Borderline Personality Disorder: DSM-5 Criteria, Symptoms, and Treatment

This document discusses Borderline Personality Disorder (BPD) DSM-5 criteria, symptoms, and treatment. It analyzes the case of Liz and how her symptoms impair her functionality and relationships. It also provides a treatment plan for BPD, including immediate, short-term, and long-term goals. Finally, it reviews Chapter 12 for information on personality disorders and discusses the reactions to the information.

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Name of the Student
Name of the University
Author note

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1. Below you will find the DSM-5 criteria for Borderline Personality Disorder. From the
video of Liz, which criteria apply to her (or do not apply to her)? Provide specific
examples to back up your categorization of her symptoms.
a. Frantic efforts to avoid real or imagined abandonment (do NOT include suicidal or self-
injurious behaviors here—that fits with item e, below)
This criterion applies to her, as she herself has mentioned multiple times during the
interview that she feels abandoned by those near and dear to her, even though there might
not be any real issue.
b. A pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation
This applies to her as well, given she has mentioned that she feels extreme
emotions on both ends of the spectrum, where she might either be very nice and sensitive
or extremely rude and angry.
c. Identity disturbance: markedly and persistently unstable self-image or sense of self
Liz finds herself alone, without any purpose on occasions where her abandonment
feelings come up. That shows that she does not identify herself as an independent person
capable of managing her own life.
d. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating…again, suicidal or self-injurious behaviors
are NOT included here)
Liz has confessed that she is an impulsive shopper
Liz attempted suicide twice.
e. Recurrent suicidal behavior, gestures, or threats, or self-injurious behavior
Liz shows this symptom, where she has tried to commit suicide multiple times,
once through overdosing on prescription medication.

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f. 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)
Liz shows these symptoms as well, especially during her mother’s intervention in
her work or fights with her fiancé.
g. Chronic feelings of emptiness
Liz explains that she has recurring feelings of abandonment and admits that it also
happens when she is actually not alone.
h. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights)
Liz gives an instance that when she is driving, her feelings of loneliness and
abandonment start appearing and often it is accompanied by so much anger and rage that
she wants to engage in a road rage. Moreover, her attempt to overdose herself also stems
from her anger and frustration at the thought of the email which subsequently led to the
feeling that she was going to be alone.
i. Transient, stress-related paranoid ideation or severe dissociative symptoms
Liz explains that her transition from seeing the email to deciding to end her life was
like a snowball effect where all she did was see an email and her instant decision was that
she was going to be alone.
2. In what ways do Liz’s symptoms of borderline personality disorder seem to impair her
ability to function in the world (e.g., work, academics, relationships, meeting obligations,
managing day-to-day affairs, etc.)?
Liz has exemplified multiple instances where her behaviour were damaging to her
functionality. The instance where she confronted her boyfriend based on an assumption
regarding an email and attempted to commit suicide has negative impacts on her behavior.

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Managing day-to-day affairs have been tough because of her recurring impulsive behavior.
At the same time her relationship with her parents also changed because of her
impulsiveness.
3. What do you think it would be like to have a relationship with Liz (or anyone experiencing
borderline personality disorder)? Think of a range of relationships in which you may
interact with her in different ways (e.g., acquaintances, co-workers, close friend,
significant other, parent, and therapist).
The first think I would like to explain is that my perception of that individual will
be biased by my priming of the situation. My knowledge of said individual suffering from
borderline personality disorder would render my cognition of her as more of a patient than
a human with certain different characteristics and behavioral traits. That being said, I think
my relationship with that person would be influenced by my judgement and behavior
during the relationship. I would have to be ready to face extremities of all possible
behavioral traits. However, if instead of keeping a cool head, I retort back with aggression,
I would be making her as well as my own situation, worse. However if I am able to hold
my patience and engage with that person without triggering them, I believe it might
stabilize the relation and provide reassurance to my partner as well.
Possible relationships:
Acquaintance: Friendly and helpful.
Co-workers: Friendly and helpful, responsive to conversations and queries.
Close friend: Open, caring, there needs to be efficient conversation and empathy towards
issues and feelings.

