一种人际关系、自我形象和情感不稳定以及显著冲突的普遍心理行为模式:始于成年早期,存在于各种背景下,表现为下列5项(或更多)症状:
自杀或自残行为)。
极力避免真正的或想象出来的被遗弃(注:不包括诊断标准第5项中的一种不稳定的紧张的人际关系模式,以极端理想化和极端贬低之间交替变动为特征。
身份紊乱:显著的持续而不稳定的自我形象或自我感觉。
至少在2个方面有潜在的自我损伤的冲动性(例如,消费、性行为、物质滥用、鲁莽驾驶、暴食)(注:不包括诊断标准第5项中的自杀或自残行为)。
反复发生自杀行为、自杀姿态或威胁或自残行为。
焦虑,通常持续几个小时,很少超过几天)。
由于显著的心境反应所致的情感不稳定(例如,强烈的发作性的烦躁,易激惹或是慢性的空虚感。
不恰当的强烈愤怒或难以控制发怒(例如,经常发脾气,持续发怒,重复性斗殴)。
短暂的与应激有关的偏执观念或严重的分离症状。
Borderline Personality Disorder
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Diagnostic Criteria 301.83 (F60.3)
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A pervasive pattern of instability of interpersonal relationships, self-image, and affects,and marked impulsivity, beginning by early adulthood and present in a variety of contexts,as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, 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诊断特征
The essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.
Individuals with borderline personality disorder make frantic 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 self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic 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 someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.
Individuals with borderline personality disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, or is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternatively be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.