Diagnostic Criteria

ICD-11: Criteria for a diagnosis of Personality Disorder and related traits

ICD-11: Complex Post Traumatic Stress Disorder (CPTSD)

Intro: BPD is usually diagnosed in Australia using the American Psychiatric Association Diagnostic and statistical manual of mental disorders 5th edition (DSM-5). Prior to the release of the DSM-5 there was much discussion re changing the diagnostic criteria however a decision could not be reached and the criteria remained unchanged from the DSM-IV-TR. (# see note below)

World Health Organization International statistical classification of diseases and related health problems 11th Revision (ICD-11) includes diagnostic criteria for personality disorder and a borderline pattern. The ICD11 also includes a new diagnosis of complex post traumatic stress disorder

DSM-5 diagnostic criteria for BPD^

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:

Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)
A pattern of unstable and intense interpersonal relationships characterised by alternating
between extremes of idealisation and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
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)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper,
constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms

^ DSM-5 p663

# The appendix (p 766-7) of the DSM-5 lists Proposed Diagnostic Criteria for BPD which mentions "the typical features of BPD as instability of self-image, personal goals, interpersonal relationships, and affect, accompanied by impulsivity, risk taking, and/or hostility. Characteristic difficulties are apparent in identity, self-direction, empathy, and/or intimacy, along with specific maladaptive traits in the domain of Negative Affectivity, and also Antagonism and/or Disinhibition"

ICD-11: Criteria for a diagnosis of Personality Disorder and related traits

……characterised by problems in:

Functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction),
and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others’ perspectives and to manage conflict in relationships) that have persisted over an extended period of time (e.g., 2 years or more).
Manifest in patterns of cognition, emotional experience, emotional expression, and behaviour that are maladaptive (e.g., inflexible or poorly regulated) and is manifest across a range of personal and social situations (i.e., is not limited to specific relationships or social roles).
Not developmentally appropriate and cannot be explained primarily by social or cultural factors
Associated with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

The ICD-11 describes one of the predominant traits as ‘borderline pattern’

The Borderline pattern descriptor may be applied to individuals whose pattern of personality disturbance is characterized by:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following:

Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships
Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self
A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours
Recurrent episodes of self-harm
Emotional instability due to marked reactivity of mood
Chronic feelings of emptiness
Inappropriate intense anger or difficulty controlling anger
Transient dissociative symptoms or psychotic-like features in situations of high affective arousal

ICD-11: Complex Post Traumatic Stress Disorder (CPTSD)

Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met.

In addition, Complex PTSD is characterised by severe and persistent

1) problems in affect regulation;
2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and
3) difficulties in sustaining relationships and in feeling close to others.

These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

PTSD, CPTSD and BPD

CPTSD can co exist with approximately 50% of women diagnosed with BPD
BPD co exists with only approximately 8% of those diagnosed with CPTSD
60% of people with BPD can have PTSD

Ref: Ref: European Journal of Psychotraumatology 2013, 4:20706 and DSM 5
NB. This is a representation of the current understanding. For full criteria please refer to the DSM5 and ICD11

BPD & PTSD Psychiatric Interview | Jake & Dr. Lois Choi-Kain

A first meeting/consultation interview between Jake -- diagnosed with BPD (Borderline Personality Disorder) and likely co-occurring PTSD -- and Dr. Choi-Kain, who is an expert clinician and director of the Gunderson Personality Disorders Institute at McLean Hospital.

Debrief w/ Jake after Dr. Choi-Kain Session

Debrief with Jake -- diagnosed with BPD (Borderline Personality Disorder) and likely co-occurring PTSD -- after his first meeting with Dr. Choi-Kain (expert clinician/researcher).

BPD & PTSD | Debrief w/ Dr. Choi-Kain after Jake Session | Borderline & Trauma

Debrief with Dr. Choi-Kain (expert clinician/researcher) after her first meeting with Jake -- diagnosed with BPD (borderline personality disorder) and likely co-occurring PTSD (post-traumatic stress disorder). The main topic is the differences and similarities between BPD and PTSD, and which treatment options may be appropriate at what time -- with a backdrop of Dr. Choi-Kain's first meeting with Jake