abandonment.<unk>  is characterized by nine signs and symptoms. To be diagnosed, a person must meet at least five of the following: * Frantic efforts to avoid real or imagined abandonment * Unstable and chaotic interpersonal relationships, often characterized by alternating between extremes of idealization and devaluation, also known as "splitting" * Markedly disturbed sense of identity and distorted self-image * Impulsive or reckless behaviors (e.g., impulsive or uncontrollable spending, unsafe sex, substance use disorders, reckless driving, binge eating) * Recurrent suicidal gestures or self harm * Intense or uncontrollable emotional reactions and rapidly shifting between different emotional states * Chronic feelings of emptiness * Inappropriate, intense anger or difficulty controlling anger * Transient, stress-related paranoid ideation or severe dissociative symptoms Overall, the most distinguishing symptoms of<unk>  are pervasive patterns of instability in interpersonal relationships and self-image, alternating between extremes of idealization and devaluation of others, along with varying moods and difficulty regulating strong emotional reactions. Dangerous or impulsive behavior is also correlated with the disorder. Other symptoms may include feeling unsure of one's identity, morals, and values; having paranoid thoughts when feeling stressed; depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes. Individuals with<unk>  often have comorbid conditions, such as depressive and bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder. Emotions People with<unk>  may feel emotions with greater ease and depth and for a longer time than others do. A core characteristic of<unk>  is affective instability, which generally manifests as unusually intense emotional responses to environmental triggers, with a slower return to a baseline emotional state. According to Marsha Linehan, the sensitivity, intensity, and duration with which people with<unk>  feel emotions have both positive and negative effects. People with<unk>  are often exceptionally enthusiastic, idealistic, joyful, and loving, but may feel overwhelmed by negative emotions (anxiety, depression, guilt/shame, worry, anger, etc.), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness. Studies have shown that<unk>  patients experience chronic and significant emotional suffering and mental agony. People with<unk>  are also especially sensitive to feelings of rejection, criticism, isolation, and perceived failure. Before learning other coping mechanisms, their efforts to manage or escape from their very negative emotions may lead to emotional isolation, self-injury or suicidal behavior. They are often aware of the intensity of their negative emotional reactions and, since they cannot regulate them, shut them down entirely since awareness would only cause further distress. This can be harmful since negative emotions alert people to the presence of a problematic situation and move them to address it. While people with<unk>  feel euphoria (ephemeral or occasional intense joy), they are especially prone to dysphoria (a profound state of unease or dissatisfaction), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognized four categories of dysphoria typical of this condition: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity, and feelings of victimization. Within these categories, a<unk>  diagnosis is strongly associated with a combination of three specific states: feeling betrayed, feeling out of control, and "feeling like hurting myself". Since there is great variety in the types of dysphoria people with<unk>  experience, the amplitude of the distress is a helpful indicator. In addition to intense emotions, people with<unk>  experience emotional "lability" (changeability, or fluctuation). Although that term suggests rapid changes between depression and elation, mood swings in people with<unk>  more frequently involve anxiety, with fluctuations between anger and anxiety and between depression and anxiety. Interpersonal relationships People with<unk>  can be very sensitive to the way others treat them, by feeling intense joy and gratitude at perceived expressions of kindness, and intense sadness or anger at perceived criticism or hurtfulness. People with<unk>  often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them. Their feelings about others often shift from admiration or love to anger or dislike after a disappointment, a threat of losing someone, or a perceived loss of esteem in the eyes of someone they value. This phenomenon is sometimes called splitting. Combined with mood disturbances, idealization and devaluation can undermine relationships with family, friends, and co-workers. While strongly desiring intimacy, people with<unk>  tend toward insecure, avoidant or ambivalent, or fearfully preoccupied attachment patterns in relationships, and often view the world as dangerous and malevolent. Like other personality disorders,<unk>  is linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse, and