Lorna Wykes

August 5, 2021

Borderline Personality Disorder DSM-5 Criteria

3 min read|

Borderline personality disorder can make everything feel unstable-from your relationships, to your moods, and sometimes, even your identity.

BPD often develops in adolescence or early adulthood and can cause significant distress if left untreated. To better understand BPD, this article explores the symptoms, diagnostic criteria, potential causes of BPD, as well as treatment options.

Symptoms

Sometimes, the smallest of things can trigger intense reactions. And once you’re upset, it can feel nearly impossible to calm down. When emotions feel overwhelming, it’s easy to say hurtful things or engage in risky behaviour. It’s a painful cycle, making it challenging to feel fulfilled in your relationships, work, and school.

What Defines Borderline Personality Disorder?

The DSM (Diagnostic and Statistical Manual of Mental Disorders) lists diagnostic information for psychiatric disorders, including BPD. The current criteria listed for a BPD diagnosis include a pervasive pattern of instability in:

  • Interpersonal relationships
  • Self-image
  • Emotion
  • Impulsivity starting by early adulthood

BPD presents in a variety of contexts, which are indicated by five or more of the following:

  1. Frantic attempts to avoid real or ​imagined abandonment​.
  2. A pattern of ​unstable and intense​ interpersonal relationships-such as idealising someone one moment and suddenly believing that person is cruel and doesn’t care.
  3. Rapid changes in identity and unstable self-image include changing goals, values, seeing yourself as bad or as if you don’t exist at all.
  4. Impulsive and risky behaviour, like reckless driving, gambling, unsafe sex, binge eating, and drug abuse, becomes self-sabotage.
  5. Recurrent suicidal behaviour, gestures, ​threats,​ or self-mutilation often responds to a fear of rejection or abandonment.
    Wide mood swings that last from a couple of hours to a few days can include intense happiness, irritability, shame, or anxiety.
  6. Ongoing feelings of emptiness
  7. Inappropriate, extreme anger, or ​trouble controlling anger
  8. Periods of stress-related paranoia or severe dissociative symptoms.

Cluster B Personality Disorders

As a cluster B personality disorder, BPD shares a few overlapping symptoms with other diagnoses listed in this group, like:

  • Narcissistic personality disorder
  • Histrionic personality disorder
  • Antisocial personality disorder

These disorders share issues with impulse control and emotional regulation.

What Causes Borderline Personality Disorder?

Researchers haven’t identified one single cause of BPD. However, the following elements may play a role in the development of the disorder:
Genetics: People with a close family member, like a parent or a sibling, may be at increased risk for BPD.

Neurobiological factors: Research has shown that people with BPD can sometimes have functional changes in the brain that are responsible for regulating emotion and controlling impulses. However, experts haven’t identified whether these changes are the cause or a result of the disorder.

Environmental factors: People with BPD often have a history of trauma, including physical, emotional, sexual abuse, ACEs (adverse childhood experiences), or exposure to violence. However, it’s important to note that not everyone with BPD has had traumatic experiences. On the other hand, many people who have experienced them don’t necessarily develop BPD.

Treatment

Although BPD can often feel like a painful cycle that’s impossible to escape, there are effective treatments available that can help you cope, learn new skills, and feel in control of your thoughts, feelings, and actions.

Treatment options may include:

Psychotherapy: This is a standard treatment for BPD, and can include DBT (dialectical behavioural therapy) or CBT (cognitive behavioural therapy).

Medication: There is no specific prescription for personality disorders. However, medicines can improve particular symptoms and aid with co-occurring problems, like anxiety and depression.

What works for one person may not work for another — so it’s essential to work with a professional to develop the right treatment plan. With appropriate support, many people with BPD can maintain healthy, joyful relationships, and lead fulfilling lives.

Lorna has worked extensively in a therapeutic setting for the last 18 years and throughout this time worked with many conditions and client groups including Depression, Anxiety, Personality Disorders, Autism & PDA, Eating disorders, Complex Addiction, PTSD, and Emotional and Social disorders in Young Children and Adolescents.

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