- Frantic efforts to avoid real or imagined abandonment, including efforts to avoid being left alone
- A history of intense and unstable personal relationships that are characterized by alternating extremes in how the other person in the relationship is perceived
- Significantly and persistently unstable self-image or sense of self
- Impulsivity in at least two potentially damaging areas (e.g., substance use, spending, sex, reckless driving, binge eating)
- Recurrent self-injury or suicidal behavior, gestures, or threats
- Significantly reactive mood leading to emotional instability (e.g., intense emotions that usually only last a few hours)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid thoughts or dissociation
Symptoms of BPD are often triggered or exacerbated by interpersonal stressors, including perceived rejection, neglect, or abandonment. Recurrent suicidal ideation is the reason that many individuals with BPD present for treatment and risk of completed suicide is elevated in individuals with this disorder. For BPD to be diagnosed, the symptoms must be observable by early adulthood and be present across a variety of contexts. Although the disorder has a relatively chronic course, symptoms tend to improve with age and many individuals with BPD no longer meet full criteria for the disorder by middle adulthood.