unwanted pregnancy. Behavior Impulsive behavior is common, including substance use disorders (e.g., alcohol use disorder), eating in excess, unprotected sex or indiscriminate sex with multiple partners, reckless spending, and reckless driving. Impulsive behavior may also include leaving jobs or relationships, running away, and self-injury. People with<unk>  might do this because it gives them the feeling of immediate relief from their emotional pain, but in the long term may feel shame and guilt over consequences of this behavior. A cycle often begins in which people with<unk>  feel emotional pain, engage in impulsive behavior to relieve that pain, feel shame and guilt over their actions, feel emotional pain from the shame and guilt, and then experience stronger urges to engage in impulsive behavior to relieve the new pain. As time goes on, impulsive behavior may become an automatic response to emotional pain. Self-harm and suicide Scarring as a result of self-harm, which is a common sign in<unk> . Self-harming or suicidal behavior is one of the core diagnostic criteria in the DSM-5. Self-harm occurs in 50 to 80% of people with<unk> . The most frequent method of self-harm is cutting. Bruising, burning, head banging or biting are also common with<unk> . People with<unk>  may feel emotional relief after engaging in self-harm. The estimation of lifetime risk of suicide among people with<unk>  varied – depending on method of investigation – between 3% and 10%. There is evidence that men diagnosed with<unk>  are approximately twice as likely to die by suicide as women diagnosed with<unk> . There is also evidence that a considerable percentage of men who die by suicide may have undiagnosed<unk> . The reported reasons for self-harm differ from the reasons for suicide attempts. Nearly 70% of people with<unk>  self-harm without trying to end their lives. Reasons for self-harm include expressing anger, self-punishment, generating normal feelings (often in response to dissociation), and distracting oneself from emotional pain or difficult circumstances. In contrast, suicide attempts typically reflect a belief that others will be better off following the suicide. Suicide and self-harm are responses to feeling negative emotions. Sexual abuse can be a particular trigger for suicidal behavior in adolescents with<unk>  tendencies. Sense of self People with<unk>  tend to have trouble seeing their identity clearly. In particular, they tend to have difficulty knowing what they value, believe, prefer, and enjoy. They are often unsure about their long-term goals for relationships and jobs. This can cause people with<unk>  to feel "empty" and "lost". Self-image can also change rapidly from healthy to unhealthy. People with<unk>  may base their identity on others, leading to chameleon-like changes in identity. Cognitions The often intense emotions people with<unk>  experience may make it difficult for them to concentrate. They may also tend to dissociate, which can be thought of as an intense form of "zoning out". Others can sometimes tell when someone with<unk>  is dissociating because their facial or vocal expressions may become flat or expressionless, or they may appear distracted. Dissociation often occurs in response to a painful event (or something that triggers the memory of a painful event). It involves the mind automatically redirecting attention away from that event—presumably to protect against intense emotion and unwanted behavioral impulses that such emotion might trigger. The mind's habit of blocking out intense painful emotions may provide temporary relief, but it can also have the side effect of blocking or blunting ordinary emotions, reducing the access of people with<unk>  to the information those emotions provide, information that helps guide effective decision-making in daily life. Psychotic symptoms Though<unk>  is primarily seen as a disorder of emotional regulation, psychotic symptoms are fairly common, with an estimated 21–54% prevalence in clinical<unk>  populations. These symptoms are sometimes referred to as "pseudo-psychotic" or "psychotic-like," terms that suggest a distinction from those seen in primary psychotic disorders. Recent research, however, has indicated that there is more similarity between pseudo-psychotic symptoms in<unk>  and "true" psychosis than originally thought. Some researchers critique the concept of pseudo-psychosis for, on top of weak construct validity, the implication that it is "not true" or "less severe," which could trivialize distress and serve as a barrier to diagnosis and treatment. Some researchers have suggested classifying these<unk>  symptoms as "true" psychosis, or even eliminating the distinction between pseudo-psychosis and true psychosis altogether. The DSM-5 recognizes transient paranoia that
Borderline personality disorder
Substance use disorder
Depressive personality disorder
Cluster B personality disorders
Organic personality disorder
Identity disorder
Dependent personality disorder
Post-traumatic stress disorder