Diagnosis of<unk>  is based on a clinical assessment by a mental health professional. The best method is to present the criteria of the disorder to a person and to ask them if they feel that these characteristics accurately describe them. Actively involving people with<unk>  in determining their diagnosis can help them become more willing to accept it. Some clinicians prefer not to tell people with<unk>  what their diagnosis is, either from concern about the stigma attached to this condition or because<unk>  used to be considered untreatable; it is usually helpful for the person with<unk>  to know their diagnosis. This helps them know that others have had similar experiences and can point them toward effective treatments. In general, the psychological evaluation includes asking the patient about the beginning and severity of symptoms, as well as other questions about how symptoms impact the patient's quality of life. Issues of particular note are suicidal ideations, experiences with self-harm, and thoughts about harming others. Diagnosis is based both on the person's report of their symptoms and on the clinician's own observations. Additional tests for<unk>  can include a physical exam and laboratory tests to rule out other possible triggers for symptoms, such as thyroid conditions or a substance use disorder. The ICD-10 manual refers to the disorder as emotionally unstable<unk>  disorder and has similar diagnostic criteria. In the DSM-5, the name of the disorder remains the same as in the previous editions. Diagnostic and Statistical Manual The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) has removed the multiaxial system. Consequently, all disorders, including<unk>  disorders, are listed in Section II of the manual. A person must meet five of nine criteria to receive a diagnosis of<unk> . The DSM-5 defines the main features of the condition as a pervasive pattern of instability in interpersonal relationships, self-image, and affect, as well as markedly impulsive behavior. In addition, the DSM-5 proposes alternative diagnostic criteria for<unk>  in section III, "Alternative DSM-5 Model for<unk>  Disorders". These alternative criteria are based on trait research and include specifying at least four of seven maladaptive traits. According to Marsha Linehan, many mental health professionals find it challenging to diagnose<unk>  using the DSM criteria, since these criteria describe such a wide variety of behaviors. To address this issue, Linehan has grouped the symptoms of<unk>  under five main areas of dysregulation: emotions, behavior, interpersonal relationships, sense of self, and cognition. International Classification of Disease The World Health Organization's ICD-10 defines a disorder that is conceptually similar to<unk> , called () Emotionally unstable<unk>  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): # marked tendency to act unexpectedly and without consideration of the consequences; # marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized; # liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions; # difficulty in maintaining any course of action that offers no immediate reward; # unstable and capricious (impulsive, whimsical) mood. F60.31<unk>  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: # disturbances in and uncertainty about self-image, aims, and internal preferences; # liable to become involved in intense and unstable relationships, often leading to emotional crisis; # excessive efforts to avoid abandonment; # recurrent threats or acts of self-harm; # chronic feelings of emptiness; # demonstrates impulsive behavior, e.g., speeding in a car or substance use. The ICD-10 also describes some general criteria that define what is considered a<unk>  disorder. Millon's subtypes American psychologist Theodore Millon has proposed four subtypes of<unk> . He suggests that an individual diagnosed with<unk>  may exhibit none, one, or multiple of the following: Subtype Features Discouraged<unk>  (including avoidant and dependent features) Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless. Petulant<unk>  (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily feels "slighted" and quickly disillusioned. Impulsive<unk>  (including histrionic or antisocial features) Captivating, capricious, superficial, flighty, distractable, frenetic, and seductive; fearing loss, the individual becomes agitated; gloomy and irritable; and potentially suicidal. Self-destructive<unk>  (including depressive or masochistic features) Inward-turning, intropunitive (self-punishing), angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide. Misdiagnosis People with<unk>  may be misdiagnosed for a variety of reasons. One reason for misdiagnosis is<unk>  has symptoms that coexist (comorbidity) with other disorders such as depression, post-traumatic stress disorder (PTSD), and bipolar