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Borderline Personality Disorder
DSM-IV Diagnostic Criteria
A pervasive pattern of unstable interpersonal relationships, unstable self-image, unstable affects, and poor impulse control beginning by early adulthood and indicated by at least five of the following:
- Frantic efforts to avoid real or imagined abandonment.
- Unstable and intense interpersonal relationships, alternating between extremes of idealization and devaluation.
- Identity disturbance: unstable self-image or sense of
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuity, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures or threats; or
- Affective instability (e.g., sudden intense dysphoria, irritability or anxiety of short duration).
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling
- Transient, stress-related paranoid ideation or severe dissociative symptoms. Borderline Personality Disorder
- Clinical Features of Borderline Personality Disorder
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- Clinical presentation is highly variable.
- Chronic dysphoria is common.
- Desperate dependence on others is caused by inability to tolerate being alone. Borderline Personality Disorder
- Chaotic interpersonal relationships are characteristic.
- Self-destructive or self-mutilatory behavior is common.
- Childhood history of abuse or parental neglect is common.
- Epidemiology of Borderline Personality Disorder
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- The female-male ratio is 2:1.
- Five times more common in first-degree relatives.
- Prevalence is 1-2%, but occurs border line in 30-60% of psychiatric patients.
- Differential Diagnosis
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- Adolescence: Identity disturbance and emotional lability of normal adolescence may have the characteristics of borderline personality disorder; however, a persistent pattern is not present.
- Histrionic Personality Disorder: These patients are also manipulative and attention seeking, but they do not display self-destructiveness and rage. Psychosis and dissociation are not typically seen in Histrionic patients.
- Dependent Personality Disorder: When faced with abandonment, Dependent patients will increase their submissive behavior rather than display rage as