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Significant other: Open, Caring, Patient with their actions, soft spoken, understand the
trigger topics and streamline approach and conversation accordingly, stay nonviolent on
my part but be prepared for instances of violence or abuse at any moment.
Parent: Be sensitive to what they are feeling, provide constant reassurance so that they can
understand that whatever they are feeling is not an actual truth. Avoiding explaining that
they have a certain ‘psychological disorder’ might be a good approach but that would
depend on factors like parent’s knowledge and awareness, intensity of the disorder and
sensitivity of their feelings.
Therapist: Complete honesty, openness and full disclosure of all facts and figures.
4. Develop a treatment plan for Liz. What immediate needs/treatment goals would you
recommend for her (immediate goals are those that directly address immediate safety and
security issues)? What short-term treatment goals would you recommend for her (short-
term goals tend to address symptom reduction, improved coping, and enhanced
functioning)? What long-term treatment goals would you recommend for her (long-term
goals tend to focus more on improving the overall quality of life)?
Borderline personality disorder can be treated mainly by psychotherapy but
medication can be implemented for added influence. Treatment can help one cope with the
issues that accompany borderline personality disorder, but t is also advised to get checked for
other mental health issues like anxiety and depression.
Psychotherapy (or talk therapy) is a fundamental treatment for borderline personality
disorder (Bateman & Krawitz, 2013). In order to meet the patient’s needs, the approach can
be modified by the therapist but the practice is mostly targeted towards:
 Focus on current ability to function
 Learn to manage emotions that feel uncomfortable

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 Observe feelings rather than acting on them in order to reduce impulsiveness.
 Work on improving relationships by being aware of feelings and those of others
 Learn about the disorder
Types of psychotherapy that have been found to be effective include:
 Dialectical behaviour therapy (DBT). DBT includes group and individual therapy
designed specifically to treat borderline personality disorder. DBT uses a skills-based
approach to teach you how to manage your emotions, tolerate distress and improve
relationships (Bateman & Krawitz, 2013).
 Schema-focused therapy. Schema-focused therapy can be done individually or in a
group. It can help you identify unmet needs that have led to negative life patterns,
which at some time may have been helpful for survival, but as an adult are hurtful in
many areas of your life (Bateman & Krawitz, 2013). Therapy focuses on helping you
get your needs met in a healthy manner to promote positive life patterns.
 Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you
identify your own thoughts and feelings at any given moment and create an alternate
perspective on the situation. MBT emphasizes thinking before reacting (Bateman &
Krawitz, 2013).
 Systems training for emotional predictability and problem-solving (STEPPS).
STEPPS is a 20-week treatment that involves working in groups that incorporate your
family members, caregivers, friends or significant others into treatment (Channen &
McKutcheon, 2013). STEPPS is used in addition to other types of psychotherapy
(Bateman & Krawitz, 2013).
 Transference-focused psychotherapy (TFP). Also called psychodynamic
psychotherapy, TFP aims to help you understand your emotions and interpersonal

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difficulties through the developing relationship between you and your therapist. You
then apply these insights to ongoing situations.
 Good psychiatric management. This treatment approach relies on case management,
anchoring treatment in an expectation of work or school participation. It focuses on
making sense of emotionally difficult moments by considering the interpersonal
context for feelings. It may integrate medications, groups, family education and
individual therapy.
Symptoms associated with borderline personality disorder can be stressful and
challenging for her and those around her (Linehan, 2018). She may be aware that her
emotions, thoughts and behaviours are self-destructive or damaging, yet she feels unable to
manage them.
In addition to getting professional treatment, she can help manage and cope with her
condition if she does the following:
 Learn about the disorder so that you understand its causes and treatments
 Learn to recognize what may trigger angry outbursts or impulsive behaviour
 Seek professional help and stick to your treatment plan — attend all therapy sessions
and take medications as directed
 Work with your mental health provider to develop a plan for what to do the next time
a crisis occurs
 Get treatment for related problems, such as substance misuse
 Consider involving people close to you in your treatment to help them understand and
support you
 Manage intense emotions by practicing coping skills, such as the use of breathing
techniques and mindfulness meditation

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 Set limits and boundaries for yourself and others by learning how to appropriately
express emotions in a manner that doesn't push others away or trigger abandonment or
instability
 Don't make assumptions about what people are feeling or thinking about you (Miano
et al., 2013)
 Reach out to others with the disorder to share insights and experiences
 Build a support system of people who can understand and respect you
 Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and
engaging in social activities
 Don't blame yourself for the disorder, but recognize your responsibility to get it
treated
5. Review the rest of Chapter 12 for information on the personality disorders. Discuss your
reactions to the information from this chapter (either related to personality disorders in
general, other aspects of borderline personality disorder, or what you learned about the
other personality disorders).

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References
Bateman, A. W., & Krawitz, R. (2013). Borderline personality disorder: an evidence-
based guide for generalist mental health professionals. Oxford University Press.
Chanen, A. M., & McCutcheon, L. (2013). Prevention and early intervention for borderline
personality disorder: current status and recent evidence. The British Journal of
Psychiatry, 202(s54), s24-s29.
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder.
Guilford Publications.
Miano, A., Fertuck, E. A., Arntz, A., & Stanley, B. (2013). Rejection sensitivity is a
mediator between borderline personality disorder features and facial trust
appraisal. Journal of personality disorders, 27(4), 442-456.