#to justify the moral panic regarding self diagnosis

[edwardshundredyearoldspunk]

I really think you're telling on yourself if you actually think that people are diagnosing themselves with every and any mental disorder in the DSM-5 from a tiktok. chronically online of you to think this tbh. it's giving, "I don't actually talk to people irl and all my information about this is from social media."

[psychweeb]

Watamote Analysis Pt.2: More Than SAD?

Alright, so a quick overview: in my last post regarding Watamote (Watamote: An Intriguing Perspective On Social Anxiety), I discussed how many of the situations in Watamote, as well as the traits of the protagonist Tomoko Kuroki, indicate that she is suffering from Social Anxiety Disorder. This is a disorder that is characterized by extreme avoidance of social situations and people, to the extent where it is also considered “social phobia”. If you want to understand this concept more in depth, you can read my previous post, and there are many online resources that can provide more info- I recommend https://adaa.org/understanding-anxiety/social-anxiety-disorder as a great starting point, where I found many of the statistics and verified the information used in my last post.

Anyways, in this post, we will be continuing from where we left off. At the end of the last post, I acknowledged that while SAD seems to be the most plausible diagnosis for Tomoko, some other sources and discussions I came across online while researching suggested that she could be suffering from ASPD (anti-social personality disorder) or BPD (borderline personality disorder), either alongside SAD or alone. Both are widely associated with psychopathy and sociopathy, respectively. To begin, let’s first distinguish the differences and similarities between both. I will add that much of the information on these I’ve gathered is from notes from my abnormal psychology class, so I do genuinely believe it’s reliable- the rest will be in the list of sources.

Anti-social personality disorder, according to the  Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), can only be diagnosed after the age of 18- However, signs of it may emerge from around the age of 15 (defined as conduct disorder). Therefore, while she may have some traits of an ASPD affliction, it is already unlikely that Tomoko canonically suffers from this. Even though her age is never directly stated in the anime, she attends high school, implying she’s a teenager. Regardless, for the sake of the article, we’ll discuss some of the characteristics that classify it as its own diagnosis:

- Many behaviours of an individual with ASPD notably indicate a great focus on oneself, regardless of morals or ethical implications. Since they exclusively focus on themselves and personal gain, others are no more than pawns to use and aid them in their own pursuits. True intimate relationships are usually nonexistent due to issues with empathy and a general carelessness for others’ feelings. It is worth noting that, while all psychopaths are narcissists, not all narcissistic individuals exhibit behaviours of a psychopath. 

- Generally, they are manipulative liars, which ties into the above statement that they view others as “pawns”. They use their charm and wit, which they normally learn through observation of others, to convince others of their trustworthiness and integrate into society. 

- Normally, lack of remorse and impulsivity lead to criminal activity in these individuals. Irresponsibility and failure to learn from their mistakes is also commonplace.

BPD, on the other hand, does not have an age requirement to warrant diagnosis. It has been argued that, while Psychopathy/ASPD is within you from birth, despite the 18 or older diagnosis rule, Sociopathy/BPD is developed during one’s life. Some symptoms of it include: 

- Fears of abandonment or rejection. May push the individual to threaten self-harm or suicide.

- Unstable opinions of people and self-image or identity, such as shifting values and thoughts on others (which can intensify the above fears). Moods are also unstable in these individuals, and they often experience intense mood swings. 

- Paranoia caused by stress and losing touch with reality.

- Impulsivity, recklessness and irresponsibility (one symptom BPD shares with ASPD).

So, does Tomoko fit the bill for either of these? 

 I mentioned that narcissists and individuals with ASPD share similar self-centered behaviours. Tomoko does focus on herself, and appears to search for pity and validation among her peers, which narcissists tend to do. One instance that is frequently referred to to justify this argument is the scene in which she claims she has been “raped” to Yu, after hearing other girls in her class have been molested and feels left out. It can be interpreted as a way to exploit Yu’s friendship and get concern and pity from her- I, personally, just see it as another manifestation of her desire to fit in and be like her other peers. It is worth mentioning that, either way you interpret the objective of these questionable actions of her’s- whether fishing for pity or attempting to fit in, both would be indicative of ASPD. It’s a form of manipulative lying, as even if it doesn’t blatatly have any benefits for her, it provides her with some emotional gratification, either through a feeling of belonging or by offering the pity and concern she yearns for.

