One of the things that make BPD hard to diagnose is the combination of symptoms.

You generally need to experience 5 of the following symptoms to be diagnosed with BPD:

• Extreme reactions to feeling abandoned – this may involve efforts to avoid being abandoned, or by cutting someone out before they can abandon and hurt you;
• Unstable relationships – you may find that you idealise someone and then quickly swing to intensely disliking them;
• Confused feelings about who you are – not sure who you are or what to think about yourself;
• Being impulsive in ways that could be damaging – for example, spending money, substance abuse and reckless driving, risky sexual behaviour, binge eating;
• Self-harm, suicidal thoughts and behaviours – talking or thinking about suicide, repeatedly harming youself or
• Long-lasting feelings of emptiness and feeling abandoned – a feeling of being completely alone and abandoned, or feeling empty inside;
• Difficulty controlling emotions and anger – getting angry and being unable to control it, reacting out of proportion to the person who trigged the anger, or being unable to control anger resulting in physical fights or fits of rage;
• Overwhelming mood swings and intense emotions – experiencing intense emotional lows (depression) and highs (mania) – this can last anywhere between an hour and days;
• Paranoid thoughts when you’re stressed – being suspicious of others around you, or having a feeling that someone is ‘out to get you’. This may also include the feeling of being detached from your emotions or body.

Everyone is different – certain individuals may exhibit only a limited number of symptoms while others may experience all of them. Moreover, the severity of these symptoms also varies from person to person, with certain individuals experiencing more pronounced effects for specific symptoms.

There are 256 possible combinations of these symptom sets, combined with comorbid conditions (other conditions which may also be present such as depression, anxiety/panic, eating disorders, OCD, etc), can make it very difficult to diagnose.

Living with any one of these symptom sets would be challenging, not to mention dealing with five or more. It is crucial to acknowledge that the symptoms experienced by individuals with BPD are completely valid to them and should be acknowledged accordingly.