Both classifications are constantly in flux and there remain significant differences between ICD-10/11 and DSM-5 (adopted 2013) with regard to Borderline Personality Disorder.
ICD-10 / ICD-11 (proposed for 2015)
The World Health Organisation (WHO)'s International Classification of Diseases, or ICD-10, tends not to use the term "Borderline Personality Disorder", in favour of the term, Borderline Type.
For a positive diagnosis, the patient must meet the general criteria, F60, for all personality disorders, plus three from F60.30 (Emotionally Unstable Personality Disorder), plus at least two from:
- "Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual)
- "Liability to become involved in intense and unstable relationships, often leading to emotional crises
- "Excessive efforts to avoid abandonment
- "Recurrent threats or acts of self-harm
- "Chronic feelings of emptiness"
In January 2013, the Chair of the ICD-11 Revision Steering Group (Mental Health) published an editorial piece in the journal, Criminal Behaviour and Mental Health entitled, The classification of personality disorders in ICD-11: Implications for forensic psychiatry, in which he described the ICD-10 diagnosis of Borderline Personality Disorder, as well as other PDs, as "unproductive".
Instead he proposed a 'continuum' with severity levels ranging from "Personality difficulty" to "Mild personality disorder" to "Moderate personality disorder" to "Severe personality disorder", to be applied across four "domains": internalising (emotional); externalising (antagonistic), detached and anankastic - the names of the severity levels were not finalised at the time the editorial was published.
Effectively though, the consequence of the ICD-11 revision was that "categories of personality disorder [(Borderline (BPD), Anit-Social, Narcissistic, Emotionally Unstable, Histrionic, etc.)] would become redundant"
Professor Tyrer, in an interview with Clare Allan in a documentary on BBC Radio 4, first broadcast 28 May 2013 (approx. 24 minutes in), reasserted his objective for ICD-11 to adopt this simplification by 2015.
DSM-IV and DSM-V (DSM-5)
Better known as the DSM-IV-TR, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision) is the most widely used classification of mental disorders.
The UK National Institute for Clinical Excellence (NICE), in collaboration with The British Psychological Society and The Royal College of Psychiatrists, to date has endorsed the DSM-IV-TR diagnosis of BPD
In the DSM-IV-TR, Borderline Personality Disorder is defined as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- frantic efforts to avoid real or imagined abandonment.
- a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealization and devaluation.
- identity disturbance: markedly and persistently unstable self-image or sense of self.
- impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
- 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
DSM-5 was jointly sponsored by the APA and the National Institute for Mental Health (also a US body) with its formal publication imminent .
As of 1 December, 2012, the defintion of Borderline Personality Disorder remained unchanged in DSM-5. However, a comprehensive revision of BPD has been tabled for further study and research, and is included in the manual's Appendix (Section 3).
See my article, 'What is Borderline Personality Disorder?'