And that leads to another aspect of Tomoko’s personality worth contemplating-despite her undeniable disdain of her peers, she desires to be like them. I believe that a large part of this disdain towards other girls is actually jealousy, whether she realizes it or not. She attempts to be like them on multiple occasions, and fantasizes about being pretty and popular (although in her mind, this means being a “bitch”, solidifying her grudge/jealousy against other girls). In fact, a small part of her even seems to consider Yu a “bitch”. 

While being arrogant doesn’t always indicate ASPD, it is certainly a symptom, on account of the fact that it heavily ties into narcissism. Again, narcissism doesn’t automatically mean psychopathy- but in this case, it seems it would tie into something greater, since she actively lied and used her closest friend to feed her narcissism.

This arrogance may be a coping mechanism of sorts, a way to help her accept that she is not like them (”who would want to be a basic bitch?”), but her constant cognitive dissonance and changing opinions are indicative of BPD. As I mentioned above, instability in feelings towards people and situations is one of the . Some days, she hates the girls around her, other days she wants to be them. With Yu, Even though she’s a “bitch” like the rest of them, she appears to admire her beauty and popularity (ironically the key things that make her a “bitch”), and sometimes it’s even hinted at throughout the series that she has a crush on her.

*Side note: grabbing her butt is a very impulsive and reckless thing to do, as she isn’t considering Yu’s reaction or the consequences it may have of their friendship. 

Finally, Tomoko demonstrates the paranoia characteristic that is typically associated with BPD. Much of her stress and social anxiety is likely caused by SAD, but this stress undeniably worsens her paranoia. Consequently, she will lose touch with reality as the fear overtakes her- after all, even neurotypical people can drift off and begin to think up ludicrous situations when they’re extremely stressed. This losing touch with reality is VERY different from fantasizing, though, which she does often as well- daydreaming is not necessarily losing touch with reality. For instance, she sometimes daydreams that she has the looks of a sexy centerfold- but will eventually break out of this fantasy and realize she is herself again. Meanwhile, when in a state of panic, it is difficult for her to rationalize and think about the situation, more-so than for most people. In the infamous train scene - which is what leads to her “confessing” to Yu that she had been raped- she fears that she is being molested on the train when she feels something long and hard poking underneath her skirt. She nearly goes into hysterics. Even if she doesn’t blatantly show her fear until the end of the predicament, her internal monologue reveals her utter horror throughout her train ride.

 In reality, in just ended up being a schoolgirl’s stick (I’m unsure if it was a broomstick or what, honestly, but it was a long stick). Not a molester. In her defense, she doesn’t know what a penis feels like, but anyone in this situation probably would have been able to reason their way to the conclusion that it wasn’t. Tomoko jumps from conclusion to conclusion, letting her unrealistic thoughts feed her paranoia and fear.

In conclusion, I certainly think Tomoko suffers from Social Anxiety Disorder- there is no doubt in my mind about that. However, after doing some extensive research, I think it’s also plausible that she has Borderline Personality Disorder. While no trauma or particular cause of the emergence of BPD is shown in the anime, there is a flashback of her as a child in one episode, where she seems like a normal, pleasant child, which leads me to believe the wasn’t always like this. ASPD is not only something you inherently possess, but it seems a little extreme for Tomoko- I feel like she would feel guilt if she were to seriously hurt someone, or at least worry about the consequences afterward (even if her impulsivity prevented her from thinking about this beforehand). Her ever changing internal monologues regarding the things around her, as well as frequently becoming paranoid and losing touch with reality (which I think is worsened by her SAD) are all indicative of BPD. So, yes, I agree that she suffers from SAD and BPD- but not ASPD.

