How Doctors Diagnose Borderline Personality Disorder

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Borderline personality disorder (BPD) is a mental illness characterized by a history of unstable relationships, dramatic mood swings, and unstable self-image. It can cause significant pain and suffering, both for those who have the condition and those who love them. 

Appropriate diagnosis is often a relief; finally, an explanation for years of confusing behavior! Diagnosis also points the way to effective treatment, which can improve quality of life. 

Discover what borderline personality disorder criteria healthcare professionals use to make a BPD diagnosis and distinguish it from other mental health conditions like bipolar disorder

Borderline Personality Disorder Diagnosis 

People with borderline personality disorder symptoms (including impulsiveness, reckless behavior, unstable self-image, dramatic mood swings, and a history of broken relationships) should be assessed by a mental health professional. Psychiatrists, psychologists, and licensed clinical social workers are qualified to diagnose and treat mental health conditions. Primary healthcare providers, like family doctors and general practitioners, aren’t qualified to diagnose BPD but they can refer you to an experienced mental health provider with the expertise you need. 

There is no borderline personality disorder test, but your doctor may ask you to answer mental health questionnaires or take psychological tests and assessments to learn more about you. To diagnose the condition, mental health professionals gather information about your symptoms, life experience, and family history. You can help your provider arrive at an accurate diagnosis by providing detailed information about your symptoms. Your provider will want to know when symptoms first started, which ones you experience most often, and how they affect your personal and professional life. 

You can expect your provider to ask questions about your family and childhood as well. Research has shown that people who have a parent or sibling with BPD are more likely to have the condition, so if someone in your family has borderline personality disorder, the odds that you might have it are increased. Answer the questions about your family and childhood as truthfully as possible, even if they are painful. A history of trauma, abuse or neglect increases the probability that you have BPD. 

In some cases, your provider may recommend a full medical examination by a physician to look for possible physical causes for your symptoms. 

Borderline Personality Disorder Criteria 

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), you must exhibit 5 out of the 9 following symptoms to be diagnosed with borderline personality disorder: 

  • Intense fear of abandonment

  • Pattern of unstable relationships

  • Unstable self-image

  • Impulsive, potentially dangerous behavior, including unsafe sex, reckless driving and substance abuse

  • Self-harming behavior (such as cutting) or suicide attempts

  • Dramatic mood swings

  • Chronic feeling of emptiness

  • Inappropriate or uncontrolled anger

  • Paranoid thoughts, delusions or temporary disconnect from reality

Many of these symptoms occur with other mental health conditions as well. Mood swings, for instance, are a cardinal symptom of bipolar disorder and paranoia is a classic symptom of schizophrenia. But paranoid episodes associated with BPD tend to be brief, while people with schizophrenia may experience prolonged bouts of paranoia. Details such as these help healthcare providers differentiate between mental health conditions with overlapping traits. 

However, because BPD often occurs alongside other mental health conditions, including attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), bipolar disorder, anxiety, and depression, it can take a while for mental health providers to untangle symptoms and behavior and arrive at an accurate diagnosis.

Sometimes, people with BPD are diagnosed with another disorder—for example, ADHD—first. If symptoms persist despite treatment for ADHD, your provider will begin to suspect the presence of another mental health condition (such as BPD). If you continue having symptoms despite diagnosis and treatment, tell your healthcare provider.

Borderline Personality Disorder Treatment 

With treatment, many people with BPD experience significant relief. Treatment also decreases the likelihood that a person with BPD will commit suicide.

The primary treatment for borderline personality disorder is psychotherapy. It’s not an immediate solution, but over time, it’s possible to learn new coping strategies and develop healthy thought patterns and behaviors. 

Appropriate diagnosis and treatment of BPD can open the door to personal satisfaction and close connections with friends and family members.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 15
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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