BPD was officially recognized and diagnosed by psychiatrists in 1980, although the understanding and diagnostic criteria have evolved over time.
People diagnosed with a personality disorder are usually young adults aged 18 and older. Often, BPD develops to a full disorder by early teenage years, but BPD is not generally diagnosed in people under 18 unless the symptoms are present for more than 1 year.
The BPD diagnosis is typically made by a physician or psychiatrist based on a set of criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (“DSM-5”).
The DSM-5 criteria for BPD include a pervasive pattern over at least one year of instability of interpersonal relationships, self-image, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:
- Fear of abandonment & desperate efforts to avoid abandonment (actual or imagined),
- Unstable, intense relationships that alternate between idealizing and devaluing the other person (known as “splitting”),
- Unclear or unstable self-image, including struggles with sense of self and identity,
- Temporary paranoid thoughts or severe dissociative symptoms triggered by stress,
- Inappropriately intense anger or anger regulation problems, including frequent loss of temper or physical fights,
- Consistent and constant feelings of emptiness, sadness or worthlessness (“dysphoria”),
- Recurrent self-injury, self-mutilation, suicidal ideation, suicidal gestures, or suicidal thoughts or behavior,
- Emotional dysregulation – Frequent, rapid, drastic changes in mood, lasting usually only a few hours and rarely more than a few days. Emotional instability in reaction to day-to-day events (ex. intense episodic sadness, irritability, anger, or anxiety),
- Two or more impulsive behaviors such as unsafe sex, reckless driving, binge eating, substance abuse, or excessive spending.