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for Borderline Personality Disorder

Diagnostic Criteria

BPD is usually diagnosed in Australia using the American Psychiatric Association Diagnostic and statistical manual of mental disorders 5th edition (DSM-5).  Prior to the release of the DSM-5 there was much discussion re changing the diagnostic criteria however a decision could not be reached and the criteria remained unchanged from the DSM-IV-TR. (# see note below)

World Health Organization International statistical classification of diseases and related health problems 10th Revision (ICD-10) also includes diagnostic criteria for unstable personality disorder, borderline type (see table below).

DSM-5 diagnostic criteria for BPD^

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 behaviour coverered in Criterion 5)
2. A pattern of unstable and intense interpersonal relationships characterised by alternating
between extremes of idealisation and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. 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 behaviour coverered in Criterion 5)
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. 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)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper,
constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

^ DSM-5 p663

# In an appendix (p 766-7) the DSM-5  lists Proposed Diagnostic Criteria for BPD which mentions "the typical features of BPD as instability of self-image, personal goals, interpersonal relationships, and affect, accompanied by impulsivity, risk taking, and/or hostility.  Characteristic difficulties are apparent in identity, self-direction, empathy, and/or intimacy, along with specific maladaptive traits in the domain of Negative Affectivity, and also Antagonism and/or Disinhibition"

ICD-10 diagnostic criteria for emotionally unstable personality disorder, borderline type*

Emotionally unstable personality disorder is characterised by:
• a definite tendency to act impulsively and without consideration of the consequence
• unpredictable and capricious mood
• liability to outbursts of emotion and an incapacity to control the behavioural explosions
• tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored.
Two types may be distinguished: impulsive type and borderline type.
The borderline type is characterised by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicidal gestures and suicide attempts

*Source Clinical Practice Guideline for the Management of Borderline Personality Disorder (NHMRC 2012) p44