image that is based on being bad or evil, individuals with this disorder may at times have
feelings that they do not exist at all. Such experiences usually occur in situations in which
the individual feels a lack of a meaningful relationship, nurturing, and support. These in-
dividuals may show worse performance in unstructured work or school situations.
Individuals with borderline pe rsonality disorder display impulsivity in at least two areas
that are potentially self-damaging (Criterion  4). They may gamble, spend money irrespon-
sibly, binge eat, abuse substanc es, engage in unsafe sex, or  drive recklessly. Individuals
with this disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilat-
ing behavior (Criterion 5). Completed suicide occurs in 8%–10% of such individuals, and
self-mutilative acts (e.g., cutting or burnin g) and suicide threats and attempts are very
common. Recurrent suicidality is often the reason that these individuals present for help.
These self-destructive acts are usually precipit ated by threats of separation or rejection or
by expectations that the individual assumes increased responsibility. Self-mutilation may
occur during dissociative experiences and often brings relief by reaffirming the ability to
feel or by expiating the individual’s sense of being evil.
Individuals with borderline personality disorder may display affective instability that
is due to a marked reactivity of  mood (e.g., intense episodic dysphoria, irritability, or anx-
iety usually lasting a few hours and only rarely more than a few days) (Criterion 6). The
basic dysphoric mood of those with borderline personality disorder is often disrupted by
periods of anger, panic, or de spair and is rarely relieved by periods of well-being or satis-