Diagnosis of BPD Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) For a diagnosis of borderline personality disorder, patients must have A persistent pattern of unstable relationships, self-image, and emotions (ie, emotional dysregulation) and pronounced impulsivity This persistent pattern is shown by ≥ 5 of the following: Desperate efforts to avoid abandonment (actual or imagined) Unstable, intense relationships that alternate between idealizing and devaluing the other person An unstable self-image or sense of self Impulsivity in ≥ 2 areas that could harm themselves (eg, unsafe sex, binge eating, reckless driving) Repeated suicidal behavior and / or gestures or threats or self-mutilation Rapid changes in mood, lasting usually only a few hours and rarely more than a few days Persistent feelings of emptiness Inappropriately intense anger or problems controlling anger Temporary paranoid thoughts or severe dissociative symptoms triggered by stress Also, symptoms must have begun by early adulthood but can occur during adolescence.