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) also includes diagnostic criteria for personality disorder and a borderline pattern (see table below).
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"
……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