There are nine specific diagnostic criteria (symptoms) for borderline personality disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (referred to as DSM-5) published in 2013 by the American Psychiatric Association.1 In order to be diagnosed with borderline disorder, you must have five of the nine criteria.
It is now common to list the symptoms of the disorder in four groups or domains:
Domain A. Excessive, unstable and poorly regulated emotional responses.
The most commonly affected emotions in borderline disorder are anger, anxiety and depression. Of the nine DSM-5 criteria for borderline disorder, three fall into this group:
- Affective (emotional) instability including intense, episodic emotional anguish, irritability, and anxiety/panic attacks
- Anger that is inappropriate, intense and difficult to control, and
- Chronic feelings of emptiness
In addition, if you suffer from borderline disorder, you may also experience emotional hyper-reactivity (“emotional storms”), or emotional responses that are occasionally under- reactive, and frequent episodes of loneliness, and boredom.
Domain B. Impulsive behaviors that are harmful to you or to others.
Two of the DSM-5 criteria for borderline disorder are in this group:
4. Self-damaging acts such as excessive spending, unsafe and inappropriate sexual conduct, substance abuse, reckless driving, and binge eating, and
5. Recurrent suicidal behavior, gestures, threats, or self-injurious behavior such as cutting or hitting yourself. (If you cut yourself under stress, you should be evaluated by a psychiatrist to determine why you do this. It is a dangerous activity, and a frequent cause is borderline disorder.)
Also, you may engage in other impulsive behaviors such as actions that are harmful and destructive to yourself, others or property
Domain C. Inaccurate perceptions of yourself and others, and high levels of suspiciousness.
Two of the DSM-5 criteria for borderline disorder are included in this group:
6. A markedly and persistently unstable self-image or sense of yourself (your perceptions of yourself, your identity), and
7. Suspiciousness of others thoughts about you, and even paranoid ideation, or transient and stress related dissociative episodes during which you feel that you or your surroundings appear unreal.
Other symptoms in this Domain include split- or “all-or-nothing” thinking, difficulty “pulling” your thoughts together so they make sense, and rational problem solving, especially in social conflicts.
Domain D. Finally, you may experience tumultuous and very unstable relationships.
The final two DSM-5 criteria fall in this group:
8. You may engage in frantic efforts to avoid real or imagined abandonment, and
9. Your relationships may be very intense, unstable, and alternate between the extremes of over idealizing and undervaluing people who are important to you.
You may also recognize that you have overly dependent and clinging behavior in important relationships. In addition, you may consistently have expectations of negative and harmful attitudes and behaviors from most people, and difficulty in reasoning clearly in stressful social situations.