Why is a borderline personality disorder diagnosis needed?

Borderline personality disorder facts / borderline personality disorder diagnosis.

Borderline personality disorder facts.

A borderline personality disorder diagnosis can help people with borderline personality disorder to get the right treatment for their problems. People with borderline personality disorder (BPD) have an extreme fear of abandonment and experience difficulties in regulating emotion. This results in unstable and impulsive behaviour, severe mood swings, turbulent relationships, and low self-esteem. On its own an extreme fear of abandonment could be related to post-traumatic stress disorder; severe mood swings could be related to bipolar disorder and having a low self-esteem could be related to all sorts of things. But combined they point in the direction of borderline personality disorder. By knowing what kind of mental disorder someone has, a professional can offer the most effective treatment.

In this case the most effective treatments for BPD are schema therapy and dialectical behavioural therapy (DBT) [1],[2]. But how does one know if a treatment is effective? A treatment is effective if it reduces the symptoms of that specific disorder (both short-term and long-term). So in order to treat someone effectively for BPD one needs to know if the patient has (most of) the borderline personality disorder symptoms. And that is why it’s important to have a borderline personality disorder diagnosis. Someone who meets the borderline personality disorder diagnosis criteria has a much bigger chance of benefiting from a treatment specific for BPD compared to ‘treatment as usual’.
On this page you find the official DSM criteria for borderline personality disorder.

At Barends Psychology Practice we offer (online) therapy for borderline personality disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).

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Borderline personality disorder diagnosis.

In order to receive the diagnosis for borderline personality disorder (BPD) you need to meet certain criteria:

(A) – Significant impairments in personality functioning manifest by:

  • 1. Impairments in self-functioning (a or b):
    a) Identity: markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
    b) Self-direction: Instability in goals, aspiration, values, or career plans.

  • 2. Impairments in interpersonal functioning (a or b):
    a) Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
    b) Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.
    (B). Pathological personality traits in the following domains:

  • 1. Negative Affectivity, characterized by:
    a) Emotional liability: unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
    b) Anxiousness: intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
    c) Separation insecurity: Fears of rejection by -and/or separation from- significant others, associated with fears of excessive dependency and complete loss of autonomy.
    d) Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behaviour.
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  • 2. Disinhibition, characterized by:
    a) Impulsiveness: acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behaviour under emotional distress.
    b) Risk taking: engagement in dangerous, risky, and potentially self-damaging activities; unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

  • 3. Antagonism, characterized by:
    a) Hostility: persistent or frequent angry feelings; anger or irritability in response to minor insights and insults.
    (C). The impairments in personality in functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
    (D). The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
    (E). The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g.: a drug of abuse, medication) or a general medical condition (e.g.: severe head trauma).
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  • [1] Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A., 2006. Outpatient psychotherapy for borderline personality disorder randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry, 63, 649-658.
  • [2] Verheul, R., Van Den Bosch, L. M. C., Koeter, M. W. J., De Ridder, M. A. J., Stijnen, T., & Van Den Brink, W., 2003. Dialectical behaviour therapy for women with borderline personality disorder
    12-month, randomised clinical trial in The Netherlands. The British Journal of Psychiatry, 182, 135-140.