symptoms are more transient, in terpersonally reactive, and responsive to external structur-
ing in borderline personality disorder. Althou gh paranoid personalit y disorder and narcis-
sistic personality disorder may also be charac terized by an angry reaction to minor stimuli,
the relative stability of self-ima ge, as well as the relative lack  of self-destructiveness, impul-
sivity, and abandonment concerns, distinguishe s these disorders from borderline person-
ality disorder. Although antisocial personality disorder and borderline personality disorder
are both characterized by mani pulative behavior, in dividuals with antisocial personality
disorder are manipulative to gain profit, po wer, or some other material gratification,
whereas the goal in borderline personality disorder is directed  more toward gaining the con-
cern of caretakers. Both depe ndent personality disorder and borderline personality disorder
are characterized by fear of abandonment; however, the individual with borderline person-
ality disorder reacts to abandonment with f eelings of emotional emptiness, rage, and de-
mands, whereas the individual with dependent personality disorder re acts with increasing
appeasement and submissiveness and urgently seeks a replacement relationship to provide
caregiving and support. Borderline personality disorder can further be distinguished from
dependent personality disorder by the typical pattern of unstable and intense relationships.
Personality change due to another medical condition. Borderline personality disor-
der must be distinguished from personality change due to another medical condition, in
which the traits that emerge ar e attributable to the effects of another medical condition on
the central nervous system.
Substance use disorders. Borderline personality disorder must also be distinguished
from symptoms that may develop in a ssociation with persistent substance use.
Identity problems. Borderline personality disorder sh ould be distinguished from an