Carla Sharp, PhD, a professor at the University of Houston who studies the development of personality disorders, joins host Kiki Fehling, PhD, to discuss how our understanding of borderline personality disorder (BPD) is changing and how the way we define BPD affects the people who receive the diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the standard classification system for mental health diagnoses in the USA. The DSM-5-TR lists nine criteria for BPD, with five required for a diagnosis:

1. Frantic efforts to avoid abandonment

2. Unstable, intense relationships (idealization and devaluation)

3. Unstable self-image

4. Impulsivity in at least two self-damaging areas

5. Recurrent suicidal behavior, gestures, or self-mutilation

6. Mood reactivity and emotional instability

7. Chronic emptiness

8. Intense or poorly controlled anger

9. Stress-related paranoia or dissociation.

Dr. Sharp discusses another approach, the Alternative Model for Personality Disorders (AMPD). Introduced in Section III of DSM-5 in 2013, the AMPD looks at more than a list of symptoms. It considers the personality patterns a person struggles with and how much those difficulties affect their sense of self and their relationships with other people.

It focuses on four areas: identity (how you understand who you are), self-direction (your ability to set goals and make choices), empathy (your ability to understand other people’s experiences), and intimacy (your ability to form and maintain close relationships).

This gives clinicians a fuller picture of where someone is struggling instead of defining them by whether they check off a certain number of symptoms.

The episode also addresses the idea that BPD reflects a flaw in someone’s character. BPD is a mental health condition, effective treatments are available, and people can improve.

(00:00) The pain of not being understood

(01:36) What is BPD? Moving beyond traits

(03:18) There is no single pathway to BPD

(06:21) A different way to understand personality disorder

(09:13) From fixed traits to a capacity that can change

(15:18) BPD is not a character flaw

(15:33) BPD is treatable, and why early intervention helps

(17:51) Try this: challenge what you believe about BPD

Try This Today: Think of a belief you have heard about BPD: “Everyone with BPD has experienced abuse.” “BPD is a character flaw.” “People with BPD can’t change.” Write it down. Next to it, write something you learned in this episode that challenges that belief. Notice the assumptions you may have absorbed about BPD and consider whether they match what we now know.