Page 3 of 3: Prev | Next | Top of Article
research
- Does This Patient Need Psychiatric Referral?
- Giftedness and Psychological Abuse in Borderline Personality Disorder
- NonBlind Placebo Trial
- Personal Intelligence
- Psychiatry at JHU
Table: D5M-IV diagnostic criteria for borderline personality disorder*
- 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:
- Frantic efforts to avoid real or imagined abandonment. (Do not include suicidal or self-mutilating behavior covered in criterion 5.)
- A pattern of unstable and intense interpersonal relationships characterized by alternating extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance use, reckless driving, binge eating). (Do not include suicidal or self-mutilating behavior covered in criterion 5.)
- Recurrent suicidal behavior, gestures, or threats or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
*Criteria are numbered in order of decreasing diagnostic efficiency.
Reprinted with permission from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, DC, American Psychiatric Association, 1994.
Recognizing BPD in the primary care setting
When present in a cohesive pattern, various signals can alert the primary care physician to the presence of BPD and the need for immediate referral to a specialist.
Patients are often lonely young adults, usually women, who tend to present with a combination of chronic moodiness and/or depression and somatic complaints. The physical complaints frequently have an inadequate objective basis and may occasionally sound bizarre (eg, the sensation that the arms are falling off or that there is an itch inside the head). Patients may have self-inflicted injuries, bruises, or cuts that they may explain away as incurred in an accident or caused by someone else.
BPD patients may express great uncertainty about their identity, goals, and values and have an excessive need to talk about self-doubts and upsetting personal relationships. They may be angry, self-sabotaging, impulsive, confusingly appealing and charismatic, and anxiety-provoking all at the same time. There is often a history of suicidal thinking and failed mental health care.
References
- Gunderson JG; Empirical studies of the borderline diagnosis, in Grinspoon L (ed): Psychiatry 1982: The American Psychiatric Association Annual Review. Washington DC, American Psychiatric Press, 1982, ch 28, pp 415-437.
- Rockland LH: Supportive Therapy for Borderline Patients; A Psychodynamic Approach. New York, Guilford Press, 1992.
- Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, DC, American Psychiatric Association, 1994, p 654.
- Swartz M. Blazer D, George L, Winfield I: Estimating the prevalence of borderline personality disorder in the community. J Pers Disorders 4:257, 1990.
- Adler G: Borderline Psychopathology and Its Treatment. NorthVale. New Jersey, Jason Aronson, 1985. pp 203-207.
- Kernberg OF: Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, 1975.
- Gutheil TG. Borderline personality disorder, boundary violations, and patient-therapist sex: medicolegal pitfalls. Am J Psychiatry 146:597, 1989.
- Stone MH: The Fate of Borderline Patients: Successful Outcome and Psychiatric Practice. New York. Guilford Press. 1990. pp40-65.
- Gunderson JG, Zanarini MC: Pathogenesis of borderline personality, in Tasman D, Hales RE. Frances AJ (eds): American Psychiatric Press Review of Psychiatry, vol 8. Washington, DC, American Psychiatric Press. 1989, ch 2. pp 25-49.
- Gunderson JG, Sabo AN: The phenomenological and conceptual interface between borderline personality disorder and PTSD. Am J Psychiatry 150:19, 1993.
- Herman JL, Perry JC, van der Kolk BA; Childhood trauma in borderline personality disorder. Am J Psychiatry 146:490,1989.
- Links PS. Steiner M, Offord DR, Eppel A: Characteristics of borderline personality disorder: a Canadian study. Can J Psychiatry 33:336, 1988.
- Zanarini MC, Gunderson JG, Marino MF, et al: Childhood experiences of borderline patients. Compr Psychiatry 30:18, 1989.
- Park LC, Imboden JB, Park TJ, et al: Giftedness and psychological abuse in borderline personality disorder: their relevance to genesis and treatment. J Pers Disorders 6:226, 1992.
- Frances A: Foreword, in Stone MH: The Fate of Borderline Patients. New York, Guilford Press, 1990, pp vii-ix.
- Linehan MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford Press, 1993.
- Perry JC, Herman JL, van der Kolk BA, Hoke LA: Psychotherapy and psychological trauma in borderline personality disorder. Psychiatr Ann 20:30, 1990.