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Borderline PD: Definition

In psychiatry, borderline personality disorder (BPD) is a personality disorder characterised by extreme "black and white" thinking, mood swings, emotional dysregulation, disrupted relationships and difficulty in functioning in a way society accepts as normal. The name comes from the DSM-IV-TR; the ICD-10 has an equivalent called Emotionally Unstable Personality Disorder, borderline type. Psychiatrists describe borderline personality disorder as a serious disorder characterized by pervasive instability in mood, interpersonal relationships, self-image and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity.

Originally thought to be at the "borderline" between psychosis and neurosis, people with BPD actually suffer from what has come to be called emotional dysregulation. While less well-known than schizophrenia or bipolar disorder (manic-depression), BPD is more common, affecting two percent of adults, mostly young women. There is a high rate of self-injury without suicidal intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. In some instances people with BPD kill themselves by accident in a case of self-injury that goes too far. Patients often need extensive mental health services, and they account for 20 percent of psychiatric hospitalizations. With help, however, many improve over time and are eventually able to lead productive lives.

DSM-IV-TR

The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines borderline personality disorder (see DSM cautionary statement) as 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) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (not including 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
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; [not including] suicidal or self-mutilating behavior covered in Criterion 5)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Chronic feelings of emptiness
7. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
8. Transient, stress-related paranoid ideation or severe dissociative symptoms

ICD-10