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Borderline Personality Disorder Diagnosis

How Is BPD Diagnosed?

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Updated April 24, 2014

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. 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.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM, which is published by the American Psychiatric Association, is the official source of diagnostic information for psychiatric disorders, including BPD and related conditions. For each disorder, the DSM provides a list of symptoms and specifies how many symptoms are needed (and how severe the symptoms must be) to warrant a particular diagnosis.

The current DSM criteria for a BPD diagnosis are summarized below.

The Criteria for a Borderline Personality Disorder 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:
  • Frantic efforts to avoid real or imagined abandonment

  • A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as "splitting")

  • Identity disturbance: Markedly or persistently unstable self-image or sense of self

  • Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

  • Recurrent suicidal behavior, gestures, or threats, or self-harming behavior

  • 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)

  • 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

How Were the Criteria for BPD Established?

A team of psychologists and psychiatrists who are considered experts in BPD developed the DSM symptom criteria. Many of the work group members are considered preeminent BPD researchers, and most also 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 are always being fine-tuned as new research comes out. Currently, the DSM is in its fourth edition, and has undergone a text revision (this is why you will sometimes see it referred to as the DSM-IV-TR). In the next edition of the DSM (DSM-V), the symptom criteria for BPD may be altered to keep up to date with new research.

The Assessment Process

There are a number of psychological disorders and even medical problems that can cause symptoms very similar to those associated with BPD. For this reason, it is very 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. He or she 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.

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 to work with. While they can be hard to find, there are clinicians who are specially trained to treat BPD.
If you have health insurance, you may want to talk to the insurance company about clinicians who take your insurance and who have expertise in BPD (you should also ask 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.

Sources:

American Psychiatric Association. 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.

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