From the Guidelines
The clinical criteria for Borderline Personality Disorder (BPD) include a pervasive pattern of instability in interpersonal relationships, self-image, emotions, and impulsivity, beginning by early adulthood and present in various contexts, as outlined in the DSM-IV criteria 1. To diagnose BPD, at least five of the following symptoms must be present:
- Frantic efforts to avoid real or imagined abandonment
- Unstable and intense interpersonal relationships alternating between idealization and devaluation
- Identity disturbance with markedly unstable self-image
- Impulsivity in at least two potentially self-damaging areas such as spending, sex, substance abuse, or reckless driving
- Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
- Affective instability due to marked mood reactivity
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms These criteria help clinicians distinguish BPD from other personality disorders and mental health conditions, such as bipolar disorder or major depressive disorder with psychotic features, which may present with similar symptoms 1. A comprehensive psychological evaluation is necessary to diagnose BPD, as symptoms may overlap with trauma responses, mood disorders, or other personality disorders 1. Early diagnosis enables appropriate treatment, typically involving dialectical behavior therapy (DBT), schema therapy, or mentalization-based therapy, sometimes combined with medications to target specific symptoms like mood instability or impulsivity.
From the Research
Clinical Criteria for BPD
The clinical criteria for Borderline Personality Disorder (BPD) include:
- Pervasive patterns of instability in emotions, interpersonal relationships, and self-image 2
- Emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies 3
- Sudden shifts in identity, interpersonal relationships, and affect, as well as impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms 4
- Unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors 5
Diagnostic Criteria
BPD is typically diagnosed by a mental health specialist using semistructured interviews 4. The diagnostic criteria include a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image 3.
Key Characteristics
Key characteristics of BPD include:
- Impulsivity and impulsive aggression 3
- Repeated self-injury and chronic suicidal tendencies 3
- Emotional dysregulation and intense anger 4
- Feelings of emptiness and dissociative symptoms 4
- Unstable sense of self and chaotic relationships 5
Comorbidities
BPD often co-occurs with other mental disorders, including: