The European diagnostic criterion for BPD in the International Classification of Diseases is not clearly laid out in section 6D10 Personality disorder and 6D11.5 Borderline pattern but it offers a scale of mild, moderate and severe. Most Clinical Psychologists use the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V). BPD is one of the Cluster B personality disorders which are known for the display of dramatic, emotional, and erratic behaviour. The diagnostic criteria for BPD is in section 301.83(F60.3) on page 663 of the DSM-V.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (1994) identifies those with BPD as having:
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) of 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 characterized by alternating between extremes of idealization 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 behavior, gestures, or threats, or self-mutilating behavior.
- 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.
Often BPD doesn’t stand alone. Suffers of BPD may suffer from elements of other personality disorders. This is due mainly to the fact that it is not possible to define an exact set of criteria for each personality disorder which will apply to all cases. Personality disorders are a relatively new field of research and it is likely the criteria used to define specific disorders will change over time.
In America it is estimated that up to 5.9% of the population has BPD. Most sufferers diagnosed with BPD are women. Most people diagnosed with BPD have had significant trauma in their lives and there is work in the mental health community which suggests that those diagnosed with BPD are actually suffering from Post Traumatic Stress Disorder (PTSD) or should be diagnosed with NPD.
In our article Healthy Narcissism vs Unhealthy Narcissism we introduced you to the concept of narcissism. We explained that those displaying a pattern of unhealthy narcissism may suffer from Narcissistic Personality Disorder (NPD). We also introduced you to Dr Alexander Lowen’s Narcissistic Scale which indicates that people diagnosed from BPD are higher up the scale than those with NPD. It was called “Borderline” because at the time of concept, the symptoms patients showed were in between the borders of neurosis (mild mental illness) and psychosis (severe mental disorder where the person loses contact with reality).