Andy Novinska, MS, LCPC, CADC
• Personality disorders are associated with ways of thinking and
feeling about oneself and others that significantly and
adversely affect how an individual functions in many aspects
• During the development process of the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-
5), several proposed revisions were drafted that would have
significantly changed the method by which individuals with
these disorders are diagnosed.
• Based on feedback from a multilevel review of proposed
revisions, the American Psychiatric Association Board of
Trustees ultimately decided to retain the DSM-IV categorical
approach with the same 10 personality disorders.
Part of the “Cluster B” – Dramatic, Emotional or Erratic
• Antisocial - Disregard for the rights of others that begins in
childhood/early adolescence and continues into adulthood. Criminal
• Narcissistic - Grandiosity with a need for admiration coupled with a
lack of empathy for others. Preoccupied with competence, power
and prestige. Closely linked to self-centeredness.
• Histrionic - Excessive need for approval. Are often animated,
dramatic, enthusiastic, seductive or flirtatious.
• Borderline - Poor self-image/identity with an abnormal level of
mood swings. Chaotic and unbalanced in their interpersonal
Borderline Personality Disorder (BPD) 301.83
(Emotionally unstable personality disorder, emotional intensity disorder, borderline type in the ICD-10)
Diagnostic criteria require at least 5 of the following features:
Frantic efforts to avoid real or imagined abandonment. (Note: Do not include
suicidal or self-mutilating behavior from criterion 5.)
A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of
Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge eating). (Note: Do not include
suicidal or self mutilating behavior covered in criterion 5.)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely
more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g. frequent
displays of temper, constant anger, recurrent physical fights).
Transient stress –related paranoid ideation or severe dissociative symptoms.
Common Co-Occurring Disorders
• Depressive Disorders
• Bipolar Disorder
• Substance Use Disorders
• Eating Disorders (especially bulimia)
• Posttraumatic Stress Disorder
• Attention Deficit/Hyperactivity Disorder
• Other Personality Disorders (especially other cluster B)
Causes & Development of BPD
• Childhood abuse (especially sexual abuse)
• Loss of primary caregivers
• Hostile conflicts with caregivers or within environment
• Chromosomal and neurological abnormalities
• Brain region (occipital lobe & amygdala) functioning
• 5x’s as likely in first degree biological relatives
Temperament, Culture & Development
• Diagnosed 75% of the time in females
• Adolescents may display transient “symptoms”
• Temperament (mood, intensity, adaptability) may mimic traits
Is Borderline Personality Disorder a “disorder”
• Symptom or reaction to trauma, loss, neglect?
• A gender stereotype that is expressed in “feminine” terms?
• Estimated at 1.6% of the population (might be as high as 5.9%)
but can be a dumping ground (“they are acting just like a
borderline”) or a dismissive disorder (“oh, they are just a
• Symptoms tend to diminish with age.
• A lack of emotional development due to drug and alcohol use,
abuse, neglect, etc.
Therapeutic Alliance & Interactions
• Idealization & devaluation will occur, be consistent.
• Splitting in a practice, office, team will occur. Utilize team
staffings and stay unified.
• Empathize experiences without getting pulled in (or under!).
• Have client partake in the world as much as possible (tricky as
you must attend to suicidality and the co-occurring disorders,
like depression, that can accompany suicidal thinking and
Andy Novinska, MS, LCPC, CADC