What Is the Diagnostic Criteria for BPD?

Are you wondering if you or someone you know has Borderline Personality Disorder (BPD)? While a true diagnosis requires the expertise of a mental health professional, you can start by familiarizing yourself with the diagnostic criteria for BPD.

Below are the nine diagnostic criteria for Borderline Personality Disorder, as set out in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), as well as a brief explanation of what each one means. For there to be a diagnosis of BPD, at least five of the criteria must be met.

1. Frantic efforts to avoid real or imagined abandonment.

People with Borderline Personality Disorder often experience intense fears of abandonment, which can have a serious effect on their self-image and behavior, as well as their ability to maintain relationships.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

One of the most marked traits of people suffering from BPD is unstable relationships. They will jump from one relationship to another, never really settling down. Sometimes they will put their partner on a pedestal, almost to the point of worshipping them. If something goes wrong, they will demonize the other person. They lack perspective on situations – people are either very good or very bad. These same behaviors apply to all relationships, not just romantic relationships.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

People with Borderline Personality Disorder will often experiment with lifestyles and switch jobs, never quite figuring out who they really are and what they want to do in life.

4. Impulsivity in at least two areas that are potentially self-damaging.

Such self-damaging behaviors include eating disorders, substance abuse, gambling, and promiscuity. People with BPD often engage in several impulsive behaviors.

5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.

People with BPD often struggle with suicidal thoughts and ideations, as well as suicide attempts. They also frequently engage in self-harmful behaviors in an attempt to make themselves feel better emotionally.

“Self-mutilating behavior has no suicidal intent behind it, but is used to punish themselves, to get some relief from emotional pain, or to manipulate others,” says Cincinnati-based psychologist Nikki Instone, Ph.D. “This behavior, like cutting, brings relief via distracting from emotional pain with physical pain, brings an endorphin rush, and feels like something they can manage, since they struggle to manage emotions.”

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).

“People with BPD do not have good stress management skills,” Instone explains. “They are very sensitive to their surroundings, causing an emotional roller coaster ride.”

7. Chronic feelings of emptiness.

Because people with Borderline Personality Disorder can feel empty and alone, they may use relationships to fill the “void” in their life.

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

People with BPD are always facing an internal conflict that can often result in displays of anger.  “The two extremes are most apparent in relationships, where they vacillate between loving and hating others. In a matter of moments, someone can make a comment that the person with BPD interprets as derogatory, critical, or hurtful in some manner. Their mood then follows this interpretation to an extreme, resulting in fighting, yelling, attacking back, or falling into deep despair,” says Instone.

“Because they are so reactive to their environment and so sensitive to what they think others think of them, their mood changes several times throughout the day. It can change more rapidly if the situation is volatile, unstable, or confusing.”

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

When people with Borderline Personality Disorder find themselves in a very stressful situation that they have an intense reaction to but can’t resolve, they may exhibit symptoms of paranoia as a way to cope. They may also dissociate in order to escape intense emotional pain.

“When they fall into paranoia or dissociation, it is a temporary reaction to a period of high stress,” Instone says.

Changes to BPD Diagnostic Criteria

The revision of the DSM – DSM-V — will be released in 2013. The working group of the DSM-V has proposed a few changes to the diagnostic criteria for Borderline Personality Disorder.