DSM-IV Criteria

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) is the American classification system for mental disorders. It lists 9 criteria for Borderline Personality Disorder.

Diagnostic Criteria

At least 5 of the following 9 criteria should be present:

1. Fear of Being Alone

Difficulty being alone, fear of separation, or desperate efforts to prevent it.

Explanation

The affected person experiences even temporary solitude as permanent isolation from the outside world. Often a feeling of “not being alive” sets in. While alone, they become anxious, irritable, or fall into depressive phases. They feel an inner emptiness that they try to fill – through alcohol, other drugs, sex, conflict, or binge eating.

2. Unstable Relationships

A pervasive pattern of very intense but unstable relationships. These are typically characterised by an extreme alternation between idealisation and devaluation.

Explanation

The affected person shows clear intolerance toward separation, yet on the other hand has a fear of too much closeness. The smallest rejections are experienced as disappointments and lead to devaluation of the partner or the feeling of being “abandoned.”

3. Identity Disturbance

Difficulty describing who and what one truly is.

Explanation

The affected person feels, thinks, and acts only for the moment – “why should I care about what I said yesterday.” They “are” in that moment. This leaves them confused about their own persona. Self-evaluation fluctuates: they either devalue themselves or experience feelings of omnipotence (all-powerfulness). This alternation is extremely stark.

4. Impulsivity

Potentially self-damaging and frequently impulsive actions, such as spending money, frequently changing sexual contacts, substance abuse, theft, reckless driving, eating disorders.

Explanation

The affected person uses impulsive actions to compensate. Impulsive behaviours serve here as protective mechanisms. Often, they turn to alcohol or other drugs.

5. Suicidality and Self-Harm

Repeated suicide attempts or threats, or self-harming behaviour.

Trigger Warning

This section discusses self-harming behaviour.

Explanation

The affected person usually self-harms in secret or in front of their partner. This also includes self-induced illnesses such as eating disorders. The affected person typically experiences overwhelming feelings of anxiety, inner emptiness, tension, or rage beforehand.

6. Mood Swings

Frequent mood swings.

Explanation

The affected person alternates between anxiety, anger, rage, depression, omnipotence, happiness, and unhappiness. These states typically last only a few hours or days.

7. Chronic Emptiness

A chronic feeling of inner emptiness.

Explanation

The affected person experiences themselves as a hollow shell, completely empty inside. This feeling of emptiness is so terrifying that it seems life-threatening. Enduring this fear requires almost superhuman strength.

8. Anger and Rage

Intense anger or difficulty controlling anger or rage. The anger bears no relation to the trigger. For example: frequent irritability, constant rage, recurring physical confrontations.

Explanation

The affected person experiences their own outbursts of rage as uncontrollable. The outbursts are unpredictable and bear no relation to the trigger. They are often directed at the person the affected individual loves the most.

9. Dissociation and Paranoia

Transient, stress-related feelings of detachment or the belief of being threatened or persecuted.

Explanation

The affected person feels paralysed. Their body is numb and barely capable of movement. Particularly emotional stress situations are experienced as life-threatening. These compel the affected person to “make themselves feel” – often through self-harm.

The Borderline Spectrum

Important

Borderline is not all the same. The spectrum is very broad.

Multi-comorbidity is a hallmark of Borderline Personality Disorder. It can be understood as a cascade disorder: individual co-occurring disorders interlock and develop on the foundation of the borderline disorder.

See Also

• ICD-10 Criteria (F60.31) – European diagnostic system
• Splitting – the central defence mechanism in Borderline