dsm criteria for bpd

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 different contexts, as indicated by five (or more) of the following:

1-   Frantic efforts to avoid real or imagined abandonment

People with BPD can be very sensitive to any cue (real or perceived) that they are being rejected or abandoned. This can include strong reactions to seemingly minor rejections by others (e.g., becoming terrified or enraged when someone cancels plans).  Since feeling rejected triggers such strong emotional reactions in people with BPD, they will often engage in behaviors designed to reduce concerns that they are being abandoned (e.g., frequently calling someone they are in a relationship with to “make sure” that there are no signs of impending abandonment).

Unfortunately, this type of behavior may actually create the feared outcome, leading to failed relationships and even greater fears of being abandoned.

2-  A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation also known as “splitting”

“Splitting” is a term that describes difficulty with the ability to hold opposing thoughts, feelings, or beliefs about oneself or others. In other words, positive and negative attributes of a person are not joined together into a cohesive set of beliefs. Splitting is very common in people with borderline personality disorder (BPD), and it leads people with BPD to view others and themselves in “all or nothing” terms.

For example, a person with BPD may view one family member as always “good” and another as always “bad.” Or, a person with BPD may see themselves as “good” one minute, but shift to seeing themselves as all “bad” or even evil the next.  Because of splitting, it is difficult for individuals with BPD to recognize that “good” people sometimes do things imperfectly or make mistakes. The experience of splitting is very confusing and frustrating for people with BPD and their loved ones.

Splitting can interfere with relationships and work life, and can lead to intense anger and self-destructive behaviors.

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

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

Impulsivity can be a very troubling aspect of BPD. Impulsive behavior can lead to problems with relationships, physical health, and finances, as well as legal issues. Learning more about impulsive behavior and treatments that target it can help reduce the impact of impulsivity in your life.

What is Impulsivity?

Impulsivity is a tendency to act quickly without thinking about the consequences of your actions. Impulsive behavior usually occurs in reaction to some event that has caused you to have some kind of emotional response.

For example, imagine you are waiting in line at the bank and someone cuts in front of you. If you were to act on an impulse, you might immediately behave aggressively toward that person (e.g., yelling, or even becoming violent), without thinking about the consequence of this kind of behavior (e.g., being escorted out of the bank or even arrested).

It is important to note that occasional impulsive behavior is not necessarily indicative of a diagnosis of BPD. Everyone acts impulsively from time to time. Only when this type of behavior becomes either frequent or serious (e.g., dangerous), is it considered problematic.

Some examples of impulsive behaviors include:

   ο  Going on spending sprees
     ο  Driving recklessly
     ο  Promiscuous sex
     ο  Binge eating
     ο  Yelling, shouting, or screaming at others
     ο  Threatening to harm others
     ο  Destroying property
     ο  Shoplifting
     ο  Getting in physical fights with people

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

Suicidal Behaviour:

Unfortunately, suicidal behaviors and completed suicides are very common in individuals with BPD. Research has shown that around 70 percent of people with BPD will have at least one suicide attempt in their lifetime, and many will make multiple suicide attempts.

People with BPD are more likely to complete suicide than individuals with any other psychiatric disorder. Between 8 and 10 percent of people with BPD will complete suicide; this rate is more than 50 times the rate of suicide in the general population.

Why is Suicide so Common in BPD?

There are several factors related to BPD that may explain why suicide is so common.

First, BPD is associated with very intense negative emotional experiences. These experiences are so painful that many people with BPD report that they would like to find a way to escape. They may use a number of different strategies to try to reduce the emotional pain (e.g., deliberate self-harm, substance use), including suicide.

Also, BPD is a chronic condition; it usually lasts for years. Conditions that are more chronic may lead to more risk for suicide since they do not tend to get better quickly without treatment. This may leave people with BPD feeling that there is no other way out, despite the fact that there are now effective treatments available for BPD.

BPD is also associated with impulsivity, or a tendency to act quickly without thinking about consequences. This may be another reason that suicide is common in BPD; individuals with BPD may engage in suicidal behaviors in a moment of intense emotional pain without fully considering the consequences.

Finally, BPD often co-occurs with substance use. The use of drugs or alcohol is a risk factor for suicide alone. However, substance use issues combined with BPD may be a particularly lethal combination; substance use can lead to even greater im-pulsivity. And, people who are using substances have access to a means for overdose.

Self Harming Behaviour:  The content of this article may be very triggering if you engage in self mutilation; please consider this carefully before reading on.

Self mutilation is very difficult to understand from the prospective of people who have never experienced the behavior themselves. For family members or friends of someone who self mutilates, it is terrifying, confusing, and frustrating.

