Borderline Personality Disorder Diagnostic Criteria

Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following...

Criterion 1

(1) frantic efforts to avoid real or imagined abandonment. Note: do not include suicidal or self-mutilating behavior covered in criterion 5

– Fear of abandonment is pervasive and causes anger towards dependents

Criterion 2

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

– Case example swings from loving people to hating them

• Idealized as the best person on earth or

• Devalued as a demon from hell

– This can happen both within and among individuals

• Called “splitting” when done among individuals

– Often times past or present times with a single individual are idealized or devalued

Criterion 3

(3) identity disturbance; markedly and persistently unstable self-image or sense of self

– Non-affected individuals have a solid sense of identity that defines the person and gives direction in life

• Borderline patients often lack stable identity and are without anchors

– Without anchors, one becomes vulnerable to transient emotions and their motivations

Criterion 4

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5

– Emotions influence current motivations and desires

• Thus, transient emotions lead to transient behaviors

Criterion 5

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

– Self-injurious behaviors (i.e. those without the intent to die) can include

• Cutting self

• Burning self

• Scratching self

• Banging head against the wall

Criterion 6

(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

– The most common emotions are those of anger and shame

– Emotions vs. moods distinction is relevant here regarding differential diagnoses

Criterion 7

(7) chronic feelings of emptiness

– Often reported as

• “A hole in my heart/chest”

• “A rotten banana in chest”

• “A frozen glass of water in chest”

• “An empty glass in chest”

• “A wringing in chest”

• “A black hole in heart”

– This feeling represents the lack of feeling

– Reported as intensely painful

• Many have incorrectly sought medical treatment for it

Criterion 8

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

– Most common present emotion

Criterion 9

(9) transient, stress-related paranoid ideation or severe dissociative symptoms

– Sensation of

• “Moving in slow motion”

• “Like an observer watching things from the outside”

– Mind shuts off as if driving a familiar route

• “Going where the GPS tells me to go”

• Passive

All diagnostic criteria come down to difficulties with

Emotion

– Frantic efforts to avoid real or imagined abandonment

– Unstable and intense interpersonal relationships

– Identity disturbance

– Impulsivity

– Recurrent suicidal behavior

– Affective instability

– Inappropriate, intense anger

– Transient, stress-related paranoid ideation