Borderline personality disorder (BPD) may not be immediately apparent to patients that have the disorder or to their physicians. Instead, patients may seek help because they are troubled by a pattern of unstable relationships or feeling of anger or emptiness. It is even more likely that someone close to the patient – such as a family member or friend – will recommend that the patient seek help for behaviors related to these feelings.

Before diagnosing BPD, a physician will first compile a thorough medical history. A physical examination will be performed to make sure there is no other potential cause for a patient’s symptoms (although this is rare). In addition, the physician may ask the patient several questions, including:

• Do they feel intense fear of abandonment?
• Do they have a pattern of unstable relationships?
• Does their self-image regularly shift?
• Do they engage in impulsive, destructive behaviors?
• Do they have a tendency toward self-mutilation or suicide?
• Do they experience wide mood swings?

BPD may be diagnosed when an individual has a lengthy pattern of instability in interpersonal relationships, self-image and feelings or emotions. These patterns are accompanied by distinctly impulsive behavior beginning in early adulthood.

In addition, five or more of the following characteristics should be present in a patient diagnosed with BPD:

• Frantic attempts to avoid real or imagined abandonment.
  
  
• Pattern of unstable, intense relationships in which the patient alternates between idealizing and devaluing the other person.
  
  
• Markedly and persistently unstable self-image.
  
  
• Impulsiveness in at least two areas of life that may be potentially self-damaging. Examples include spending, sex, substance abuse, reckless driving and binge eating.
  
  
• Recurrent suicidal behavior, gestures, threats or self-mutilating behaviors (e.g., cutting, burning).
  
  
• Unstable feelings and emotions that are characterized by mood swings.
  
  
• Chronic feelings of emptiness.
  
  
• Inappropriate, intense anger or difficulty controlling anger.
  
  
• Stress-related episodes of paranoia or symptoms of extreme dissociation.