DSM-5 Borderline Personality Disorder (BPD): Criteria, Symptoms, Diagnosis & Treatment

Borderline Personality Disorder (BPD) is one of the most complex and frequently misunderstood conditions in modern psychiatry. Often stigmatized in popular culture as a “difficult” personality type, the clinical reality defined by the DSM-5 borderline personality disorder criteria is actually one of profound emotional pain and a courageous struggle for stability.

For those living with BPD, the world can feel like a series of emotional tidal waves. For clinicians and loved ones, understanding the DSM-5 BPD criteria is the first step toward moving from confusion to compassion. This guide provides an exhaustive look at how the American Psychiatric Association (APA) defines, categorizes, and views the treatment of BPD in the current era.

What Does DSM Stand for in Psychology?

Before diving into specific symptoms, it is essential to understand the “rulebook” used to define them. What does DSM stand for in psychology? It stands for the Diagnostic and Statistical Manual of Mental Disorders.

Published by the American Psychiatric Association (APA), the DSM is the authoritative guide for healthcare professionals in the United States and much of the world. It provides a common language for clinicians to ensure that a diagnosis of “Borderline Personality Disorder” in New York means the same thing as it does in California or London.

DSM-5 vs. DSM-5-TR

The current version is the DSM-5-TR (Text Revision), released in 2022. While the core 9 symptoms of BPD remain the same from the 2013 DSM-5, the “Text Revision” updated the descriptive data regarding prevalence, risk factors, and co-occurring conditions to reflect the latest scientific research.

Where Borderline Personality Disorder Fits in the DSM-5

In the manual, personality disorders (DSM-5) are grouped into three “clusters” based on shared descriptive characteristics:

• Cluster A: Odd or eccentric behaviors (e.g., Paranoid, Schizoid).
• Cluster B: Dramatic, emotional, or erratic behaviors. This is where BPD sits, alongside Narcissistic, Antisocial, and Histrionic personality disorders.
• Cluster C: Anxious or fearful behaviors (e.g., Avoidant, Dependent).

BPD is Not a Mood Disorder

A common clinical mistake is confusing BPD with mood disorders like depression or bipolar disorder. While BPD involves “mood swings,” it is categorized as a personality disorder because the symptoms are pervasive, long-standing patterns of relating to the self and the world, rather than episodic chemical shifts.

DSM-5 Criteria for Borderline Personality Disorder (Explained Simply)

To receive a formal diagnosis of borderline personality disorder (DSM-5), an individual must demonstrate a pervasive pattern of instability that begins by early adulthood and is present in a variety of contexts.

According to the manual, the patient must meet at least five of the following nine criteria:

1. Frantic Efforts to Avoid Abandonment

This isn’t just a fear of being left; it is a “frantic” reaction to even a perceived slight. A partner being 10 minutes late for dinner might trigger intense panic or rage because it is interpreted as “they are leaving me forever.”

2. Unstable and Intense Interpersonal Relationships

This is often called “Splitting.” A person with BPD may idealize a friend one day (“They are my soulmate”) and devalue them the next (“They are the most selfish person I’ve ever met”) based on a single interaction.

3. Identity Disturbance

A markedly and persistently unstable self-image. People with BPD often feel like “chameleons,” changing their values, career goals, or even their sexual identity based on who they are with because they lack a solid core sense of self.

4. Impulsivity in Self-Damaging Areas

This must occur in at least two areas, such as reckless driving, binge eating, substance abuse, unsafe sex, or impulsive spending.

5. Recurrent Suicidal Behavior or Self-Mutilation

This includes suicidal threats, gestures, or self-harm (like cutting or burning). In BPD, these are often used as a way to “communicate” unbearable internal pain or to feel something when they are experiencing emotional numbness.

6. Affective Instability (Mood Reactivity)

Unlike bipolar disorder, where moods last weeks, BPD mood swings usually last minutes to hours. The “trigger” is almost always an external event, usually a perceived rejection.

7. Chronic Feelings of Emptiness

Many patients describe this as a “physical hole” in their chest or a feeling that they are “hollow” or “not real.”

8. Inappropriate, Intense Anger

Often referred to as “Borderline Rage.” It is an anger that is disproportionate to the event (e.g., screaming at a cashier for a small error) and is often followed by intense shame and guilt.

9. Transient, Stress-Related Paranoia or Dissociation

Under extreme stress, a person with BPD may feel “spaced out,” as if they are watching themselves from a distance (dissociation), or they may become irrationally suspicious of others’ motives (paranoia).

What Are the 3 C’s of Borderline Personality Disorder?

While the DSM-5 provides the “what,” clinicians and family members often use the 3 C’s of borderline personality disorder to describe the “how” of living with the condition. These are not diagnostic criteria, but they are vital for understanding the interpersonal landscape.

