Proposed Changes to Borderline Personality Disorder in DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is what some psychologists and psychiatrists refer to as “the Bible” of their trade. Currently, practitioners are using the DSM-IV, published in 2000, which will be replaced by the DSM-V in 2013.  

This heavy book contains, among other things, the criteria for diagnosing all types of psychiatric disorders. That includes personality disorders, which are set to undergo some changes for the next edition.  

How it Works Now 

Right now, Borderline Personality Disorder (BPD) is classified with other personality disorders under Axis II of the DSM. Unlike Axis I disorders such as depression and Bipolar Disorder, which are considered “clinical” disorders, Axis II disorders are considered long-standing and ingrained into a person’s behaviors. 

When a doctor diagnoses you with a personality disorder, such as BPD, they look at two things: 

1. Are your symptoms (mostly) internal and pervasive? That means, do your thoughts, emotions, and behaviors create an unhappy life for you (or one that is different in a negative way than most people) and have these symptoms persisted for most of your adult life?  
2. What kind of personality disorder do you have? Each of the 10 types of personality disorders have their own set of diagnostic criteria that must be met in order to make a proper diagnosis.  

Why This Isn’t the Best System 

The DSM-IV’s current approach to personality disorders can be sticky. For instance:

• Different patients may exhibit different intensities of criteria, thus seeming to have different types of personality disorders
• Some criteria may be true at some times for a patient, but not at others
• Criteria from one personality disorder might overlap with another personality disorder

How the DSM-V Will Be Different 

Because Borderline Personality Disorder is under the umbrella of personality disorders, the fundamental change coming to the definition of personality disorders itself will have an impact on BPD. Personality disorders in the DSM-V will be defined as “adaptive failures.” This means people with a legitimate personality disorder cannot function well in the world due to the fundamental aspects of their personalities. Anyone who has or knows someone with BPD can tell you that the inability to function in a healthy, productive, and successful way in society is a major problem.   

Second, practitioners will select from a total of five types (Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal types), depending on whichever one the patient seems to match the most. Instead of there being criteria for the patient to “meet,” there will be a paragraph description for the patient to “match.” In this way, the patient is seen as more of a whole picture instead of a checklist of symptoms.   

In addition to the new definition of personality disorder and the new and reduced list of personality types, patients will also be ranked on their intensity of certain characteristics:

• Negative emotionality
• Introversion
• Antagonism
• Disinhibition
• Compulsivity
• Schizotypy

Each characteristic will get a ranking of 0-3, better helping doctors understand the specific aspects of your personality that you need to work on, rather than delivering a cookie-cutter treatment plan for a generic disorder.  

The DSM-V is still being revised by researchers, so the proposed changes are not final. There is still much research to be done around the validity and usefulness of these changes, but for some it is a step in the right direction.