships
Struggling with High-functioning BPD commonly is associated with holding trauma and facing issues around abandonment. Codependency in relationships and self-blame when problems happen are common with high-functioning BPD. Any real or perceived threat of abandonment can trigger reactions.
Signs of BPD
Each sub-type of BPD has its own specific symptoms, but there are general signs of this disorder as well. Every type of borderline personality disorder includes intense moods and extreme thinking.
- Self-destructive behavior
- Aggression
- Feelings of emptiness and dissatisfaction
- Poor self-image and extreme self-criticism
- Fear of abandonment
- Unhealthy and unstable relationships
Symptoms of BPD often overlap with other mental health disorders. Bipolar disorder and Histrionic personality disorder (HPD) share similar characteristics.
What is BPD Splitting?
Splitting is a unique feature of BPD that is not present in many other mental health disorders. Splitting can be used as a way of coping and as protection from negative feelings. BPD splitting can cause perceptions of extremes such as everything is good or bad and no in-between.
Dangerous situations may occur as a result of this defense mechanism. An abusive partner can be perceived as the perfect partner when struggling with a borderline personality disorder. Codependency, exhaustion, and unstable relationships are common when BPD splitting.
Causes & Risk Factors
Research is still not sure how BPD works when it comes to the causes and risk factors. Prior studies have found some genetic links, but not enough to be significant. Other research has focused on brain function and environmental factors.
Genetics
While many mental health disorders are inherited, researchers aren’t sure if BPD is one of them. Some twin studies showed a higher rate of BPD in monozygotic twins compared with dizygotic twins. Other studies have discredited the idea, showing that environmental factors are a bigger risk factor.
More recent research has found two genes that may explain BPD inheritability – DPYD and PKP48. The issue is that these genes are also seen in cases of bipolar disorder and schizophrenia. The current agreement is that BPD does run in families, but environmental factors play a large role.
Brain Function
Neurobiological research has pinpointed several areas in the brain that link to BPD. Some of these findings focus on altered levels of neurotransmitters like serotonin. Imbalances of serotonin can cause many symptoms of BPD, like aggression and depression.
Abnormal differences in the amygdala, hippocampus, and orbitofrontal cortex were also found in the brains of people with BPD6.
Amygdala, hippocampus, and orbitofrontal cortex help with:
- Controlling emotions
- Carrying out planning and decision-making tasks
- Maintaining self-control
- Regulating behavior
The environment can affect these brain functions. These regions develop in childhood, meaning upbringing has a vast impact. Environmental factors are vital to understanding borderline personality disorder causes as well as brain function.
Environmental Factors
Childhood trauma is a frequent starting point of mental health disorders. Trauma can be short-term or ongoing throughout life.
Trauma can include:
- Physical, sexual, and verbal abuse
- Abandonment
- Rejection
- Family dysfunction
- Parental mental illness
- Extreme poverty
- War, violence, and intense stress
Research reveals that 30% to 90% of BPD patients suffered childhood trauma4. This range is much higher than other personality disorders. The takeaway is that environmental factors, genetics, and brain function all play a role in developing borderline personality disorder.
Untreated High-Functioning BPD Effects
Individuals with high-functioning BPD often hide their symptoms. But untreated BPD can lead to many life, work, and relationship complications.
- Job loss and constant career changes
- Unstable, dangerous romantic relationships
- Marital stress, dysfunctional family life, or divorce
- Loss of friends, family, and support systems
- Unplanned pregnancies or sexually transmitted diseases
- Dependence on drugs and alcohol
- Legal issues, jail time, and debt
- Suicide
Mood disorders are highly comorbid with BPD, with 96% of patients having one or more mood disorders3. Untreated BPD can lead to worsening depression, anxiety, and substance abuse.
High-Functioning BPD Diagnosis
There’s no specific test for diagnosing borderline personality disorder. Instead, a licensed clinician can use a combination of interviews and surveys when testing for BPD. According to the DSM-V, an individual must meet five out of the nine criteria for an official diagnosis2.
- Abandonment
- Relationships
- Self-image
- Impulsivity
- Self-harm
- Emotions
- Aggression
- Emptiness
- Dissociation
Diagnosing BPD is often laborious because the symptoms overlap with many other disorders. Clinicians often look for signs that began in the early teen years and remain unchanged. Thus, the most common age for a diagnosis is late adolescence.
BPD Treatments
Diagnosing BPD is often laborious because the symptoms overlap with many other disorders. Clinicians often look for signs that began in the early teen years and remain unchanged. Thus, the most common age for a diagnosis is late adolescence.
