What Are The Borderline Personality Disorder Criteria For Diagnosis?

Reviewed by Aaron Horn, LMFT

Published 10/12/2022

Receiving a mental health diagnosis can be either difficult or comforting depending on how long you have been impacted by it. Although there are concerns associated with mental illness and corresponding stigmas, many people find that receiving a diagnosis actually offers some relief. Symptoms that can make life extremely difficult—work, focus, relationships, and pursuing goals can all suffer when mental illness is at play—may be easier to digest and tackle when an official diagnosis has been delivered. What exactly are the DSM Borderline Personality Disorder criteria?

Borderline Personality Disorder: A Review

Borderline Personality Disorder is a personality disorder most commonly associated with an inability to carry on relationships and a predilection toward unpredictable behavior. This particular disorder may be confused with other disorders, the most common of which is Bipolar Disorder. There is an important difference however. Although both are known for their links to mood swings, Bipolar Disorder is characterized by mood swings that span over a period of days or weeks, while Borderline Personality Disorder is characterized by mood swings that can switch rapidly back and forth over a matter of minutes or hours.

Borderline Personality Disorder typically starts in childhood or adolescence, though it may not be diagnosed until people are in their late teens or well into adulthood. This is because the disorder's roots are begin in childhood, but symptoms may not reach their full intensity until adulthood. After all, what teenager does not exhibit symptoms such as intense mood swings, difficulty maintaining relationships, and a wildly changing personality? For this reason alone, most personality disorders (including BPD) are not diagnosed in adolescence or when the patients are teenagers.

Borderline Personality Disorder is among the most treatable disorders known today, with over half of individuals diagnosed and subsequently treated showing remission of symptoms. The difficulty associated with Borderline Personality Disorder is not actually in the treatment process, but in the diagnosis process. Borderline Personality Disorder can mimic many other disorders and mental health issues that causes it to be frequently misdiagnosed. Because of this, adequate treatment is not started as early as would typically be considered ideal.

Borderline Personality Disorder Diagnosis Criteria

Symptoms form the basis of Borderline Personality Disorder criteria, and therapists rely heavily on self-reported symptoms and observations made during sessions when a new client seeks treatment. The DSM-5 identifies the following symptoms as the requisite presenting issues to constitute Borderline Personality Disorder:

  • Avoidant behavior focused on abandonment. The core of Borderline Personality Disorder is a fear of abandonment, and efforts to avoid any type of abandonment are a core symptom of BPD.
  • Intense outbursts of anger. Borderline Personality Disorder has deep roots in childhood, and people with the disorder have typically not learned healthy ways to handle and express emotions, including anger. Intense outbursts of anger and other strong emotions can indicate the presence of Borderline Personality Disorder.

  • People with Borderline Personality Disorder may experience periods of dissociation or periods wherein they feel as though they are disconnected from their bodies or viewing themselves as though from a distance or a great height.
  • Depression and anxiety. Borderline Personality Disorder is very often accompanied by other mental health issues, including depression and anxiety. The presence of co-morbid conditions can more effectively implicate Borderline Personality Disorder than symptoms free of mood and anxiety-based symptoms.
          • Mood swings. People with Borderline Personality Disorder may appear to constantly vacillate between a large number of emotions. They may adore someone in the morning and abhor them by night, or may quickly shift between joy, anger, frustration, and contentment in a seemingly minuscule span of time.
  • Fragmented or problematic self-image. Borderline Personality Disorder is characterized by a constantly shifting sense of self and a murky self-image. Behaviors associated with the disorder are often designed to cope with this particular symptom.
  • Difficulty in relationships. People with BPD often experience a great deal of difficulty maintaining healthy relationships. Relationships of all kinds are marked by a pattern of idealization and devaluation, making maintaining friendships, familial bonds, and romantic relationships extremely difficult.

To receive a BPD diagnosis, a new patient does not have to exhibit all of the above symptoms. Instead, to qualify as having Borderline Personality Disorder, DSM-Vcriteria dictate that at least 5 of the symptoms listed above have to be present, beginning in adolescence or during the teenage years.

What Is the Diagnosis Process?

Although having a clear idea of what is required for a BPD diagnosis is helpful, many people are uncertain about the actual process of receiving a diagnosis. Incoming patients are not alone in this, as many clinicians continue to have difficulty identifying and correctly diagnosing Borderline Personality Disorder. Because BPD can present as a number of different conditions, including anxiety disorders and depressive disorders—the most common being Bipolar Disorder—diagnosing mental health professionals can mistakenly diagnose people with BPD with a host of other disorders, none of which will target and treat the actual issues at play in Borderline Personality Disorder. This makes it essential for people coming into a therapist’s office to have an idea of their own symptoms and potential causes, which can be evaluated via an online test or careful research on the DSM-V BPD criteria.

Upon entry into a therapy session, a therapist will likely ask for the reason for the visit, then provide an intake sheet with a series of rating questions, asking you to identify symptoms and the severity with which they affect you. Because Borderline Personality Disorder presents with a myriad of learned behaviors, there are no physical or neurological examinations that can determine whether or not BPD is present. Instead, mental health professionals rely entirely upon self-reported symptoms and any signs present during sessions.

This is where diagnosing BPD can get complicated. Because BPD presents in the same way as so many other conditions and is estimated to affect only 1% of the population, mental health professionals may be more inclined to pinpoint symptoms as indicative of a more common condition. Although Borderline Personality Disorder is a highly treatable disorder, there are significant obstacles to finding treatment, not the least of which is the actual diagnosis process.

Once all symptoms have been reported, patient input has been received, and signs have been evaluated during sessions, a mental health professional can then make a diagnosis and begin laying out a treatment plan. The DSM-V is the basis for all Borderline Personality Disorder evaluation and diagnosis. Borderline Personality DSM-V criteria can be studied and evaluated by anyone, not only mental health professionals, to determine how many existing symptoms match BPD symptoms.

The Criteria For Borderline Personality Disorder: The DSM-V And Diagnosis

Self-diagnosis is not a thorough enough evaluation of all of the factors involved in any type of mental health concern, let alone one complicated enough to warrant a professional diagnosis. Although self-evaluation cannot take the place of a professional evaluation, examining your symptoms, risk factors, and the likelihood of all of these components leading to a specific diagnosis can be useful. Knowing your symptoms and background and how they interact to create the potential for a clinical diagnosis can empower and help you provide a therapist with a potential starting point for clinical evaluation.

Although Borderline Personality Disorder is often viewed with fear and distrust, this is an unfounded fear. Personality disorders are not characterized by violence or danger to others, and Borderline Personality Disorder is no exception. Treatment requires a diagnosis, which is reliant upon the criteria put forth in the DSM-V. The criteria include the hallmark traits of Borderline Personality Disorder, focusing on unstable personal relationships and a high degree of impulsivity. These two traits are the well from which the rest of the requisite symptoms draw, making them the basis of the DSM-V’s view of Borderline Personality Disorder.

While it may not seem to be important to familiarize yourself with the DSM-V criteria for Borderline Personality Disorder, having a clear understanding of how you are being evaluated can better equip you to press for a more accurate diagnosis. Because the DSM-V is the gold standard for mental health evaluation and diagnosis, understanding exactly how this manual views and categorizes Borderline Personality Disorder can help you understand why you have (or have not) been diagnosed with the disorder. The DSM-V can also be useful in determining whether or not Borderline Personality Disorder is implicated by your symptoms, as it provides some insight into the most effective treatment methods and can provide you with some peace of mind regarding how you will likely need to begin the path toward recovery.