Borderline personality disorder (BPD) diagnostic criteria

If you think you or your loved one may have borderline personality disorder (BPD), then educating yourself about the diagnosis of borderline personality disorder can be very helpful. Having some information can help you take the next important step: make an appointment with a mental health professional for evaluation.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM is published by the American Psychiatric Association and is the official source of diagnostic information for mental illness (including BPD and related diseases). For each disease, DSM provides a list of symptoms and specifies how many symptoms are needed (and how severe the symptoms must be) to guarantee a specific diagnosis.

The current DSM criteria for BPD diagnosis are summarized below.

Diagnostic criteria

BPD is a ubiquitous pattern of interpersonal relationships, self-image, and emotional instability, as well as obvious impulses that begin in early adulthood and appear in various environments, as shown in the following five (or more):

  • Long-term emptiness
  • Emotional instability about daily events (for example, intense episodes of sadness, irritability, or anxiety usually last a few hours, rarely more than a few days)
  • Working wildly to avoid real or imagined abandonment
  • An identity disorder with obvious or persistently unstable self-image or self-awareness
  • Impulsive behavior in at least two areas where self-harm is possible (for example, consumption, sex, substance abuse, reckless driving, overeating)
  • Inappropriate, strong anger or uncontrollable anger (for example, frequent tantrums, constant anger, repeated physical conflicts)
  • An unstable and strong pattern of interpersonal relationships characterized by the extremes between idealization and devaluation (also known as “splitting”)
  • Recurring suicidal behaviors, gestures or threats, or self-harm
  • Temporary, stress-related paranoia or severe separation symptoms.

How are the BPD standards established?

A group of psychologists and psychiatrists who are considered experts in BPD developed DSM symptom standards. Many members of the working group are considered excellent BPD researchers and work directly with BPD patients.

Symptom criteria are established based on the best available research. However, it is important to remember that as new research emerges, the symptom criteria may be improved. After years of research and deliberation by experts, the fifth edition of DSM DSM-V was released in 2013. The symptom criteria for BPD in the new version are the same as the previous version DSM-IV.

Evaluation process

There are many psychological disorders and medical problems that can cause the symptoms associated with BPD to be very similar.For this reason, it is important to see a licensed clinician (for example, a therapist or doctor) who can listen to your concerns, conduct a thorough evaluation, and make an accurate diagnosis.

A complete assessment of BPD may include several components. Your therapist or doctor may ask you to attend an interview, during which they will ask you questions about your symptoms, physical health, and past and current living conditions. They may also ask you to fill out a written questionnaire about BPD symptoms.

Finally, if you want, your clinician may ask to talk to family members or loved ones to get complete information about the way your symptoms affect you. At the end of the evaluation process, your clinician will summarize all the information and make a diagnosis. Then, they will discuss the diagnosis and treatment options with you in detail.

What should I do if I think I have BPD?

If you think you may have BPD, the first step is to find a mental health professional. Although they are difficult to find, there are specially trained clinicians who can treat BPD and answer your questions. First ask your primary care doctor for a referral, or contact family and friends to see if they have any advice from a local professional with expertise in your condition.

Borderline Personality Disorder Discussion Guide

Get our printable guide to help you ask the right questions the next time you see a doctor.

If you have health insurance, you may want to discuss with the insurance company whether the clinician will purchase insurance for you, the number of coverages, and the co-payment.

If you do not have insurance, you may be eligible for public assistance programs or services through the mental health or social services department in your state or region. You can also ask your primary care doctor about referrals, or check whether medical centers or universities in your area provide psychiatric or psychological services.

In addition to working with clinicians, you can also help yourself understand the various effective treatments available, including medication, psychotherapy, and self-help. Finally, it is important to know that you are not alone. With help, people with BPD will lead a normal and fulfilling life.