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Borderline Personality Disorder: Low Functioning vs. High Functioning

In a study reported by the American Journal of Psychiatry of functional impairment in patients with Borderline Personality Disorder and other personality disorders, it was found that patients with Borderline Personality Disorder have significantly more impairment than patients with other personality disorders. This functional impairment can be divided between low functioning and high functioning.

The Mayo Clinic reports that as many as 15 percent of the population in the United States has a personality disorder. Personality disorders account for more impairment in functioning than Major Depressive Disorder alone.

Having a personality disorder, such as Borderline Personality Disorder, is associated with lower functional status, lower health care satisfaction, and a higher risk for major depression and substance abuse.

Indications of low functioning Borderline Personality Disorder include the following:

  • self-mutilation (self-injury, cutting, etc.)
  • excessive risk taking, such as:
    • numerous and near-fatal traffic accidents
    • extreme addictions (gambling, sex, danger, etc.)
    • substance abuse and misuse
    • sexual promiscuity and risky sexual practices
  • frequent hospitalizations
  • successive and frequent non-completed suicide attempts
  • inability to maintain employment
  • extreme instability in interpersonal relationships
  • extreme anger, rage and violent behavior beginning in adolescence (or earlier)
  • prolonged involvement with criminal justice system and prison

Most of the children that have been seen in group home settings and psychiatric institutions with a history of the above are female more often than male, and may have a diagnosis of one of the personality disorders.

Rage appears to be a behavior of all those with Borderline Personality Disorder. The intensity of the rage may vary some, but it is still a constant. This may be more problematic with low functioning borderlines, as they seem to have less inhibition control, and are more prone to public rages in front of many witnesses.

People with high functioning Borderline Personality Disorder may have the same problem with rage that low functioning borderlines do; however, they may just have the ability to hide it better – they may do their raging at home rather than in public.

High functioning borderlines are the ones who fool everyone into thinking that they are “normal,” reserving their extreme borderline behaviors for their close friends and family. On the surface, these people appear to function well in society and in the majority of areas in their lives. They are frequently employed as professionals such as: psychiatrists, social workers, therapists, nurses, or otherwise involved in the health care industry.

Other high functioning borderlines do very well in the military/prison system or places where they are in control of those around them, such as: military officers, prison guards, police officers, or as customs officers. Because of the “black-and-white” thinking characteristic of Borderline Personality Disorder, these people believe the work they are doing is “good,” and, therefore, it makes them a “good person.”

About the Author

David Oliver is the founder of a one stop source of information on how to cope and deal with borderline personality disorder.

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Cutting and other forms of self-mutilation may be hard for many people to understand. People who self-harm are more likely to have an underlying emotional problems, such as Borderline Personality Disorder (BPD). According to a study by German researchers, people with BPD may engage in self-injury because they get a sense of emotional relief from physical pain. BPD is a complex set of... Read More

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