BPD Criteria for Diagnosis

Borderline personality disorder (BPD) is one type of personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Like other conditions, borderline personality disorder has its own specific set of diagnostic criteria in the DSM.

If you think you or a loved one may have borderline personality disorder (BPD), it can be very helpful to educate yourself about borderline personality disorder diagnosis, including the BPD criteria required for diagnosis. Being armed with some information can help you to take the next important step: making an appointment for an assessment with a mental health professional.

This article covers the BPD criteria for diagnosis in the current version of the DSM-5. It also discusses how borderline personality disorder is assessed, diagnosed, and treated.

BPD Criteria for a Diagnosis

BPD is a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following symptoms. The nine criteria for BPD are:

1. Chronic feelings of emptiness
2. Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
3. Frantic efforts to avoid real or imagined abandonment
4. Identity disturbance with markedly or persistently unstable self-image or sense of self
5. Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
6. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
7. A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as "splitting")
8. Recurrent suicidal behavior, gestures, threats, or self-harming behavior
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

How many criteria do you need for BPD? To be diagnosed with BPD, you do not need to exhibit all nine of the symptoms of borderline personality disorder listed in the DSM-5. A diagnosis requires experiencing at least five of the above symptoms.

How Were the BPD Criteria Established?

A team of psychologists and psychiatrists, who are considered experts in BPD, developed the borderline personality disorder DSM-5 symptom criteria. Many of the workgroup members are considered preeminent BPD researchers and work directly with BPD patients.

The symptom criteria were established based on the best research available. However, it is important to keep in mind that the symptom criteria may be refined as new research comes out.

The fifth edition of the DSM, DSM-V, was released in 2013 after many years of research and deliberation by experts. The symptom criteria for BPD in the new version remained the same as the previous version, DSM-IV.

How Is BPD Diagnosed?

There are a number of psychological disorders and medical problems that can cause symptoms very similar to those associated with BPD. For this reason, it is important to see a licensed clinician (for example, a therapist or doctor) who can listen to your concerns, conduct a thorough assessment, and make an accurate diagnosis.

A complete assessment for BPD may include several components.

• Your therapist or doctor may ask you to participate in an interview, during which they will ask you questions about your symptoms, physical health, and past and present life situation.
• They may also ask you to fill out a written questionnaire about BPD symptoms.
• Finally, if you are willing, your clinician may ask to talk to family or loved ones to get complete information on the ways that your symptoms are affecting you.

Your doctor will also need to rule out similar conditions and evaluate your symptoms to determine if you are experiencing a co-occurring condition. BPD often co-occurs with other mental health conditions, including anxiety, bipolar disorder, depression, eating disorders, post-traumatic stress disorder, and substance use disorder.

At the end of the assessment process, your clinician will compile all of the information and make a diagnosis. Then, they will speak with you at length about the diagnosis and treatment options.

What Should I Do If I Think I Have BPD?

If you think you may have BPD, the first step is to find a mental health professional. While they can be hard to find, there are clinicians who are specially trained to treat BPD and answer your questions. Start by asking your primary care doctor for a referral, or check with family and friends to see if they have any recommendations of a local professional with expertise in your condition.

Borderline Personality Disorder Discussion Guide

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If you have health insurance, you may want to talk to the insurance company about whether the clinician takes your insurance and how many sessions would be covered, and how much the co-pay would be.

If you do not have insurance, you may qualify for public assistance programs or services through your state or region's department of mental health or social services. You can also ask your primary care physician for a referral, or look into whether medical centers or universities in your area offer psychiatric or psychological services.

In addition to working with a clinician, it may help to educate yourself about the variety of effective treatments available, including medication, psychotherapy, and self-help treatments. Finally, it is important to know that you are not alone and that with help, people with BPD lead normal and fulfilling lives.