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Dear Dr. Robert,

First, I know you cannot diagnose me over the internet. I realize that. Nonetheless, I would like to know if this sounds like BPD. I am a 19 year old male college student. For at least the past five years, I have been a very emotionally volatile person. Close friends have thought I have bipolar, but I know I do not because my mood changes hour by hour, not week by week. Furthermore, it is triggered by external causes. I have a very unstable self-image. Some day I think very highly of myself and feel great, other days I feel that I have nothing to be proud of and I am an utter failure. Sometimes I become extremely angry to the point of breaking things. I have never actually injured someone, although I've scared plenty of friends, who tell me I yell and scream like I'm possessed by some demon when I'm angry. I have a very addictive personality, but I have never been addicted to anything harmful simply because I have pretty high morals and don't try dangerous things (never tried drinking, etc). My addictions (or impulses) over the past few years have included video games, soft porn, the internet, and listening to music (I am always wearing headphones). 

I prefer to have a smaller number of very close friends rather than a larger number of loose friends. I DON'T feel abandoned by them very often. However, I have very few friends of the opposite sex. I have never had a girlfriend and sometimes doubt that I ever will, but have always wanted one a lot, much more than most people I know, who couldn't give a damn about having a serious relationship. I have always been in love, unrequitedly, with someone since I was 11; by this I mean that at every point since that age, I have had very obsessive "crushes" (I hate that word, but what else am I going to call it?) on some girl, generally who I am friends with but in a non-romantic way, which lasts three or four years and does not end until a new one begins. I feel very abandoned by the opposite sex in general, but not by my family or friends. I also feel very abandoned by God, and even after having lost all belief, I still, paradoxically, feel abandoned and angry at a God I don't even believe in. Now that I am a freshman in college, I don't have many friends in college, and feel abandoned by the students at my university in general (i.e., not by any particular person). At many points during my first year here in college, I have felt utterly miserable and worthless. I sometimes try to make my family understand how miserable I feel here by telling them, but they never seem to get it, which has made me very angry. I think they see me happy so often they can't comprehend my misery. 

Nobody I know would describe me as a manipulative person, and this seems to be half the point of BPD. No one I know would tell me that I take them on guilt trips. When I feel very sad, I just sulk in solitude; I don't drag anyone under with me. Neither do I think that people are all good or all bad. When I read about this facet of BPD online, I can't imagine myself thinking this way. 

Still, I feel mentally ill, and BPD sounds the closest to what I have out of anything of I've read about. Again, I am very confident that I DO NOT have BIPOLAR because my emotions can change minute by minute and are the products of external factors. 

I know I am being longwinded, so my question is this: although I think I do technically qualify as BPD under the DSM criteria, can I really have BPD if I do NOT feel that my friends abandon me and no one I know ever considers me manipulative? 



ask dr-robert

Hello, Castle--

The diagnostic categories established in the creation of the DSM (Diagnostic and Statistical Manual) are, in a certain sense, arbitrary. In other words, creating categories such as "borderline personality disorder" required drawing lines of separation between one type of problem or disorder and another which in real life seldom appear so clear cut as they do in the DSM. Occasionally a therapist will hear a story which seems to fit very neatly into one particular diagnostic category or another, but more frequently this is not the case. Human psychology is complicated, and usually cannot be made to fit neatly any particular pigeonhole. In fact, the very name of the DSM, the Diagnostic and Statistical Manual, indicates that the categories are based on statistical averages, not individual cases.

ask dr-robert

To put this another way, a troubled person might fit one or two of the criteria of any single DSM category without fitting any of the other criteria of that category, and hence not qualify for the diagnosis in that category. Or someone might fit a single criterion from one diagnostic category, and another single criterion from a totally different category and so, while undeniably troubled, fail to meet the requirements for any diagnosis at all. Speaking personally, I rarely consult DSM unless somehow required to do so for legal reasons, nor does the DSM does help me to formulate any treatment plans or approaches to my relations with patients.This is not to say that the DSM is totally worthless. In my view, the DSM can be useful in two ways: first, being able to put a recongnized label on suffering sometimes helps to reduce the suffering; and second, diagnostic categories can serve as a kind of shorthand for communication between colleagues when they discuss cases. But against those arguments for the DSM must be balanced the danger that complex human beings might be reduced to statistical categories, foreclosing the possibility of any really deep understanding. For example, I sometimes hear colleagues refer to a patient like this: "I am working with a borderline." This always annoys me. "Your patient is
not a 'borderline,'" I always want to say, "but a human being, some of whose ways of relating to the world may fit into the DSM category called 'borderline.'" Yes, written out that way those words seem a bit pedantic, and I never actually say them to anyone, but in my work I strive always to see people as people, never as categories. Personally, I would never refer to anyone as a "borderline," but instead would say, "His personality shows some features of borderline personality disorder. This may seem to be a small distinction, but small distinctions can be vital, particularly in the face of the monumental complexity of human psychology.

ask dr-robert

That said, your letter does suggest the kind of unstable self-image which is associated with borderline personality disorder, and I do not hear any strong indications of bipolar disorder at all.

I hear something else in your letter, Castle: the kind of intelligence and self-awareness which indicate to me that you would be an excellent candidate for depth psychotherapy, and I suggest you now begin looking for the psychotherapist who will help you to begin living the life you desire, including a girlfriend. A good therapist will understand your situation in a way which your family cannot, and will be able to help satisfy your pressing need to be seen, heard, and understood, which, I imagine, has remained unsatisfied for a long time now, probably since early childhood. I postulate this because often your type of personality belongs to people who were not properly met by early caregivers, and your statement that you try to tell your family how you feel, "but they never seem to get it," suggests just that type of early experience.

You should not have to live in psychic misery, Castle. It is time--past time really—to do something about your lack of friendship, self-esteem, and sex, and I feel strongly that a course of good therapy would help you more than you can now imagine. Your college or university should have therapy available either at no cost or at very low cost, and I urge you to investigate this as soon as possible.

Please write again when you have begun therapy, and let me know how it is going for you.

Be well.

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