Dr. Vaibhav Dubey
MBBS, MD (Psychiatry)
Dr Vaibhav Dubey is a well known young psychiatrist in the city of lakes, Bhopal, India.
Borderline Personality Disorder: new insightPosted by : Dr. Vaibhav Dubey
Typical features of borderline personality disorder are instability of self-image, personal
goals, interpersonal relationships, and affects, accompanied by impulsivity, risk taking,
and/or hostility. Characteristic difficulties are apparent in identity, self-direction, empathy,
and/or intimacy, as described below, along with specific maladaptive traits in the domain
of Negative Affectivity, and also Antagonism and/or Disinhibition.
Proposed Diagnostic Criteria
A. Moderate or greater impairment in personality functioning, manifested by characteristic
difficulties in two or more of the following four areas:
1. Identity: Markedly impoverished, poorly developed, or unstable self-image, often
associated with excessive self-criticism; chronic feelings of emptiness; dissociative
states under stress.
2. Self-direction: Instability in goals, aspirations, values, or career plans.
3. 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.
4. 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 overinvolvement and withdrawal.
B. Four or more of the following seven pathological personality traits, at least one of which
must be (5) Impulsivity, (6) Risk taking, or (7) Hostility:
1. Emotional lability (an aspect of Negative Affectivity): Unstable emotional experiences
and frequent mood changes; emotions that are easily aroused, intense,
and/or out of proportion to events and circumstances.
2. Anxiousness (an aspect of Negative Affectivity): 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.
3. Separation insecurity (an aspect of Negative Affectivity): Fears of rejection by—
and/or separation from—significant others, associated with fears of excessive dependency
and complete loss of autonomy.
4. Depressivity (an aspect of Negative Affectivity): Frequent feelings of being down,
miserable, and/or hopeless; difficulty recovering from such moods; pessimism
about the future; pervasive shame; feelings of inferior self-worth; thoughts of suicide
and suicidal behavior.
5. Impulsivity (an aspect of Disinhibition): 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 behavior under emotional distress.
6. Risk taking (an aspect of Disinhibition): 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
7. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger
or irritability in response to minor slights and insults.
Specifiers. Trait and level of personality functioning specifiers may be used to record additional
personality features that may be present in borderline personality disorder but are
not required for the diagnosis. For example, traits of Psychoticism (e.g., cognitive and perceptual
dysregulation) are not diagnostic criteria for borderline personality disorder (see
Criterion B) but can be specified when appropriate. Furthermore, although moderate or
greater impairment in personality functioning is required for the diagnosis of borderline
personality disorder (Criterion A), the level of personality functioning can also be specified.