Table 6 Borderline pattern qualifier

The Borderline pattern qualifier may be applied to individuals whose pattern of personality disturbance is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by five (or more) of the following:

● Frantic efforts to avoid real or imagined abandonment.

● A pattern of unstable and intense interpersonal relationships, typically characterized by alternating between extremes of idealization and devaluation.

● Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.

● Impulsivity manifested in potentially self-damaging behaviours (e.g., risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating).

● Recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation).

● Emotional instability due to marked reactivity of mood. Fluctuations of mood may be triggered either internally (e.g., by one’s own thoughts) or by external events. As a consequence, the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days.

● Chronic feelings of emptiness.

● Inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights).

● Transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.

Other manifestations of Borderline pattern, not all of which may be present in a given individual at a given time, include the following:

● A view of the self as inadequate, bad, guilty, disgusting, and contemptible.

● An experience of the self as profoundly different and isolated from other people; a painful sense of alienation and pervasive loneliness.

● Proneness to rejection hypersensitivity; problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships; frequent misinterpretation of social signals.