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borderline personality disorder dsm iv-r diagnosis criteria

Borderline personality disorder

DSM-IV-TR defines borderline personality disorder as a pervasive pattern of instability of interpersonal relationships, self-image and affect, and marked impulsivity. It begins in early childhood and its key characteristics include five of the following:

frantic efforts to avoid real or imagined abandonment a pattern of unstable and intense personal relationships characterized by alternating between idealization and devaluation identity disturbance: markedly and persistently unstable self-image impulsivity in at least two areas that are potentially self-damaging (such as substance abuse, reckless driving) recurrent suicidal behaviour or self-mutilating behaviour; may involve repeated threats or gestures chronic feelings of emptiness inappropriate intense anger or diffi culty in controlling anger transient stress-related paranoid ideation or severe dissociative symptoms.

About 2 per cent of the US population is thought to have this cluster of traits, and about 75 per cent of these are thought to be women (APA 2000). It typically begins in adolescence and continues through adulthood. Thoughts of suicide and suicide attempts are common: up to 10 per cent of people with this disorder eventually commit suicide (e.g. Zanarini et al. 2005). Self-harm – in particular cutting of arms, legs or torso, burning or other mutilatory acts – is also common. This is usually in response to experiencing strong negative emotions such as anger or nxiety, attempts to block painful memories or as a cry for help. These behaviours may also be used in a manipulative manner, to control relationships or the behaviour of others around them. People with the disorder often have intense, over-involved relationships, and have a deep fear of being rejected. This may result in them becoming panicky at the thought of being isolated, and they may engage in self-destructive behaviour to try to maintain relationships that are disintegrating (‘If you leave, I will hurt myself  .  .  .’). As with other personality disorders, it is not as immutable as was once thought. Zanarini et al. (2005), for example, found that only threequarters of a cohort of people initially given this diagnosis warranted the diagnosis some six years later. In addition, only 6 per cent of those people who improved experienced a ‘relapse’.

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