BPD Diagnosis: DSM-V & ICD10

Borderline Personality Disorder is classified in Australia using the criteria in both the American Psychiatric Association’s DSM-V (301.83) and the World Health Organization’s ICD-10 (F60.3). The courts and private practitioners usually refer to the DSM-V whilst the government funding is based on ICD-10. The majority of international research is based on the DSM-V classification of BPD. The Australian DBT Institute uses the structured clinical interview format referred in DSM when establishing a diagnosis of Borderline Personality Disorder.

During the initial assessment it is recommended that the client completes the McLean Screening Instrument for BPD (MSI-BPD) 

Diagnosis of BPD using DSM-V

In July 2013 the American Psychiatric Association (APA) released an updated version of the DSM (Diagnostic and statistical manual of mental disorders). With slight variations in the wording, the new version is nearly identical to listed in the previous edition (APA 2000).

The changes in DSM-V for Borderline Personality Disorder include:

• Criterion 5: replacement of self-injuring behaviour with  self-mutilating behaviour;
• Criterion 4: removal of promiscuous sex, excessive spending and eating disorders from examples;
• Criterion 8: addition of intense anger
• Criterion 9: delusions were removed.

Read more about changes to Borderline Personality Disorder and other disorders in the DSM-V here.

To meet a diagnosis of Borderline Personality Disorder (301.83) under the in DSM-5 (APA 2013), an individual must show:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in 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-injuring 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., substance abuse, binge eating, and reckless driving). (Note: Do not include suicidal or self-injuring 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

Diagnosis of BPD using ICD10-AM

The World Health Organization’s ICD-10 defines a conceptually similar disorder to borderline personality disorder, called (F60.3) Emotionally unstable personality disorder. Its two subtypes are described below.

F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious (impulsive, whimsical) mood.

F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

1. disturbances in and uncertainty about self-image, aims, and internal preferences;
2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
3. excessive efforts to avoid abandonment;
4. recurrent threats or acts of self-harm;
5. chronic feelings of emptiness.
6. demonstrates impulsive behavior, e.g., speeding, substance abuse

The Australian DBT Institute provides leadership to the mental health sector in the application of DBT and modified DBT programs for specific populations that include youth, Indigenous Australians, correctional settings and psychiatric emergency settings. The Australian DBT Institute gives consumers & carers the confidence that accredited DBT programs apply treatment in an evidence-based manner that emphasises clinical outcomes and results.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Emotionally unstable personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) – World Health Organization

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The Australian DBT Institute, established in 2004, provides a range of professional development opportunities for Mental Health Professionals seeking to become proficient in dialectical behaviour therapy-informed approaches. Our team is led by experienced DBT clinicians who have received training, mentoring, and development from Marsha Linehan’s team at Behavioral Tech LLC (2004-8). The Australian DBT Institute has led high-fidelity DBT programs since 2004 through the Essentia Health Clinics in Melbourne, Sydney and Online. Our clinical programs have included comprehensive DBT and modified DBT programs for specific populations including youth, carers, Indigenous Australians, correctional settings and psychiatric emergency settings.