Sources:

https://www.verywellmind.com/the-diagnostic-and-statistical-manual-dsm-2795758- A resource I added for those who are unsure what the DSM is.

https://www.youtube.com/watch?v=6dv8zJiggBs- A helpful video to distinguish between Narcissism, Sociopathy, and Psychopathy with Dr.Ramani Durvasula.

https://en.wikipedia.org/wiki/Antisocial_personality_disorder Extensive notes on ASPD, good for anyone who wants to do further reading.

https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237 Extensive notes on BPD, for anyone who wants to do further reading.

My class notes from Psychology and Abnormal Psychology classes, which I have used to validate the info found in the above sources (with the exception of the DSM 5 definition and the youtube video).

* Cognitive Dissonance: In the field of psychology, cognitive dissonance is the mental discomfort experienced by a person who holds two or more contradictory beliefs, ideas, or values. This discomfort is triggered by a situation in which a person’s belief clashes with new evidence perceived by the person. (Definition copied from Wikipedia.com).

[electriceell]

Matt Murdock & Borderline Personality Disorder

It seems to be pretty universally believed among the Daredevil/Marvel fandom that Matt has some very serious neuroatypical tendencies. I’ve been told that he has depression in the comic book canon and, at first, that seemed pretty reasonable, all in all. He does really self-destructive crap, has a pretty low sense of self-worth, some pretty serious guilt, and pessimistic thoughts, all of which are Major Depressive Disorder territory. That being said, a lot of the other symptoms: loss of interest in life and reduced energy/decreased activity don’t seem to turn up at all. 

What makes more sense, to me at least, is Borderline Personality Disorder (BPD). It is, of course, necessary to acknowledge that we cannot diagnose characters since they exist in a very specific unreal spectre of our world. We have no way to reference their actions or choices and no clear insight into their thoughts and thought patterns. On top of that, I was somewhat recently diagnosed with BPD and it seemed like the things in me that are Matt Murdock are some of the stuff that started to make sense in light of the BPD diagnosis. 

The DSM-V has five general criteria for personality disorders:

Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

One or more pathological personality trait domains or trait facets.

The impairments are relatively stable across time and consistent across situations.

The impairments are not better understood as normative for the individual’s developmental stage or sociocultural environment.

The impairments are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

For BPD the first two these break down like this: 

Impairments in Personality Functioning:

Impairments in identity or self-direction: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self criticism; chronic feelings of emptiness; dissociative states under stress.

This one is really the crux of BPD and one that I think is frequently misunderstood. “Unstable self-image” is something that is hard to wrap one’s head around, especially considering that “instability in goals, aspirations, values, or career plans” are considered separately in the ‘self-direction’ category. Matt certainly has stable goals, values, etc. but despite that, he exists as many different personalities. He tends to morph to what the people around want him to be; he does his best to inhabit the space that he imagines is meant for him. With Foggy he’s gentle and kind, a fake softness to cover his sharp edges, with Elektra he becomes the sharp edges and nothing in between, for Karen he becomes the perfect gentleman and protector he sees her as needing, etc. I would argue that he leans into the traits that he thinks his partners see as desirable or good or ~Matt~ in order to become what they want. Karen and Foggy have mostly overlapping images, making it possible for them to coexist with Matt, but Elektra is totally other. By this token, Matt with Elektra cannot overlap with Foggy because the essential Matt-ness changes depending on who he’s with. On top of all of this, Matt literally exists as the two incongruous halves of himself. The show tracks the ways that Matt Murdock, attorney-at-law and Daredevil cannot inhabit Matt at the same time. But I honestly think this is less crucial to Matt’s BPD than his amorphous personality.

Impairments in empathy or 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 over involvement and withdrawal.

Do I even need to go into this one? Matt, in his entire life, manages one long-term close relationship, which is certainly intense and unstable. He is incredibly attached to Foggy, willing to strike out and start a law firm with him, but too scared to tell him about his senses. Despite evidence to the contrary, Matt doesn’t trust Foggy enough to tell him something essential, presumably for fear of abandonment. Extremes of idealization and devaluation absolutely come to play with Foggy, Karen, and Elektra. Matt seems to idolize Foggy, considers him the heart of Nelson & Murdock, but then proceeds to detach and condemn Foggy for not accepting him as Daredevil. Elektra is perfect and the center of Matt’s world and ~knows Matt better than anyone else~ and then she’s terrible and destroys everything. There’s a definite reason for this snap change, but it’s still very extreme, changing polarity quickly. 