Definition of Self Mutilation

There are various definitions of self mutilation, and even plenty of names for this type of behavior. The self mutilation referred to in this article involves the direct and deliberate destruction or alteration of the body. This type of self mutilation is sometimes referred to as self harm, or self injury.

Examples of self harming behaviors include cutting, burning, needle sticking, and severe scratching.

It is important to draw a distinction between the type of self mutilation discussed in this article versus various other forms of self harm that exist. The type of self mutilation discussed here is generally not conducted with the intent to commit suicide.

Research has shown that individuals who engage in self harm are usually not trying to kill themselves when they engage in the behavior, although some may report that they have mixed feelings about the intent of the acts.

This is not to say that people who engage in self mutilation are not suicidal; many people who self mutilate also have suicidal thoughts or even make suicide attempts.

In addition, in cases of very severe self mutilation, people have died from their injuries. But, self mutilation usually serves a different purpose than attempt at killing one’s self.

Why People Engage in Self Mutilation

Many believe that people engage in self mutilation to get attention. This is a myth. Most people who self harm do it in private and make sure that the location of the injury is one that cannot be seen. They are also often ashamed of the behavior and keep it a secret.

This sort of secrecy and shame about the behavior suggests that it is certainly not meant to manipulate others or to garner attention. Of course, there are some people who report that they self mutilate for attention, but they are in a very small minority.

Research has shown that most people self mutilate in order to help regulate internal experiences such as emotions, thoughts, memories, and physical sensations. People who self mutilate report that they do this behavior to escape from emotional pain, release anger, slow racing thoughts, end episodes of dissociation, or have a sense of control.

In fact, for many people who self harm, the behavior probably serves many different purposes depending on what experience they are having at the time.

Who Engages in Self Mutilation?

Unfortunately, self mutilation is not an uncommon behavior. For example, one study found that about 40% of college students have engaged in self mutilation at least once, and about 10% have engaged in self mutilation 10 or more times. There is evidence that men and women engage in self mutilation at equal rates.

People who have experienced maltreatment during their childhood (sexual abuse or neglect, for example) or who were separated from a caregiver in childhood are at greater risk for self mutilation than the general population. Also, there is evidence the people who experience dissociation are at greater risk for self mutilation.

6-    Emotional instability in reaction to day-to-day events

(e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and rarely more than few days)

One of the key features of borderline personality disorder is emotional instability (also called emotional lability or affective dysregulation). People with BPD experience a lot of dramatic shifts in their emotional states. They may feel okay one moment but feel extremely angry, sad, lonely, afraid, jealous, or shameful moments later.

Having a lot of emotional changes does not mean you have BPD. First, emotional instability is just one of the symptoms of BPD. To meet diagnostic criteria for BPD you would have to also have some of the other symptoms (e.g., impulsivity, sensitivity to abandonment, self-harm or suicidality).

Also, the emotional shifts typical of someone with BPD are very intense and frequent. Everyone has emotional changes every now and then. But, people with BPD experience mood changes that are very dramatic and very severe, so much so that they significantly impact work, school, relationships, or other areas of functioning.

They also happen consistently (more than just every once in a while) and over the course of years.

Finally, in addition to the mood changes, people who have BPD also have other problems with emotions. For example, they tend to feel less positive emotions than other people. They also report chronic feelings of emptiness, or times when they feel nothing inside.

7-     Chronic feelings of emptiness

8-    Inappropriate, intense anger or difficulty controlling anger

(e.g., frequent displays of temper, constant anger, recurrent physical fights)

Intense, inappropriate anger is one of the most troubling symptoms of borderline personality disorder (BPD). It is so intense that it is often referred to as “borderline rage.” While anger is a key feature of BPD, very little is known about why people with BPD experience anger differently than other people or even how this experience is different. New research, however, is shedding light on the nature of borderline rage.

What is Borderline Anger?

Borderline anger is more than just a standard emotional reaction. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), anger in BPD is described as “inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).”

Clinically, anger in BPD is called “inappropriate,” because the level of anger seems to be more intense than is warranted by the situation or event that triggered it.

For example, a person with BPD may react to an event that may seem small or unimportant to someone else (e.g., a misunderstanding) with very strong feelings of anger and unhealthy expressions of anger (e.g., yelling, being sarcastic or becoming physically violent).

9- Transient, stress-related paranoid ideation or severe dissociative symptoms

Paranoid Ideation: Having beliefs that you are being harassed or persecuted, or beliefs involving general suspiciousness about others’ motives or intent.

Dissociation: A disruption of the normal state of consciousness and perception. Dissociation has been described as periods of feeling numb, detached, zoned-out, or unreal. Other people or things may also seem strange or unreal.

In its most severe forms, dissociation may involve loss of memory. Dissociation is usually triggered by stress or a traumatic event


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