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 despair and is rarely relieved by periods of well-being or satis- faction. These episodes may reflect the individual’s extreme reactivity to interpersonal stresses. Individuals with borderline personality disorder may be troubled by chronic feel- ings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do.
Individuals with this disorder frequently express 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 these are generally of insufficient severity or duration to warrant an additional 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.
Individuals with borderline personality disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; de- stroying a good relationship just when it is clear that the relationship could last). Some in- dividuals develop psychotic—like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, hypnagogic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individu- als with this disorder, especially in those with co-occurring depressive disorders or sub- stance use disorders. Physical handicaps may result from self—inﬂicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and separation or di- vorce are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss are more common in the childhood histories of those with borderline personality dis- order. Common co-occurring disorders include depressive and bipolar disorders, sub- stance use disorders, eating disorders (notably bulimia nervosa), posttraumatic stress disorder, and attention—deficit/hyperactivity disorder. Borderline personality disorder also frequently co-occurs with the other personality disorders.
The median population prevalence of borderline personality disorder is estimated to be 1.6% but may be as high as 5.9%. The prevalence of borderline personality disorder is about 6% in primary care settings, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients. The prevalence of borderline personality disorder may decrease in older age groups.