Pathological Personality Traits:

Negative Affectivity characterized by  emotional lability - Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

I mean. Matt does not have normal emotional responses as an adult. He flares with anger easily, which would explain his sense that the devil is in him. Outbursts of anger with following intense remorse, shame and guilt are also considered common in people with BPD. 

anxiousness - Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

This is another one that I have trouble even digging into because it feels so obvious. We’ve all seen Matt’s ability to handle interpersonal stress. He basically backs out awkwardly while mumbling about random things. Or he yells or punches things. That’s basically the only ways he handles things. 

In addition, Matt clearly clings to ‘killing his father’ and then, of course, Stick leaving him. He says he ‘has an incredible ability to bring disaster into his life’. I have to think both of those are attached to this sentiment. And of course, nearly driving Foggy out with Daredevil and keeping his senses to himself. 

He’s terrified of losing control and crossing the line and killing someone. Despite a strong, intense moral compass, he seems to exist in a state of fear that he might murder someone in an outburst of anger (see emotional lability).

separation insecurity - Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

Jack, Stick, Elektra, Foggy - people leave him. And since his dad died he’s fucking terrified of it. His resistance to loss of autonomy is demonstrated most clearly with Elektra and Stick. It’s easy to justify with them because they’re ~bad influences~ and morally ambiguous, but Matt is scared of becoming their puppets despite being, you know, an autonomous human being. 

depressivity - Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

Matt never feels good enough, has terrible sense of self-worth to the point where he LITERALLY BELIEVES HE’S THE DEVIL SOMETIMES. Shame surrounds his existence as Daredevil and lying to the people around him and also not doing enough as DD. I don’t think it’s that much of a reach to say what he does as DD is suicidal behavior. He knows this can’t be sustained. But he keeps going with no sense of self preservation. 

Disinhibition, characterized by 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 or following plans; a sense of urgency and self-harming behavior under emotional distress.

... Nothing says acting on the spur of the moment or without plan quite like when he gets hacked to pieces by Nobu or goes on a rescue mission for Stick. Or for Karen et al. to be entirely honest. Urgency and no regard for his safety are basically the backbone of Matt Murdock’s Daredevil. 

risk taking -  Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

HAHAHAHAHAHAHA NEXT

Antagonism characterized by: hostility - Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

Is he ever not angry? Like really. Pretty small things (Stick’s commenting on Jack) set Matt off and get him swinging. Repeat on the devil in him - small things spark anger in him. 

Stable across time check Not explained by age or socio-cultural environment check Not due to substances (drugs or meds) or a medical condition (head trauma) check (even if Matt has serious head trauma, I don’t think that’s what shapes his personality functioning)

Being raised in an abusive environment is common among people with BPD. Correlation, of course, does not imply causation, but Matt’s early and intense relationship with Stick was abusive and could have shaped BPD tendencies.

When it comes down to it, a personality disorder makes a lot more sense for Matt’s unstable and non-normative functioning than depression.

“I’m so good at beginnings, but in the end I always seem to destroy everything, including myself.” - Kiera Van Gelder, The Buddha and the Borderline

[cyno-sexual]

Borderline personality disorder

This isn’t about justifying my actions or anything of the sort, only laying this out more so as a reminder and to be able to understand me a little better. I’m fighting this mental illness every day, and more often I fail at it too. I could write more here, but that would only be about my hate for myself or my feelings or anything really about my being. Don’t wanna do that.

