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Borderline Personality Disorder

DSM-IV Diagnostic Criteria

A pervasive pattern of unstable interpersonal relationships, unstable self-image, unstable affects, and poor impulse control beginning by early adulthood and indicated by at least five of the following:

  1. Frantic efforts to avoid real or imagined abandonment.
  2. Unstable and intense interpersonal relationships, alternating between extremes of idealization and devaluation.
  3. Identity disturbance: unstable self-image.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuity, substance abuse, reckless driving, binge eating).
  5. Recurrent suicidal behavior, gestures or threats.
  6. Affective instability (e.g., sudden intense dysphoria, irritability or anxiety of short duration).
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling 
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
  1. Clinical Features of Borderline Personality Disorder
  2.  
    1. Clinical presentation is highly variable.
    2. Chronic dysphoria is common.
    3. Desperate dependence on others is caused by inability to tolerate being alone. Borderline Personality Disorder
    4. Chaotic interpersonal relationships are characteristic.
    5. Self-destructive or self-mutilatory behavior is common.
    6. Childhood history of abuse or parental neglect is common.
  3. Epidemiology of Borderline Personality Disorder
  4.  
    1. The female-male ratio is 2:1.
    2. Five times more common in first-degree relatives.
    3. Prevalence is 1-2%, but occurs border line in 30-60% of psychiatric patients.
  5. Differential Diagnosis
  6.  
    1. Adolescence: Identity disturbance and emotional lability of normal adolescence may have the characteristics of borderline personality disorder; however, a persistent pattern is not present.
    2. Histrionic Personality Disorder: These patients are also manipulative and attention seeking, but they do not display self-destructiveness and rage. Psychosis and dissociation are not typically seen in Histrionic patients.
    3. Dependent Personality Disorder: When faced with abandonment, Dependent patients will increase their submissive behavior rather than display rage as