What are the DSM-5 diagnostic criteria for borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), [4] BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:

  • Frantic efforts to avoid real or imagined abandonment; this does not include suicidal or self-mutilating behavior covered in criterion 5

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

  • Markedly and persistently unstable self-image or sense of self

  • Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating) [5] ; this does not include suicidal or self-mutilating behavior covered in criterion 5

  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

  • Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, or recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

An alternative model described in DSM-5 for personality disorders includes essential features for personality disorders, with specific features added to denote the specific personality disorder. Essential features of personality disorders using this model include: impairment in self-concept and interpersonal relationships, inflexible traits causing impairment in personal and social situations, and pathological personality traits. Pathological personality traits included in this model are Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism.


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