Borderline Personality Disorder Test

There is no definitive test to diagnose borderline personality disorder (BPD). It is diagnosed through a clinical interview with a licensed mental health professional, explains Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.

The mental health professional may ask the person to complete some assessment measures to aid in the diagnosis. They may also talk with the person’s previous health care providers, look at earlier medical evaluations, and conduct interviews with friends and family.¹

BPD is most often diagnosed by a mental health professional, such as a psychologist, psychiatrist, or social worker, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.

About 1.4% of adults in the U.S. have BPD¹, and it is estimated that around 75% of those diagnosed with borderline personality disorder are women.² However, more recent research suggests that BPD may be equally as common in men, but is often misdiagnosed as another disorder, such as post-traumatic stress disorder or depression, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.

Diagnosing BPD typically takes one or two sessions, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City. “However, because borderline personality disorder can be confused with other disorders, such as bipolar disorder, unfortunately, getting the correct diagnosis can take some time,” he explains.

For example, a 2009 study found that 74% of the patients who met the criteria for the condition had never been diagnosed with BPD in the past, despite an average of more than 10 years since their first “psychiatric encounter.”³

Some researchers think that there may be biological, psychological, and social/environmental factors that predispose women to BPD, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City. However, he explains, evidence also suggests that the difference may be accounted for by a “diagnostic gender bias.”

A diagnostic gender bias means that if the person is a woman, she is much more likely to receive the diagnosis of BPD than if she were a man reporting the same symptoms, Rego says.

The most common diagnoses that borderline personality disorder is mistaken for are bipolar disorder, depression, anxiety disorders, and eating disorders, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for a diagnosis. BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affect (the outward display of a person's emotional state, including their speech, body language, and gestures) and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following nine criteria:

1. Frantic efforts to avoid real or imagined abandonment; this does 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. 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). This does 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
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

BPD is characterized by intense emotional highs and lows, and can make someone feel very anxious, depressed, and unstable, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.

A person with BPD can have mood swings and unstable relationships. They tend to view things in extremes, as in all good or all bad. Their opinions of other people can change quickly. For instance, they may see a person as a friend one day and an enemy the next.¹

While BPD has historically been seen as a lifelong, very disabling mental health condition, recent research is challenging this assumption. Now it appears that there may be a positive trajectory over time, with many of the most troubling symptoms remitting during the first few years. Unfortunately, other symptoms may remain for longer periods.

Even though many psychotherapies have been developed to help people with BPD, long-term recovery in social functioning is still difficult for them, says Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, both in New York City.