disorder. Family members People with<unk>  are prone to feeling angry at members of their family and alienated from them. On their part, family members often feel angry and helpless at how their<unk>  family members relate to them. Parents of adults with<unk>  are often both over-involved and under-involved in family interactions. In romantic relationships,<unk>  is linked to increased levels of chronic stress and conflict, decreased satisfaction of romantic partners, domestic abuse, and unwanted pregnancy. However, these links may apply to<unk>  disorders in general. Adolescence Onset of symptoms typically occurs during adolescence or young adulthood, although symptoms suggestive of this disorder can sometimes be observed in children. Symptoms among adolescents that predict the development of<unk>  in adulthood may include problems with body-image, extreme sensitivity to rejection, behavioral problems, non-suicidal self-injury, attempts to find exclusive relationships, and severe shame. Many adolescents experience these symptoms without going on to develop<unk> , but those who experience them are 9 times as likely as their peers to develop<unk> . They are also more likely to develop other forms of long-term social disabilities.<unk>  is recognised as a valid and stable diagnosis during adolescence. The diagnosis of<unk>  (also described as<unk>  disorder:<unk>  pattern qualifier") in adolescents is supported in recent updates to the international diagnostic and psychiatric classification tools including the DSM-5 and ICD-11. Early diagnosis of<unk>  has been recognised as instrumental to the early intervention and effective treatment for<unk>  in young people. Accordingly, national treatment guidelines recommend the diagnosis and treatment of<unk>  among adolescents in many countries including Australia, the United Kingdom, Spain, and Switzerland. The diagnosis of<unk>  during adolescence has been controversial. Early clinical guidelines encouraged caution when diagnosing<unk>  during adolescence. Perceived barriers to the diagnosis of<unk>  during adolescence included concerns about the validity of a diagnosis in young people, the misdiagnosis normal adolescent behaviour as symptoms of<unk> , the stigmatising effect of a diagnosis for adolescents, and whether<unk>  during adolescence was sufficiently stable for a valid diagnosis of<unk> . Psychiatric research has since shown<unk>  to be a valid, stable and clinically useful diagnosis in adolescent populations. However, ongoing misconceptions about the diagnosis of<unk>  in adolescence remain prevalent among mental health professionals. Clinical reluctance to diagnose<unk>  is a key barrier to the provision of effective treatment in adolescent populations. A<unk>  diagnosis in adolescence might predict that the disorder will continue into adulthood. Among individuals diagnosed with<unk>  during adolescence, there appears to be one group in which the disorder remains stable over time and another group in which the individuals move in and out of the diagnosis. Earlier diagnoses may be helpful in creating a more effective treatment plan for the adolescent. Family therapy is considered a helpful component of treatment for adolescents with<unk> . Differential diagnosis and comorbidity Lifetime comorbid (co-occurring) conditions are common in<unk> . Compared to those diagnosed with other<unk>  disorders, people with<unk>  showed a higher rate of also meeting criteria for * mood disorders, including major depression and bipolar disorder * anxiety disorders, including panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD) * other<unk>  disorders, including schizotypal, antisocial and dependent<unk>  disorder * substance use * eating disorders, including anorexia nervosa and bulimia * attention deficit hyperactivity disorder * somatic symptom disorders (formerly known as somatoform disorders: a category of mental disorders included in a number of diagnostic schemes of mental illness) * dissociative disorders A diagnosis of a<unk>  disorder should not be made during an untreated mood episode/disorder, unless the lifetime history supports the presence of a<unk>  disorder. Comorbid Axis I disorders +Sex differences in Axis I lifetime comorbid diagnosis, 2008 and 1998 Axis I diagnosis Overall (%) Male (%) Female (%) Mood disorders 75.0 68.7 80.2 Major depressive disorder 32.1 27.2 36.1 Dysthymia 9.7 7.1 11.9 Bipolar I disorder 31.8 30.6 32.7 Bipolar II disorder 7.7 6.7 8.5 Anxiety disorders 74.2 66.1 81.1 Panic disorder with agoraphobia 11.5 7.7 14.6 Panic disorder without agoraphobia 18.8 16.2 20.9 Social phobia 29.3 25.2 32.7 Specific phobia 37.5 26.6 46.6 PTSD 39.2 29.5 47.2 Generalized anxiety disorder 35.1 27.3 41.6 Obsessive-compulsive disorder** 15.6 --- --- Substance use disorders 72.9 80.9 66.2 Any
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