Borderline Personality Disorder Criteria For Diagnosis – DSM-5

Following the right criteria for diagnosing borderline personality disorder is crucial because BPD has several similarities to other mental conditions like bipolar disorder.

Unfortunately, many people with BPD are not identified, even during counseling and psychiatric testing.

Most borderline disorder cases are observed after a suicide attempt or threat of suicide has occurred. It usually happens when the patient is taken to an emergency department.

Learning about the current diagnostic criteria for borderline personality disorder is helpful. The most commonly followed criteria for BPD diagnosis are found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), published in 2000. And in 2013, DSM-5 criteria were introduced with further updates on symptoms for diagnosing BPD.

The American Psychiatric Association approves and publishes the DSM, which gives diagnostic information for psychiatric disorders.

The symptoms and causes of borderline personality disorder can be different in men and women.

The DSM contains a list of symptoms associated with diagnosing a particular mental disorder. It also suggests the number of symptoms required to confirm the existence of disorders like BPD.

DSM-IV-TR (2000) Criteria for Borderline Personality Disorder

The symptoms should have a pervasive pattern of instability in interpersonal relationships and self-image. The patient has marked impulsivity beginning by early adulthood and present in a variety of contexts and situations. At least indicated by five or more of the following symptoms must exist to validate a possible case of BPD. The criteria are:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Intense episodic irritability or anxiety usually lasting a few hours
  • Identity disturbance: markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging areas (e.g., spending, sex, substance abuse, reckless driving, binge eating).
  • Recurrent suicidal behavior, gestures, physical fights, frequent display of temper, threats, or self-mutilating behavior
  • Affective instability due to a marked reactivity of mood
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger.
  • Transient, stress-related paranoid ideation, or severe dissociative symptoms.

DSM-5 (2013) Criteria for Diagnosing Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than ten years of effort by hundreds of international experts in all aspects of mental health.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5, published on May 18, 2013, by the American Psychiatric Association (APA), supersedes the DSM-IV-TR, released in 2000.

A summary of the criteria included in DSM-5 is as follows:

Criterion A

Moderate or greater impairment in personality functioning; two or more of the following criteria:

Identity: markedly poor, poorly developed, or unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness, and dissociative states under stress.

Self-direction: instability in goals, aspirations, values, or career plans.

Empathy: The compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., being prone to feeling slighted or insulted); others’ perceptions that are selectively biased toward negative attributes or vulnerabilities.

Intimacy: intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships are often viewed in extremes of idealization and devaluation and alternating between over-involvement and withdrawal.

Criterion B

Four or more of the following seven pathological personality traits must be present:

Emotional lability: unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and out of proportion to events and circumstances

Anxiety: intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

Separation insecurity: fears of rejection by— and separation from—significant others, associated with fears of excessive dependency and complete loss of autonomy.

Depressive: frequent feelings of being down, miserable, and hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior self-worth; thoughts of suicide and suicidal behavior.

Impulsivity: acting on the spur of the moment in response to immediate stimuli; acting momentarily without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

Risk-taking: engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations; and denial of the reality of the personal danger.

Hostility: persistent or frequent anger or irritability in response to minor slights and insults.

Criterion C

The impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across various personal and social situations.

Criterion D

The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time, with onsets that can be traced back at least to adolescence or early adulthood.

Criterion E

Another mental disorder does not better explain the impairments in personality functioning and the individual’s personality trait expression.

Criterion F

The impairments in personality functioning and the individual’s personality trait expression are not attributable to a substance (e.g., a drug of abuse, medication, or exposure to a toxin) or a general medical condition (e.g., severe head trauma).

Criterion G

The impairments in personality functioning and personality trait expression are not better understood as normal for the individual’s developmental stage or the socio-cultural environment.

Strength and Reliability of the Criterion for Diagnosing BPD

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been developed and evolved over two decades. A team of expert psychiatrists and psychologists jointly developed the DSM criteria. Most team members are preeminent BPD researchers with years of experience dealing with BPD patients.

The American Psychiatric Association continuously tries to refine criteria according to the latest research on mental disorders.

According to a 2019 study, the dimensional components of the DSM-5 Alternative Model demonstrated significantly more diagnostic reliability than the DSM-IV categorical diagnoses. The DSM-5 Alternative Model has easy ways to conceptualize borderline personality with greater reliability than the extant DSM-IV definition.

BPD Diagnosis Process

It is difficult to diagnose BPD because many other psychological disorders and medical problems have similar symptoms. Therefore, it is necessary to avail oneself of the services of a qualified and well-experienced mental health expert to diagnose the disorder.

A proficient psychiatrist or psychologist will conduct a thorough assessment and diagnose correctly.

A proper and complete assessment of BPD involves several steps, including:

  • Conduct friendly interviews to inquire about symptoms, genetics and biological factors, health conditions, environmental factors, and living conditions.
  • I am using written questionnaires or quizzes on BPD symptoms.
  • Inquiries about the patient’s behavior from family members, friends, lovers, and colleagues
  • Categorizes the identified symptoms and compares them with DSM diagnostic criteria.

Recommended reading list:

Article Source:

  • Robert S. Biskin, MD and Joel Paris, MD, Diagnosing borderline personality disorder, CMAJ-JAMC, 2012 Nov 6; 184(16): 1789–1794.
  • American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC: Author, 2007.
  • Oldham, MD, John. “Launching DSM-V.” Journal of Psychiatric Practice, 13: 351, November 2007.