Borderline Personality Disorder in the DSM-5: Criteria for Diagnosis

Key Takeaways

• Borderline personality disorder (BPD) is marked by instability in relationships, self-image, and emotions.
• To be diagnosed with BPD, a person needs to exhibit at least five out of nine specific symptoms.
• If you’re thinking of suicide, reach out to the National Suicide Prevention Lifeline at 988 for help.

Borderline personality disorder (aka BPD) is a serious mental health condition, but it’s also one of the most misunderstood. The term is often thrown around (especially on social media) to refer to anyone who seems overly emotional, which is a mischaracterization of what the condition really is.

BPD is one type of personality disorder recognized in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR). Like other conditions, borderline personality disorder has its own specific set of diagnostic criteria in the DSM.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM, which is published by the American Psychiatric Association, is the official source of diagnostic information for psychiatric disorders, including BPD and related conditions. For each disorder, the DSM provides a list of symptoms and specifies how many symptoms are needed (and how severe the symptoms must be) to warrant a particular diagnosis.

If you think you or someone you care about may have borderline personality disorder (BPD), it’s a great idea to learn more about the condition and the specific criteria that are involved in a diagnosis. Being armed with some information can help you take the next important step: making an appointment for an assessment with a mental health professional.

BPD Criteria for a Diagnosis

The DSM-5 describes BPD as a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following symptoms.

The nine criteria for BPD are:

1. Chronic feelings of emptiness
2. Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
3. Frantic efforts to avoid real or imagined abandonment
4. Identity disturbance with markedly or persistently unstable self-image or sense of self
5. Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
6. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
7. A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as “splitting”)
8. Recurrent suicidal behavior, gestures, threats, or self-harming behavior
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

How many criteria do you need for BPD? To be diagnosed with BPD, you do not need to exhibit *all* nine of the symptoms of borderline personality disorder listed in the DSM-5.

A diagnosis requires experiencing at least five of the above symptoms.

How Were the BPD Criteria Established?

A team of psychologists and psychiatrists, who are considered experts in BPD, developed the borderline personality disorder DSM-5 symptom criteria. Many of the workgroup members are considered preeminent BPD researchers and work directly with BPD patients.

The symptom criteria were established based on the best research available. However, it is important to keep in mind that the symptom criteria may be refined as new research comes out.

The fifth edition of the DSM, DSM-V, was released in 2013 after many years of research and deliberation by experts. The symptom criteria for BPD in the new version remained the same as the previous version, DSM-IV.

The latest version of the manual is the DSM-5-TR (text revision), which includes updates to many diagnostic criteria.  However, BPD criteria remain the same in the newest version as they did in the previous version of the DSM-5.

How Is BPD Diagnosed?

There are a number of psychological disorders and medical problems that can cause symptoms very similar to those associated with BPD. That’s why it’s really important to reach out to a licensed clinician (for example, a therapist or doctor) who can listen to your concerns, conduct a thorough assessment, and make an accurate diagnosis.

A complete assessment for BPD may include several components.

• Your therapist or doctor may ask you to participate in an interview, during which they will ask you questions about your symptoms, physical health, and past and present life situation.
• They may also ask you to fill out a written questionnaire about BPD symptoms.
• Finally, if you are willing, your clinician may ask to talk to family or loved ones to get complete information on the ways that your symptoms are affecting you.

Your doctor will work closely with you to rule out similar conditions and evaluate your symptoms to determine if you are experiencing a co-occurring condition. BPD often co-occurs with other mental health conditions, including anxiety, bipolar disorder, depression, eating disorders, post-traumatic stress disorder, and substance use disorder.

Once you wrap up this assessment process, your clinician will gather all the necessary information to make an accurate diagnosis. Then, they will have a thorough and open conversation about what your diagnosis really means and how you might move forward with your treatment options.

What Should I Do If I Think I Have BPD?

If you think you may have BPD, the first step is to find a mental health professional. While they can be hard to find, there are clinicians who are specially trained to treat BPD and answer your questions. Start by asking your primary care doctor for a referral, or check with family and friends to see if they have any recommendations of a local professional with expertise in your condition.

Borderline Personality Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor’s appointment.

Learn the best ways to manage stress and negativity in your life.

Sign Up

You’re in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

If you have health insurance, you may want to talk to the insurance company about whether the clinician takes your insurance and how many sessions would be covered, and how much the co-pay would be.

If you do not have insurance, you may qualify for public assistance programs or services through your state or region’s department of mental health or social services. You can also ask your primary care physician for a referral, or look into whether medical centers or universities in your area offer psychiatric or psychological services.

Treatments for BPD

In the past, BPD was believed to be very difficult to treat. More recent research indicates that it responds well to treatment and that getting help can reduce the risks associated with self-harm, impulsivity, and suicidal behaviors.

In addition to working with a clinician, it may help to educate yourself about the variety of effective treatments available, including medication, psychotherapy, and self-help treatments.

• Therapy: Therapy is the first-line treatment for BPD, and may involve dialectical behavior therapy (DBT), mentalization-based treatment (MBT), or group therapy.
• Medication: Medications may sometimes be prescribed to help treat some symptoms of borderline personality disorder. This may include antidepressants, antipsychotics, anti-anxiety medications, and mood stabilizers.
• Self-help: Stress management strategies can also help with some symptoms of BPD. This can include mindfulness, meditation, and deep breathing. Self-care strategies and mood tracking can also help improve well-being and help people better recognize their emotions and moods.

Finally, it is important to know that you are not alone and that with help, people with BPD lead normal and fulfilling lives. Getting a diagnosis and seeking treatment are the first steps toward retaking control over your symptoms.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Association AP. Diagnostic and statistical manual of mental disorders. 5th edition. 2013. doi:10.1176/appi.books.9780890425596

2. National Institute of Mental Health. Borderline Personality Disorder.

3. National Institute of Mental Health. Borderline personality disorder.

4. Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorder. Curr Behav Neurosci Rep. 2017;4(1):21–30. doi:10.1007/s40473-017-0103-z

5. Stoffers JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2012;2012(8):CD005652. doi:10.1002/14651858.CD005652.pub2

Additional Reading

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC: Author, 2007.

• Oldham, MD, John. “Launching DSM-V.” Journal of Psychiatric Practice, 13: 351, November 2007.

By Kristalyn Salters-Pedneault, PhD

 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.

Thanks for your feedback!

What is your feedback?

Helpful

Report an Error

Other