Borderline personality disorder (BPD) is characterized by emotional instability, unstable self-image (“who am I?”), unstable (“love-hate”) interpersonal relationships, and poor impulse control. BPD is the most prevalent personality disorder in clinical settings and is associated with severe functional impairment, substantial treatment utilization, and high rates of mortality by suicide. BPD is strongly associated with substance use disorders, mood disorders, anxiety disorders, and other personality disorders. BPD is not due to a medical or substance use disorder.
Lasts For Years/Lifetime
- Unemployment (interrupted education; sudden shifts in vocational aspirations; recurrent job losses)
Cooperation (Critical, Quarrelsome):
Unstable, Intense, Chaotic Relationships:
- Unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Unstable self-image or sense of self
- Frantic efforts to avoid real or imagined abandonment
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
- Inappropriate, intense anger or difficulty controlling anger
Justice (Disorganized, Careless):
- Impulsivity at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating)
Courage (Anxious, Easily Upset):
- Emotional instability due to a marked reactivity of mood
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Chronic feelings of emptiness
Borderline (Emotionally Unstable) Personality Disorder 301.83
This diagnosis is based on the following findings:
- Frantic efforts to avoid real or imagined abandonment ( still present )
- Unstable and intense ‘love-hate’ relationships ( still present )
- Identity disturbance: markedly and persistently unstable self-image or sense of self ( still present )
- Impulsivity in at least two areas that are potentially self-damaging ( still present )
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior ( still present )
- Rapidly shifting emotions ( still present )
- Chronic feelings of emptiness ( still present )
- Inappropriate, intense anger or difficulty controlling anger ( still present )
- Transient, stress-related paranoid ideation or severe dissociative symptoms ( still present )
Individuals with Borderline (Emotionally Unstable) Personality Disorder have impaired ability to regulate their emotions, have unstable perceptions of self and others that lead to intense and chaotic relationships, and are prone to act on impulses, including self-destructive impulses.
- Have emotions that can change rapidly and spiral out of control, leading to extremes of sadness, anxiety, and rage.
- “Catastrophize,” seeing problems as disastrous or unsolvable, and are often unable to soothe or comfort themselves without the help of another person.
- Become irrational when strong emotions are stirred up, showing a significant decline from their usual level of functioning.
- Lack a stable sense of self: Their attitudes, values, goals, and feelings about themselves may seem unstable or ever-changing, and they are prone to painful feelings of emptiness.
- Have difficulty maintaining stable, balanced views of others: When upset, they have trouble perceiving positive and negative qualities in the same person at the same time, seeing others in extreme, black-or-white terms. Consequently, their relationships tend to be unstable, chaotic, and rapidly changing.
- Fear rejection and abandonment, fear being alone, and tend to become attached quickly and intensely.
- Are prone to feeling misunderstood, mistreated, or victimized.
- While playing the role of “victim”, often elicit intense emotions in other people who they manipulate into playing the role of “villan” or “rescuer”.
- Stir up conflict or animosity between other people.
- Act impulsively.
- Their work life or living arrangements may be chaotic and unstable.
- May act on self-destructive impulses, including self-mutilating behavior, suicidal threats or gestures, and genuine suicidality, especially when an attachment relationship is disrupted or threatened.
- Goal: overcome fear of abandonment.
If this problem persists: She will continue to show frantic efforts to avoid real or imagined abandonment. Her frantic efforts to avoid abandonment might include impulsive actions such as self-mutilating or suicidal behaviors.
- Goal: have less unstable and intense “love-hate” relationships.
If this problem persists: She will continue to show a pattern of unstable and intense relationships. She will switch quickly from idealizing other people to devaluing them. She will see things in terms of extremes, either all good or all bad.
- Goal: develop a positive, stable self-image or sense of self.
If this problem persists: Her self-image (“who-am-I?”) will continue to be very unstable. There will be sudden and dramatic shifts in her self-image, characterized by shifting goals, values, and vocational aspirations. She will see herself as a “victim” (taking little responsibility for any problem).
- Goal: stop impulsive, self-damaging behavior.
If this problem persists: She will continue to show impulsivity in at least two areas that are potentially self-damaging (i.e., gambling, spending money irresponsibly, binge eating, abusing substances, engaging in unsafe sex, driving recklessly, or being impulsively suicidal).
- Goal: stop self-mutilating or suicidal behavior.
If this problem persists: She will continue to have recurrent suicidal gestures such as wrist cutting, overdosing, or self-mutilation. Her self-destructive acts will be precipitated by threats of separation or rejection.
- Goal: stop over-reacting to stress.
If this problem persists: She will continue to have rapidly shifting moods due to extreme reactivity to interpersonal stress (e.g., intense unhappiness, anger, or anxiety usually lasting a few hours and only rarely more than a few days).
- Goal: discover a meaning or purpose to life.
If this problem persists: She will continue to have chronic feelings of emptiness. She will be easily bored and constantly seeking something to do.
- Goal: better control anger.
If this problem persists: She will continue to be inappropriately angry. Her anger will be triggered when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning.
- Goal: stop becoming paranoid or dissociating under stress.
If this problem persists: During periods of extreme stress, she will continue to have transient paranoid ideation or dissociative symptoms (e.g., depersonalization). This will occur most frequently in response to a real or imagined abandonment.