- Explore emotion management and control
- Make behavioral changes to reduce impulsivity and aggression
- Learn how to build healthy relationships with others and self
- Understand the BPD diagnosis
Cognitive-Behavioral Therapy (CBT)
Borderline personality disorder and cognitive behavior therapy often go hand-in-hand. CBT is a very present-focused method that aims to change thinking and behavior. CBT is based on the assumption that your symptoms result from your actions and thinking patterns.
The treatment usually consists of a few hours each week with a therapist. The therapist may set goals and provide advice and guidance. Homework is a continual aspect of the program to encourage change outside the therapist’s office.
Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy is a sub-type of cognitive behavior therapy that focuses on emotional regulation. It can involve group skills training, phone sessions, and one-on-one therapy. The goal is to learn how to handle emotions and move away from unhealthy coping mechanisms.
Dialectical behavior therapy for borderline personality disorder is sometimes called “the gold standard.” Studies have found this type of therapy to be one of the most effective. In one study, over 77% of patients no longer qualified for a BPD diagnosis after one year of DBT7.
Medication
There’s currently no approved, specific BPD medication. But because mood disorders and substance abuse are so common in people with BPD, these are usually treated with medication. Doctors might prescribe anti-depressants or anti-psychotics for patients who experience depression or anxiety.
Coping Methods
A borderline personality disorder diagnosis can be hard to process. Feeling lost, scared, or unsure of how to manage symptoms can be common after receiving this diagnosis. Professional help is essential, but steps can be taken to create healthy coping methods.
First, education about borderline personality disorder can be helpful. Knowing the details can often calm the fear and anxiety surrounding the diagnosis.
Self-help steps for BPD can include:
- Recognizing and documenting triggers
- Creating limits and setting boundaries, especially in relationships
- Finding a support group with family, organizations, and friends
- Treating co-occurring mood disorders
- Enjoying mindfulness, exercise, and a healthy diet
- Trying not to assume other people's feelings
- Seeking help for substance use disorders
The best way to receive help is to seek professional treatment. There are many options available, depending on lifestyle and preferences. The first step is finding a licensed clinician and getting an official diagnosis.
Learn How to Manage BPD
After taking the high-functioning borderline personality disorder test, you may find that you have met the criteria for high-functioning or severe BPD. Treatment is available for BPD with therapy and medication as needed. With treatment for BPD, daily functioning and healthy relationships can be achieved.
If you or a loved one are struggling with symptoms of borderline personality disorder, reach out to SoCal Mental Health today. It’s our goal to answer any questions you may have and give you a better understanding of the programs offered by our preferred providers.
Sources
- American Psychiatric Association. (2012). DSM-IV and DSM-5 criteria for the personality disorders. APA. Retrieved June 7, 2022, from https://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf
- Biskin, R. S., & Paris, J. (2012, November 6). Diagnosing borderline personality disorder. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. Retrieved June 7, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/
- Biskin, R. S., & Paris, J. (2013, January 9). Comorbidities in borderline personality disorder. Psychiatric Times. Retrieved June 7, 2022, from https://www.psychiatrictimes.com/view/comorbidities-borderline-personality-disorder
- Bozzatello, P., Rocca, P., Baldassarri, L., Bosia, M., & Bellino, S. (2021, September 23). The role of trauma in early onset borderline personality disorder: A biopsychosocial perspective. Frontiers. Retrieved June 7, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2021.721361/full
- Chapman, J., Jamil, R. T., & Fleisher, C. (2022, May 2). Borderline personality disorder. National Library of Medicine. Retrieved June 7, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK430883/
- National Health Service. (2019, July 17). Causes – Borderline personality disorder. NHS choices. Retrieved June 7, 2022, from https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/causes/
- Stiglmayr, C., Stecher-Mohr, J., Wagner, T., Meibner, J., Spretz, D., Steffens, C., Roepke, S., Fydrich, T., Salbach-Andrae, H., Schulze, J., & Renneberg, B. (2014, December 18). Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study – borderline personality disorder and emotion dysregulation. BioMed Central. Retrieved June 7, 2022, from https://bpded.biomedcentral.com/articles/10.1186/2051-6673-1-20
- Witt, S. H., Streit, F., Jungkunz, M., Frank, J., Awasthi, S., Reinbold, C. S., Treutlein, J., Degenhardt, F., Forstner, A. J., Heilmann-Heimbach, S., Dietl, L., Schwarze, C. E., Schendel, D., Strohmaier, J., Abdellaoui, A., Adolfsson, R., Air, T. M., Akil, H., Alda, M., … Rietschel, M. (2017, June 20). Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia. Nature News. Retrieved June 7, 2022, from https://www.nature.com/articles/tp2017115