1. Crisis: Life for someone with untreated BPD often feels like a series of emergencies. Minor setbacks are experienced as catastrophic events.
2. Chaos: Because of unstable relationships and impulsivity, the social and professional life of someone with BPD can be chaotic, with frequent job changes and “stormy” friendships.
3. Control: This refers to the “control” of emotions. The person with BPD often feels they have no control over their internal world, leading them to try and “control” their external environment or the people around them to feel safe.

The “Non-Mantra” for Loved Ones: There is a separate set of “3 C’s” for family members: I didn’t Cause it, I can’t Cure it, and I can’t Control it.

DSM-5 Borderline Personality Disorder Symptoms vs. Emotional Instability

It is important to differentiate between general emotionality and the pathology of BPD. Many people ask, “What are some symptoms of being emotionally unstable?” and worry they have BPD.

However, DSM-5 borderline personality disorder symptoms are distinguished by their:

• Pervasiveness: They affect almost every area of life (work, home, social).
• Duration: They are not a “phase”; they have been present since at least late adolescence.
• Severity: They cause significant distress or impairment in functioning.

Simply having a “bad temper” or being “sensitive” does not meet the high bar of a personality disorder.

DSM-5 Diagnostic Code for Borderline Personality Disorder

In the world of medical billing and clinical documentation, the DSM-5 borderline personality disorder code is a crucial piece of data. While the DSM provides the diagnostic criteria, it uses codes from the International Classification of Diseases (ICD) for administrative purposes.

• ICD-10-CM Code: F60.3 (Emotionally unstable personality disorder).
• ICD-11 Context: The newer ICD-11 has moved toward a “dimensional” approach, categorizing the condition as 6D10 (Personality Disorder) with a “Borderline pattern” specifier.

These codes are essential for insurance reimbursement and allow researchers to track prevalence rates globally. However, for a patient, the code is simply a clinical shorthand for the complex emotional landscape they navigate daily.

Types of Borderline Personality Disorder (DSM-5 Context)

It is a common point of confusion: “Which type of BPD do I have?” Officially, the APA recognizes only one diagnosis. There are no “types” of borderline personality disorder in the DSM-5. However, the disorder is highly heterogeneous—meaning two people can both have BPD but look entirely different.

To better describe these differences, psychologists (most notably Theodore Millon) proposed four descriptive subtypes. While not official DSM diagnoses, these are widely used by therapists to tailor treatment:

1. Quiet (Discouraged) BPD: These individuals “act in” rather than “act out.” They are often high-functioning but struggle with intense internal shame, self-loathing, and “quiet” suicidal thoughts.
2. Petulant BPD: Characterized by irritability, passive-aggression, and a “push-pull” dynamic in relationships. They often feel unloved and resentful.
3. Impulsive BPD: This type aligns with the “thrill-seeker” profile. They may engage in risky behaviors (spending, substance use, dangerous driving) to escape feelings of boredom or numbness.
4. Self-Destructive BPD: The focus here is on self-punishment. This subtype is most strongly associated with self-harm and a subconscious urge to sabotage one’s own success.

How to Explain Borderline Personality Disorder to Others

Explaining BPD to a partner, parent, or employer is notoriously difficult because the symptoms often look like “bad behavior” rather than a mental health condition.

The “Burn Victim” Analogy:

One of the most effective ways to explain BPD is through the words of Marsha Linehan:

“People with BPD are like people with third-degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”

What Not to Say to Someone with Borderline Personality Disorder

• “You’re just doing this for attention.” (In reality, they are doing it to survive emotional pain).
• “Just calm down; it’s not a big deal.” (This is “invalidating” and actually triggers the BPD brain to escalate).
• “You’re being manipulative.” (While their actions may feel manipulative, they are usually desperate, unskilled attempts to get their needs met).

BPD vs. Other Personality Disorders in the DSM-5

Because BPD is in Cluster B, it shares a “neighborhood” with other disorders. Differentiating them is key for an accurate BPD diagnosis.

BPD vs. Bipolar Disorder (DSM-5 Clarification)

The most frequent misdiagnosis for BPD is Bipolar Disorder. While both involve mood swings, the DSM-5 highlights distinct differences:

• The Trigger: BPD mood shifts are almost always interpersonal (triggered by a text, a tone, or a perceived rejection). Bipolar shifts are often biological/cyclical and can happen even when life is going perfectly.
• The Duration: A BPD mood shift lasts minutes to hours. A Bipolar episode (Mania or Depression) must last days to weeks to meet DSM criteria.
• The “High”: Bipolar mania involves euphoric “highs” and a decreased need for sleep. BPD “highs” are usually intense periods of relief or idealization that crash quickly.

The BPD Brain: What DSM-5 Doesn’t Fully Explain

The DSM-5 tells us what BPD looks like, but neurobiology tells us what it is. Research into the BPD brain shows structural differences that explain the “9 symptoms”:

1. The Amygdala (The Alarm): In BPD, the amygdala is hyper-reactive and sometimes smaller in volume. It perceives threats everywhere, especially in social cues.
2. The Prefrontal Cortex (The Brakes): This area, responsible for “thinking before acting,” is often less active during emotional stress in BPD patients. The “brakes” simply don’t work when the “alarm” is screaming.
3. The Hippocampus: Often shows reduced volume, likely due to chronic stress or childhood trauma, affecting how the brain processes and stores emotional memories.

