Individuals with this disorder frequently expr ess inappropriate, intense anger or have dif-
ficulty controlling their anger (Criterion 8) . They may display extreme sarcasm, enduring
bitterness, or verbal outbursts. The anger is often elicited when  a caregiver or lover is seen
as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often
followed by shame and guilt and contribute to the feeling they have of being evil. During
periods of extreme stress , transient paranoid ideation or dissociative symptoms (e.g., de-
personalization) may occur (Criterion 9), but th ese are generally of insufficient severity or
duration to warrant an addition al diagnosis. These episodes occur most frequently in re-
sponse to a real or imagined abandonment. Symptoms tend to be transient, lasting min-
utes or hours. The real or perceived return of the caregiver’s nurturance may result in a
remission of symptoms.