Exposure to actual/threatened death, serious injury, or sexual violence (direct, witnessed, learning about close person, or repeated indirect exposure)
AA. Pervasive pattern of instability of interpersonal relationships, self-image, and affect, with marked impulsivity beginning by early adulthood; ≥5 of 9: frantic efforts to avoid abandonment; unstable intense relationships; identity disturbance; impulsivity in ≥2 damaging areas; suicidal/self-mutilating behaviour; affective instability; chronic emptiness; inappropriate intense anger; transient stress-related paranoia/dissociation
BA. Exposure to actual/threatened death, serious injury, or sexual violence (direct, witnessed, learning about close person, or repeated indirect exposure) B. ≥1 intrusion symptom: involuntary memories; nightmares; dissociative reactions (flashbacks); intense psychological distress; marked physiological reactions to trauma cues C. ≥1 persistent avoidance: avoidance of trauma-related internal stimuli or external reminders
Common specifiers
AMild / Moderate / Severe; With prominent dissociative features; With predominant impulsive behaviour; With predominant affective instability
BWith dissociative symptoms (depersonalisation); With dissociative symptoms (derealisation); With delayed expression
Differential flags
ABipolar II disorder (episodic mood elevation; not reactive mood instability); MDD (full depressive episodes; without chronic identity/relational disturbance); PTSD (highly comorbid with BPD)