Borderline personality disorder
- A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
- Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
- Completed suicide rates 8-10%, 50 times higher than general population
- Depressive and bipolar disorders
- Other personality disorders
- Personality dysfunction due to another medical condition
- Substance use disorders
- Identity problems
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
- Point-of-care glucose
- Chem 7
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Treat medical complications of self-harm behavior
- Consider psychiatry consult or admission if acutely suicidal
- Set boundaries
- Tolerate emotions but not outbursts
- Be empathetic yet direct and fact-based, avoid emotionality
- Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as anger and affective instability.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158(suppl 10):1-52.