Borderline Personality Disorder (BPD)
BPD is defined as a pattern of unstable personal relationships, self-image, moods, and marked impulsivity. It occurs in about 2–3% of the population and is by far the most common personality disorder in clinical settings — it occurs in 11% of patients seen in outpatient mental health clinics and 19% of psychiatric inpatients. 5 or more of 9 symptoms suggests the presence of the disorder.
- P Paranoid ideas (stress-related & transient, or severe dissociative symptoms)
- R Relationship instability (alternating between idealization & devaluation)
- A Abandonment fears. Anger outbursts. Affect instability (marked mood reactivity, e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours)
- I Impulsivity (in ≥ 2 potentially self-damaging areas, e.g. spending, sex, substance abuse) and Identity disturbance (unstable self-image or sense of self)
- S Suicidal behavior (gestures, threats, or self-mutilating behavior)
- E Emptiness (chronic feelings of)
Screening & Tracking
The McLean Screening Instrument helps detect BPD. The Zanarini Rating Scale (ZAN-BPD) is a clinician-administered scale for assessing change in patients with BPD over time (usually weekly) — each of the nine criteria is rated during a structured interview.
Recommended Reading
Although written more than 20 years ago, the linked article below summarizes important aspects of BPD. The section on medication is now outdated; current pharmacological strategies can be discussed with your personal physician.
"The Dialectical Behavior Skills Workbook" by McKay, Wood & Brantley helps patients understand and cope with the challenging symptoms of BPD. "Management of Countertransference with Borderline Patients" by Gabbard & Wilkinson is strongly recommended for therapists treating BPD.