substance abuse, reckless driving, binge eating). ( Note:  Do not include suicidal or self-
mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. 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).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Diagnostic Features
The essential feature of  borderline personality disorder is  a pervasive pattern of instability
of interpersonal relationships, self-image, an d affects, and marked impulsivity that begins
by early adulthood and is present in a variety of contexts.
Individuals with borderline pe rsonality disorder make fran tic efforts to avoid real or
imagined abandonment (Criterion 1). The perception of impending separation or rejection,
or the loss of external structure, can lead to profound changes in sel f-image, affect, cognition,
and behavior. These individuals are very sensitive to environmental circumstances. They ex-
perience intense abandonment fears and inappropriate anger even when  faced with a real-
istic time-limited separation or when there are unavoidable changes in plans (e.g., sudden
despair in reaction to a clinician’s announcing the end of the hour; panic or fury when some-
one important to them is just a few minutes la te or must cancel an appointment). They may
believe that this “abandonment” implies they  are “bad.” These abandonment fears are re-
lated to an intolerance of being alone and a need  to have other people with them. Their frantic