Borderline Personality Disorder DSM-5 Criteria And How It’s Treated

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 06/24/2022

Borderline personality disorder (BPD) is a severe mental health issue that involves difficulties regulating mood and emotions. BPD's signs and symptoms can be difficult to manage but it is possible, and effective treatments are available. This article will explain what borderline personality disorder is, how it’s described in the DSM-5, and what treatments may be helpful to those with the disorder.

What Is Borderline Personality Disorder?

Borderline personality disorder belongs to a class of mental health conditions known as personality disorders, which can cause significant distress for those living with them.

Part of the criteria for ‘disorder’ requires that the symptoms and problems create significant impairment or distress. Personalities naturally vary from person to person. With personality disorders impairment, distress, and behaviors that conflict significantly with norms for behavior are present.

According to the American Psychiatric Association, with personality disorders, the personality traits not only go against the cultural norms, but they also cause difficulties with functioning and lead to distress. [1]

Currently, DSM identifies ten unique personality disorders.

These different personality disorders can be grouped into clusters shown below: [2]

Cluster A: Odd or Eccentric Thoughts & Behaviors

  • Paranoid Personality Disorder

  • Schizoid Personality Disorder

  • Schizotypal personality disorder

Cluster B: Overdramatic, Overly Emotional, or Unpredictable Thoughts & Behaviors

  • Antisocial Personality Disorder

  • Borderline Personality Disorder

  • Histrionic Personality Disorder

  • Narcissistic Personality Disorder

Cluster C: Fearful or Anxious Thoughts & Behaviors

  • Avoidant Personality Disorder

  • Dependent Personality Disorder

  • Obsessive-Compulsive Personality Disorder

It’s estimated that around 1.4 percent of the United States population has borderline personality disorder, and as you can see, BPD is just one of the many personality disorders people may experience. Altogether, personality disorders are more common than most people think. [3]

Borderline Personality Disorder DSM-5 Criteria

Mental health professionals use the most current Diagnostic and Statistical Manual by the American Psychiatric Association to diagnose individuals with mental health issues. It contains the most up-to-date information for disorders including personality disorders.

Below, you will find the most current DSM borderline personality disorder criteria that can lead to a diagnosis for BPD: [4]

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:

  1. Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5)
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  1. Identity disturbance: markedly and persistently unstable self-image or sense of self
  2. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5)
  3. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  4. Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  5. Chronic feelings of emptiness
  6. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)
  7. Transient, stress-related paranoid ideation or severe dissociative symptoms

What Causes Borderline Personality Disorder?

Like most mental health disorders, no single or exact cause is tied to BPD; rather it’s a combination of different factors that can contribute to it.

Just like the most common concerns like major depression, anxiety disorders, and obsessive-compulsive disorder, personality disorders like BPD are believed to have a biological component to them, especially in regards to genetics as well as brain structure and chemistry.

Although there isn’t a specific gene that has been identified that is connected with BPD, people who have family members with BPD or other mental health issues may be at increased risk of having it.

Some studies show that there may be differences in the structure of the brain and how it operates, which can lead to the emotional behaviors seen in borderline personality disorder. However, it isn’t yet clear if this is responsible for the disorder or its effect. [5]

Lastly, a person’s environment may also be influential in the development of the disorder.

For instance, people who have experienced trauma, toxic and abusive social relationships, including with parents, and been involved in instances of severe conflict or neglect at a very young age can contribute to the development of BPD.

Because of these kinds of situations, these individuals who have been exposed to them may display some of the symptoms that are characteristic of the disorder, such as a fear of abandonment and an inability to control or cope with their emotions, and this can present many issues for the individual with BPD.

Both environmental and biological factors are thought to contribute to the development of BPD.

What are the Consequences of Borderline Personality Disorder?

Like all of the other personality disorders, BPD can cause significant challenges in virtually every aspect of life.

Forming and maintaining social relationships due to emotional instability can be one of the biggest problems for many individuals and this can lead to additional issues such as low self-esteem, an extreme fear of being abandoned, or even suicidal ideation.

People with borderline personality disorder may also become very impulsive. Many of these behaviors, such as gambling, unsafe sex, and binge eating, can have a profoundly negative effect on their financial well-being and overall health. [2]

People with BPD may resort to substance abuse and self-harm to cope with the extreme ups and downs that come with the condition.

Deciding to seek treatment soon after recognizing issues is vital to improving symptoms and maintaining health for those with BPD.

How To Get Help For Borderline Personality Disorder

While it’s important for an individual who suspects they have BPD to have an understanding of the signs and symptoms of the condition, this personality disorder, like the others, has a specific set of guidelines laid out by the DSM-5, and treating it requires a formal assessment and diagnosis from a mental health professional.

Following an evaluation, potential testing, and diagnosis, a person can receive treatment, and this typically consists of a combination of medication and psychotherapy.

Medications like mood stabilizers, which are commonly used to treat bipolar disorder can help keep a person’s emotions more stable and can aid in controlling some of the symptoms, like anger outbursts, impulsiveness, and other aggressive behaviors.

Additionally, antidepressants can also help address the depressive-like symptoms seen in borderline personality disorder, and antipsychotics may also be prescribed to deal with other disorganized thought patterns, delusions, paranoia, and possibly disassociation.

Psychotherapy is also highly recommended because it can help patients with borderline personality disorder learn helpful coping skills, have a safe place to process emotions and provide them with understanding and support.

Therapy offers excellent strategies that can be used lifelong, and in conjunction with medication and the support of those around them, individuals with BPD can live normal lives. Several specific forms of therapy have shown themselves to be very beneficial to addressing BPD, and during evaluation and diagnosis, a clinician may help patients determine what therapy treatments may be most helpful.

Do You Have Borderline Personality Disorder?

Knowing if you truly have borderline personality disorder will require a diagnosis from a mental health professional. If you or a loved one may be struggling with BPD, seeking support from a licensed mental health professional is an important step toward recovery.

In addition to going over the DSM-5 BPD criteria listed above, you can also take this BPD test and find out if your present symptoms may be related to BPD.

The test is brief and free. It is important to remember that online tools are helpful, but are not a substitute for clinical assessment or treatment.

Conclusion

Borderline personality disorder isn’t always easy to diagnose since many of its symptoms may overlap with other issues. The information above may help you better understand BPD.

References

  1. American Psychiatric Association. (2018, November). What are Personality Disorders? Retrieved from https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
  2. Mayo Clinic Staff. (2016, September 23). Personality disorders. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  3. National Alliance on Mental Illness. (2017, December). Borderline Personality Disorder. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder
  4. Australian BPD Foundation. (2020, October 12). Diagnostic Criteria. Retrieved from https://bpdfoundation.org.au/diagnostic-criteria.php
  5. National Institute of Mental Health. (2017, December). Borderline Personality Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml