Borderline Personality Disorder: Diagnostic criteria

by Beth McHugh | More from this Blogger

06 Dec 2006 03:46 PM

The term "Borderline Personality Disorder" is often bandied about by the media and laymen alike. Many of the behaviors that constitute the disorder are common to other disorders and indeed, normal human behavior.

However for an accurate diagnosis to be made, a person must exhibit a pervasive pattern of instability in personal relationships, self esteem, and moods, in addition to marked impulsivity in behavior which typically begins in early adulthood.

For a decisive diagnosis to be made at least five of the following characteristics must be present:

1. Frantic efforts to avoid real or imagined abandonment. The sufferer reports feelings of "emptiness" and needs the constant reassurance and love of others to fill that sense of emptiness. When signs of imminent abandonment are present, the sufferer becomes increasingly agitated and unstable, leading to impulsive behaviors, even suicidal gestures.

2. An ongoing pattern of unstable and intense personal relationships characterized by alternating idealization of the person concerned or devaluation. The person could be male or female.

The sufferer moves rapidly between thinking that an acquaintance or love interest is "fantastic" or a "loser" or some other derogatory term. Most people come in shades of black and white for the borderline sufferer; there is little room in their minds for grey. However, one of the characteristics of the disorder so that the sufferer frequently cycles quickly through these likes and dislikes, and having debased a particular person on one occasion does not mean that by the following week they cannot be the best of friends again. The key is the rate at which these cycles manifest.

3. Marked and persistent unstable self-image or sense of self.

The sufferer doesn't merely have a "down" day where they are hard on themselves. The lack of self love is continuous and relentless.

4. Impulsivity in at least two areas that may lead to self harm: These include sex, substance abuse, spending, reckless driving, binge eating.

5. Recurrent suicidal thoughts, gestures, threats, or self-mutilating behavior such as slashing.

6. Intense mood swings including sadness, anxiety, or irritability that last for several hours but rarely more than a few days.

7. Chronic feelings of emptiness.

8. Anger management problems associated with mood instability and impulsivity.

9. Transient, stress-related paranoid thoughts or dissociation symptoms (where the sufferer feels unreal and/or detached from the world around them. Next blog, we'll look at causes and treatment options for this disorder.

Contact Beth McHugh for further assistance regarding this issue.

Related articles:

What is Borderline Personality Disorder?

Borderline Personality Disorder: Causes and Treatments

Learn more about Beth McHugh

Beth McHugh began her career as a geologist and worked both in industry and as a university researcher.

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ItsJustMe (5) 15 Jan 2007 02:53 PM

Beth, I'd be interested in your opinion on whether it makes any sense to diagnose a teenager with this disorder. I'm not a teenager, nor am I a cutter. I'm an advocate for those who have borderline personality disorder.

I find, too often, that teenagers who cut themselves are saddled with this diagnosis. However, as you noted in your introduction (which I must note is really full of insight), many of the "symptoms" of borderline personality disorder are exhibited in other disorders and in "normal" people. I think that's even more true in teenagers -- they are notably volatile in their behaviors, reckless, moody, random, stressed and angry. And they cycle through these behaviors to be happy again -- often in hours. Normal teenagers (I have three!).

I think the really important thing is that the behavior cannot be called persistent if it is happening in a teenager. What is persistent? A year? A few months? Five years? Few of the teenagers labeled borderline have had the behaviors that long.

I don't mean to discount the problem of self-injury in any way. I think it's incredibly scary and wish there were more understanding of it. I understand from talking to people about it that it is one way to release pain -- among other things. I never cut myself and yet do have borderline personality disorder. (I do/have engaged in other self-destructive behaviors -- don't get me wrong. :)

Anyway, I'm interested in your thoughts. I'll link to you today in my blog, http://findthedialectic.blogspot.com/

Beth McHugh (13211) 26 Jan 2007 04:49 PM

I personally would not label a teenager with Borderline Personality Disorder for the simple reason that I consider this condition to represent a blockage in the full formation of the personality and therefore to label a teen with this is akin to putting the cart before the horse. Certainly behavioral traits in an adult borderline are usually traceable back to the adolescent years. But that does not mean that those adolescents who display suspect behaviors are by definition going to end up with BPD. There are many criteria which must be satisfied in the adult before a diagnosis is given. I hope this answers your question.