Signs Suggesting Need for BPD Assessment

Repeated suicide attempts or other self-injurious behaviors, and strong urges to engage in those behaviors, are probably the most obvious and frequently used cues to assess for the possibility of BPD in a patient with a mood disorder. Although these behaviors are certainly not specific to BPD, they should lead to consideration of that diagnosis. The other two indicators that we most strongly emphasize, because they are almost universal among patients with BPD are (1) strong emotional lability in reaction to events; and (2) excessive concerns about rejection and abandonment, which often show up in the therapeutic relationship. Anger overexpression, although noted as a criterion in DSM-IV, is no more related to BPD than are other emotions, and because it certainly is not specific to BPD, it is not a strong indicator.

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