Source: Wikipedia

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD),[7] is a long-term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[4][5] There is often frequent dangerous behavior, a feeling of emptiness, self-harm, and an extreme fear of abandonment.[4] Symptoms may be brought on by seemingly normal events.[4] The behavior typically begins by early adulthood, and occurs across a variety of situations.[5] Substance abuse, depression, and eating disorders are commonly associated with BPD.[4] BPD increases the risk of self-harm and 10% of people affected die by suicide.[4][5]

BPD's causes are unclear, but seem to involve genetic, brain, environmental, and social factors.[4][6] It occurs about five times more often in a person who has an affected close relative.[4] Adverse life events also appear to play a role.[8] The underlying mechanism appears to involve the frontolimbic network of neurons.[8] BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.[5] Diagnosis is based on the symptoms while a medical exam may be done to rule out other problems.[4] The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.[5]

Borderline personality disorder is typically treated with therapy, such as cognitive behavioral therapy (CBT).[4]Another type, dialectical behavior therapy (DBT) may reduce the risk of suicide.[4] Therapy may occur one-on-one, or in a group.[4] While medications do not cure BPD, they may be used to help with the associated symptoms.[4]Some people require care in hospital.[4]

About 1.6% of people have BPD in a given year.[4] Females are diagnosed about three times as often as males.[5]It appears to become less common among older people.[5] Up to half of people improve over a ten-year period.[5]People affected typically use a high amount of healthcare resources.[5] There is an ongoing debate about the naming of the disorder, especially the suitability of the word "borderline".[4] The disorder is often stigmatized in both the media and psychiatric field.[9]

Borderline personality disorder may be characterized by the following signs and symptoms:

Markedly disturbed sense of identity

Frantic efforts to avoid real or imagined abandonment and extreme reactions to such

Splitting ("black-and-white" thinking)

Impulsivity and impulsive or dangerous behaviours

Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation

Unstable and chaotic interpersonal relationships

Self-damaging behavior

Distorted self-image[4]

Dissociation

Frequently accompanied by depression, anxiety, anger, substance abuse, or rage

The most distinguishing symptoms of BPD are marked sensitivity to rejection or criticism, and intense fear of possible abandonment.[10] Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Other symptoms may include feeling unsure of one's personal identity, morals, and values; having paranoid thoughts when feeling stressed; dissociation and depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.

Emotions

People with BPD may feel emotions with greater ease, depth and for a longer time than others do.[11][12] A core characteristic of BPD is affective instability, which generally manifests as unusually intense emotional responses to environmental triggers, with a slower return to a baseline emotional state.[13][14] People with BPD often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them.[15] In Marsha Linehan's view, the sensitivity, intensity, and duration with which people with BPD feel emotions have both positive and negative effects.[14] People with BPD are often exceptionally enthusiastic, idealistic, joyful, and loving.[16] However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.[16]

People with BPD are also especially sensitive to feelings of rejection, criticism, isolation, and perceived failure.[17] Before learning other coping mechanisms, their efforts to manage or escape from their very negative emotions may lead to emotional isolation, self-injury or suicidal behavior.[18] They are often aware of the intensity of their negative emotional reactions and, since they cannot regulate them, they shut them down entirely.[14] This can be harmful to people with BPD, since negative emotions alert people to the presence of a problematic situation and move them to address it which the person with BPD would normally be aware of only to cause further distress.[14] People with BPD may feel emotional relief after cutting themselves.[19]

While people with BPD feel euphoria (ephemeral or occasional intense joy), they are especially prone to dysphoria (a profound state of unease or dissatisfaction), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognized four categories of dysphoria that are typical of this condition: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity, and feelings of victimization.[20] Within these categories, a BPD diagnosis is strongly associated with a combination of three specific states: feeling betrayed, "feeling like hurting myself", and feeling out of control.[20] Since there is great variety in the types of dysphoria experienced by people with BPD, the amplitude of the distress is a helpful indicator of borderline personality disorder.[20] In addition to intense emotions, people with BPD experience emotional "lability"; or in other words, changeability. Although the term emotional lability suggests rapid changes between depression and elation, the mood swings in people with this condition actually fluctuate more frequently between anger and anxiety and between depression and anxiety.[21]

