As mentioned, psychotherapy is a useful way to help patients with BPD. Gunderson is a psychoanalyst who gives a criteria of diagnosis for BPD:

(In order of importance)
– Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
– Repetitive self-destructive behavior, often designed to prompt rescue.
–  Chronic fear of abandonment and panic when forced to be alone.
– Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
– Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman’s statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).
– Impulsive behaviors that often embarrass the borderline later.
– Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

The Diagnostic Interview for Borderlines, Revised
Diagnosis used in clinical interviews (Revised in 1989)

Affect chronic/major depression
helplessness
hopelessness
worthlessness
guilt
anger (including frequent expressions of anger)
anxiety
loneliness
boredom
emptiness

Cognition odd thinking
unusual perceptions
nondelusional paranoia
quasipsychosis

Impulse action patterns substance abuse/dependence
sexual deviance
manipulative suicide gestures
other impulsive behaviors

Interpersonal relationships intolerance of aloneness
abandonment, engulfment, annihilation fears
counterdependency
stormy relationships
manipulativeness
dependency
devaluation
masochism/sadism
demandingness
entitlement

The DIB-R is the most influential and best-known “test” for diagnosing BPD. Use of it has led researchers to identify four behavior patterns they consider peculiar to BPD: abandonment, engulfment, annihilation fears; demandingness and entitlement; treatment regressions; and ability to arouse inappropriately close or hostile treatment relationships.

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