Last reviewed: 28 Oct 2021
Last updated: 16 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • paranoia
  • odd thinking
  • restricted range of emotions
  • anger and irritability
  • excessive emotionality and unstable mood states
  • anxiety and tension
  • impulsive behaviours
  • grandiosity
  • evidence of self harm (e.g., scars, burns)

Risk factors

  • history of abuse
  • family history of schizophrenia
  • negative parenting interactions
  • emotional/disruptive disorder in childhood

Diagnostic investigations

Investigations to consider

  • suicide risk screening questions
  • Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
  • Millon Clinical Multiaxial Inventory-III (MCMI-III)
  • Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders Version (SCID-5-AMPD)
  • Structured Clinical Interview for DSM-5 Personality Disorders
  • MRI/CT scan of brain
  • urine drug screen
  • The Primary Care Evaluation of Mental Disorders (PRIME-MD)
  • Patient Health Questionnaire-9 (PHQ-9)
  • Mood Disorder Questionnaire
  • Generalised Anxiety Disorder-7 (GAD-7) and GAD-2

Treatment algorithm

Contributors

Authors

Michael J. Schrift, DO, MA
Michael J. Schrift

Professor

Department of Psychiatry and Behavioral Sciences

University of Washington

Seattle

WA

Disclosures

MJS declares he has no competing interests.

Acknowledgements

Dr Michael J. Schrift would like to gratefully acknowledge Dr Crystal T. Clark, and the late Dr Maria Devens, previous contributors to this topic. He would also like to acknowledge Dr Eric Gausche, who contributed the psychopharmacology sections for the initial version, and Dr Richard Stringham, who reviewed and approved information on the use of imaging and laboratory tests in the diagnosis section in the initial version. MD was an author of references cited in this topic. CTC, EG, and RS declare that they have no competing interests.

Peer reviewers

Anthony W. Bateman, FRCPsych

Consultant Psychiatrist and Visiting Professor

Halliwick Psychotherapy Unit

St Ann’s Hospital

London

UK

Disclosures

AWB declares that he has a bias towards the use of mentalization in the treatment of personality disorder.

Robin L. Kissell, MD

Director

Borderline Personality Disorder Initiative

Semel Institute

UCLA

Los Angeles

CA

Disclosures

RLK declares that she has no competing interests.

Justin Trevino, MD

Medical Director

Opioid Treatment Program

Dayton Veterans Affairs Medical Center

Dayton

OH

Disclosures

JT declares that he has no competing interests.

Dietmar Winkler, MD

Department of Psychiatry and Psychotherapy

Medical University of Vienna

Vienna

Austria

Disclosures

DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.

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