Behavior

Impulsive behavior is common, including substance or alcohol abuse, eating disorders, unprotected sex or indiscriminate sex with multiple partners, reckless spending, and reckless driving.[22] Impulsive behavior may also include leaving jobs or relationships, running away, and self-injury.[23] People with BPD act impulsively because it gives them the feeling of immediate relief from their emotional pain.[23] However, in the long term, people with BPD suffer increased pain from the shame and guilt that follow such actions.[23] A cycle often begins in which people with BPD feel emotional pain, engage in impulsive behavior to relieve that pain, feel shame and guilt over their actions, feel emotional pain from the shame and guilt, and then experience stronger urges to engage in impulsive behavior to relieve the new pain.[23] As time goes on, impulsive behavior may become an automatic response to emotional pain.[23]

Self-harm and suicide

Self-harming or suicidal behavior is one of the core diagnostic criteria in the DSM-5.[5] Self-harm occurs in 50 to 80% of people with BPD. The most frequent method of self-harm is cutting.[24] Bruising, burning, head banging or biting are not uncommon with BPD.[24]

The lifetime risk of suicide among people with BPD is between 3% and 10%.[10][25] There is evidence that men diagnosed with BPD are approximately twice as likely to die by suicide as women diagnosed with BPD.[26] There is also evidence that a considerable percentage of men who die by suicide may have undiagnosed BPD.[27]

The reported reasons for self-harm differ from the reasons for suicide attempts.[18] Nearly 70% of people with BPD self-harm without trying to end their life.[28] Reasons for self-harm include expressing anger, self-punishment, generating normal feelings (often in response to dissociation), and distracting oneself from emotional pain or difficult circumstances.[18] In contrast, suicide attempts typically reflect a belief that others will be better off following the suicide.[18] Both suicide and self-harm are a response to feeling negative emotions.[18] Sexual abuse can be a particular trigger for suicidal behavior in adolescents with BPD tendencies.[29][quantify]

Interpersonal relationships

People with BPD can be very sensitive to the way others treat them, by feeling intense joy and gratitude at perceived expressions of kindness, and intense sadness or anger at perceived criticism or hurtfulness.[30] Their feelings about others often shift from admiration or love to anger or dislike after a disappointment, a threat of losing someone, or a perceived loss of esteem in the eyes of someone they value. This phenomenon, sometimes called splitting, includes a shift from idealizing others to devaluing them.[31] Combined with mood disturbances, idealization and devaluation can undermine relationships with family, friends, and co-workers.[32] Self-image can also change rapidly from healthy to unhealthy.

While strongly desiring intimacy, people with BPD tend toward insecure, avoidant or ambivalent, or fearfully preoccupied attachment patterns in relationships,[33] and they often view the world as dangerous and malevolent.[30] BPD, like other personality disorders, is linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction on the part of romantic partners, abuse, and unwanted pregnancy.[34]

Sense of self

People with BPD tend to have trouble seeing a clear picture of their identity. In particular, they tend to have difficulty knowing what they value, believe, prefer, and enjoy.[35] They are often unsure about their long-term goals for relationships and jobs. This difficulty with knowing who they are and what they value can cause people with BPD to experience feeling "empty" and "lost".[35]

Cognitions

The often intense emotions experienced by people with BPD can make it difficult for them to control the focus of their attention—to concentrate.[35] In addition, people with BPD may tend to dissociate, which can be thought of as an intense form of "zoning out".[36] Dissociation often occurs in response to experiencing a painful event (or experiencing something that triggers the memory of a painful event). It involves the mind automatically redirecting attention away from that event, presumably to protect against experiencing intense emotion and unwanted behavioral impulses that such emotion might otherwise trigger.[36] Although the mind's habit of blocking out intense painful emotions may provide temporary relief, it can also have the unwanted side effect of blocking or blunting the experience of ordinary emotions, reducing the access of people with BPD to the information contained in those emotions, which helps guide effective decision-making in daily life.[36] Sometimes, it is possible for another person to tell when someone with BPD is dissociating, because their facial or vocal expressions may become flat or expressionless, or they may appear to be distracted; at other times, dissociation may be barely noticeable.[36]

Disability

Many people with BPD are able to work if they find appropriate jobs and their condition is not too severe. People with BPD may be found to have a disability in the workplace, if the condition is severe enough that the behaviors of sabotaging relationships, engaging in risky behaviors, or intense anger prevent the person from functioning in their professional role.[37]