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Section 1
Diagnostic Criteria for Borderline Personality Disorder

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On this track, we will discuss Structural Criteria of borderline personality disorders to make sure we are all on the same page so to speak regarding a basic BPD definition. Three criteria we will discuss are identity diffusion, primitive defense mechanisms, and reality testing. As you listen to this track, consider the structural criteria in relation to your BPD client.

Three Criteria of Boderline Personality Disorder

Criteria #1 - Identity Diffusion
First, identity diffusion, which as you are aware is clinically represented by a poorly integrated concept of the self and significant others. Subjective experiences of chronic emptiness, contradictory self-perceptions, and contradictory behavior reflect identity diffusion. Also, descriptions of significant people in the client’s life may be so grossly contradictory that the people sound more like caricatures than like real people. Identity diffusion tends to manifest as a lack continuity in respect to self image.

In a BPD client, there may also be little capacity for the realistic evaluation of others. For example, one client, Leah, age 32, displayed identity diffusion when she suggested that her mother was very nice and understanding about her BPD. However, Leah later stated, "I just don’t know why she thinks that what I’m going through is so funny. She laughs at me with her friends when I’m not around."

However, Leah stated she had never observed her mother doing this. Think of your BPD client. Does he or she experience identity diffusion regarding himself or others? You might consider trying the Playwright technique I will describe next.

Technique:  Become a Playwright
To help Leah with her identity diffusion, I asked her to try the "Become a Playwright" technique.  I asked Leah to put her life and her mother’s life on stage and then step down into the audience with me. 
--1. For this visualization, I asked Leah to picture an interaction with her mother in which Leah felt like the object of a joke. 
--2. Next, I asked Leah to imagine being a playwright, the person who has written the scene and created the characters on stage. 
--3. Finally, I asked Leah if she was willing to write a new part for herself to see how the supporting characters might respond to different lines. 

In each scene of Leah’s life, she displayed a desire to change the play so that the characters were more integrated to include realistic descriptions. When Leah described how she could rewrite a scene, I noticed that she tended to eliminate identity diffusion or her poorly integrated concept of the self and significant others. By eliminating identity diffusion by rewriting her mother’s part, Leah started to began to believe that her mother no longer laughed behind her back. 

Instead, her mother remained understanding and empathetic in the rewritten version. Are you treating a BPD client who may benefit from changing diffused perceptions through a  "Become a Playwright" technique?

Criteria #2 - Primitive Defense Mechanisms
A second structural criteria of borderline personality disorders is primitive defense mechanisms.  Leah demonstrated primitive defense mechanisms as opposed to high level defense mechanisms when she felt threatened by her mother. As you know, primitive defense mechanisms are an attempt at protecting the ego by means of dissociation or perhaps separating contradictory experiences of the self. As you are aware, primitive defense mechanisms may include idealization, projection, and denial.  

Leah displayed devaluation of self when she stated, "I can’t do anything right. Everything I touch turns to shit!" Later, in the same session, Leah’s narcissistic personality surfaced when she displayed a second derivative of idealization.  Leah displayed feelings of omnipotence when she stated, "I know what you’re thinking about me.  I know what everyone thinks!  But none of that matters because I’m better than all of you!" 

Could the "Become a Playwright" technique I described earlier be adapted for your BPD client to help him or her become conscious of his or her primitive defense mechanisms?

Criteria #3 - Reality Testing
In addition to identity diffusion and primitive defense mechanisms, the third structural criteria of a borderline personality disorder is reality testing.  BPD clients like Leah experience alterations in respect to their ability to test reality. Would you agree?  I have found that three criteria can be used to evaluate a client’s ability to maintain proficiency in reality testing.  The three clinical criteria for reality testing are the absence of hallucinations or delusions, the absence of grossly inappropriate or bizarre affect, thought content, or behavior; and the capacity to evaluate the self and others realistically. 

Leah had trouble with reality testing due to her inability to realistically evaluate herself.  As I explained earlier, Leah’s BPD was characterized by idealization in which she felt either really good about herself or really bad.  These manifestations met the structural criteria for BPD and also led to Leah’s chronic interpersonal difficulties.  By asking a BPD client like Leah to describe her evaluation of herself compared to the way others perceive her, as you have experienced, you may find common recurring contradictions.  For example, when Leah devalued herself, she described her father’s perception of her as incorrect because he thought she was very bright and capable. 

After Leah put herself down I asked her if her father felt the same way.  Leah stated, "No. He thinks I’m so smart and always tells me I could really be somebody if I tried.  How can he be so stupid!  It’s not like he doesn’t know I’m whacko!"  Clearly, Leah demonstrated the three structural criteria of BPD.  Are you treating a BPD client like Leah who has difficulty with reality testing?  If so, does his or her conflicting perceptions of self indicate poor integrations of self concepts?  This course will provide you with some specifics for these BPD issues.

On this track, we have discussed Structural Criteria of borderline personality disorders.  Three criteria we discussed were identity diffusion, primitive defense mechanisms, and reality testing. 

On the next track we will discuss communication.  Three aspects of communication as related to the BPD client include reflex communication verses conscious communication, the connection between shame and blame, and the "Three Steps to Conscious Communication" technique. 

Peer-Reviewed Journal Article References:
Benson, K. T., Donnellan, M. B., & Morey, L. C. (2017). Gender-related differential item functioning in DSM-IV/DSM-5-III (alternative model) diagnostic criteria for borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8(1), 87–93.

Hallquist, M. N., & Pilkonis, P. A. (2012). Refining the phenotype of borderline personality disorder: Diagnostic criteria and beyond. Personality Disorders: Theory, Research, and Treatment, 3(3), 228–246.

Michonski, J. D., Sharp, C., Steinberg, L., & Zanarini, M. C. (2013). An item response theory analysis of the DSM-IV borderline personality disorder criteria in a population-based sample of 11- to 12-year-old children. Personality Disorders: Theory, Research, and Treatment, 4(1), 15–22.

What are 3 Structural Criteria of borderline personality disorders? To select and enter your answer go to Test.

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