Diagnosing Borderline Personality Disorder

Borderline personality disorder (BPD) can be a lonely life. Friends and family may dismiss the relationship, rather than trying to understand the symptoms and behaviors. Even if a strong support system is in place, dealing with social stigma may increase the challenges of a debilitating mental disorder. One challenge in diagnosis is that the symptoms may be misunderstood as a manifestation of post-traumatic stress disorder or another mental disorder like dissociative identity disorder.

While BPD often appears in combination with dissociative identity disorder, the criteria for the two disorders are different.

Symptoms of Borderline Personality Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the criteria for borderline personality disorder include symptoms that demonstrate the following: unstable interpersonal relationships, unstable self-image and impulsivity. These characteristics are exemplified in at least five criteria.

Criteria for BPD diagnosis:

  • A focus on fear of abandonment
  • Unstable interpersonal relationships marked by extremes of idealization and devaluation
  • Unstable self-image
  • Impulsivity in areas such as spending or sex
  • Suicidal ideation or self-mutilating behaviors
  • Intense irritability or anxiety
  • Persistent feelings of emptiness
  • Inappropriate levels of anger or recurrent fights
  • Paranoid ideation.

BPD is similar to dissociative identity disorder in that both include instances of self-harm and multiple suicide attempts. Self-mutilating behaviors can include cases mentioning self-injury, self-harm and non-suicidal self-injury. One major difference between the two disorders includes the presence of amnesia in those with dissociative identity disorder. Amnesia can be a significant event, with “time loss” that can erase a memory of a close family member or an important event like one’s own wedding.

While dissociative identity disorder can look similar to BPD it is important to receive an accurate diagnosis, and part of that is the use of the Dissociative Experiences Scale, on which individuals with dissociative identity disorder will score at least a 40. Between BPD and dissociative identity disorder there is an increased occurrence of physical symptoms and other health issues among those with dissociative identity disorder, including autoimmune disorders, chronic fatigue syndrome, irritable bowel syndrome, morbid obesity, joint pain, headaches, chronic pelvic pain and other conditions, including insensitivity to pain, motor inhibitions and insensitivity to touch.

The Influence of Childhood Issues

Patients diagnosed with BPD often have a history of attachment disorder or severe traumatization in early childhood. Those with dissociative identity disorder tend to report a more serious history of trauma during childhood.

The two disorders can occur simultaneously in one person. Both disorders may require the patient to be enrolled in a trauma program and a screening for other mental health symptoms.

As researchers gather more information about the diagnosis of the two disorders, it may become more apparent as to how to identify where the overlap lies and the risk factors that contribute to each disorder. Both can cause severe quality of life challenge for the patient and their loved ones, and treating them is critical for the improvement of quality of life.