DSM-5 Borderline Personality Disorder Treatment Overview

The apa dsm 5 borderline personality disorder guidelines emphasize that BPD is a treatable condition, though it requires a specialized approach.

1. Psychotherapy (First-Line)

Psychotherapy is the “gold standard.” Unlike depression, where meds might be the primary tool, BPD requires “re-wiring” the brain’s response to emotion.

• Dialectical Behavior Therapy (DBT): The most researched and effective treatment.
• Mentalization-Based Therapy (MBT): Focuses on making sense of one’s own and others’ mental states.
• Schema Therapy: Addresses the “childhood scripts” that drive adult behavior.

2. Medication Limits

There is currently no FDA-approved medication specifically for BPD. Psychiatrists use medications to treat “clusters” of symptoms:

• Mood Stabilizers: To help with irritability and anger.
• Antipsychotics (low dose): To help with paranoia or “racing” distressed thoughts.
• SSRIs: For co-occurring depression or anxiety.

High-Functioning Borderline Personality Disorder

A common misconception in the DSM-5 borderline personality disorder definition is that the disorder always results in a complete inability to function in society. On the contrary, many individuals live with what is colloquially known as high-functioning BPD.

In high functioning bpd, the individual may be a high-achieving professional, a devoted parent, or a pillar of their community. They use a technique called “masking” to hide their internal turmoil from the public eye. However, this comes at a significant cost:

• The Private Collapse: The individual may hold it together all day at work, only to experience an emotional “meltdown” or “splitting” episode the moment they enter the safety of their home.
• Intense Internalization: Instead of acting out, they act in, struggling with severe self-loathing, chronic emptiness, and silent suicidal ideation.
• Delayed Diagnosis: Because they don’t fit the “dramatic” stereotype of Cluster B, these individuals are often misdiagnosed with simple anxiety or depression for years.

Famous People With Borderline Personality Disorder

To reduce the stigma surrounding the 9 traits of BPD, it is helpful to look at public figures who have navigated these symptoms. Note that we only discuss individuals who have publicly self-disclosed their diagnosis or those whose documented life patterns are used in clinical case studies to illustrate the disorder.

• Pete Davidson: The SNL comedian has been incredibly open about his BPD diagnosis and how dbt bpd treatment saved his life and career.
• Marsha Linehan: The creator of DBT herself revealed in 2011 that she struggled with BPD. Her success is the ultimate proof that BPD is treatable.
• Princess Diana: While never officially diagnosed in her lifetime, many biographers and clinicians use her public struggles with self-harm, bulimia, and “frantic efforts to avoid abandonment” as a classic case study for BPD traits in a high-pressure environment.

FAQs About DSM-5 Borderline Personality Disorder

What Is a Jekyll and Hyde Personality Disorder?

“Jekyll and Hyde” is a layperson’s term often used to describe the BPD splitting mechanism. It refers to the rapid switch from a loving, “perfect” persona to a cold, “rageful” persona. In the DSM-5 context, this is the result of affective instability and the inability to integrate positive and negative qualities of a person into a single, cohesive whole.

What are the 3 C’s of borderline personality disorder?

As discussed earlier, they are Crisis, Chaos, and Control. They represent the externalized experience of the internal emotional dysregulation defined in the DSM.

What not to say to someone with borderline personality disorder?

Avoid “invalidating” statements. Saying “you’re overreacting” or “it’s all in your head” triggers the BPD brain’s defense mechanisms. Instead, try: “I can see you’re in a lot of pain right now. How can I support you?”

Does BPD go away with age?

Longitudinal studies show that BPD has a very high “remission” rate. Over 10 years, up to 85% of people diagnosed with BPD no longer meet the DSM criteria. While some emotional sensitivity may remain, the most destructive behaviors (impulsivity, self-harm) often diminish with age and therapy.

Key Takeaways & When to Seek Professional Help

The DSM-5 borderline personality disorder framework is not a label of “brokenness,” but a map for recovery. If you or a loved one recognize at least five of the 9 symptoms of BPD, it is time to seek an evaluation.

When to Seek Immediate Help

If the self-destructive traits of BPD become life-threatening, do not wait for a therapy appointment.

• US/Canada Crisis Line: Call or text 988.
• Crisis Text Line: Text HOME to 741741.

Next Steps: A bpd diagnosis is the beginning of a new chapter, not the end of a story. With the right DSM-5 borderline personality disorder treatment—specifically a structured DBT program—individuals can move from a life of chaos to a “life worth living.”

Authoritative References

1. National Institute of Mental Health (NIMH): Borderline Personality Disorder Overview.
2. McLean Hospital: The Harvard Medical School Affiliate Guide to BPD.
3. National Education Alliance for BPD (NEA-BPD): Resources for Families.
4. Behavioral Tech: The Official Home of DBT Research.