Introduction
Borderline Personality Disorder (BPD) is a complex and often misunderstood psychiatric condition characterized by pervasive instability in mood, self-image, behavior, and interpersonal relationships. Individuals with BPD may experience intense emotional pain, fear of abandonment, impulsivity, and difficulty maintaining stable relationships. A comprehensive psychiatric evaluation is essential for accurate diagnosis, understanding contributing factors, and developing an effective treatment plan.
Purpose of the Evaluation
To confirm the diagnosis of BPD using DSM-5 criteria
To assess the severity and impact of symptoms
To identify co-occurring psychiatric or medical conditions
To evaluate risk factors such as suicidality or self-harm
To guide individualized treatment planning
To facilitate referrals and continuity of care
Key Components of the Evaluation
1. Identifying Information
Patient’s name, age, gender, occupation
Date of evaluation
Referral source (e.g., self, family, primary care)
2. Chief Complaint
Patient’s own words describing symptoms
Example: “I feel empty all the time and I’m scared people will leave me.”
3. History of Present Illness (HPI)
Onset and progression of symptoms
Triggers and stressors
Impact on relationships, work, and daily functioning
Previous treatments and responses
4. Past Psychiatric History
Prior diagnoses (e.g., depression, anxiety, PTSD)
Hospitalizations
Suicide attempts or self-harm
Substance use history
5. Medical History
Chronic illnesses
Neurological conditions
Medications and allergies
6. Family History
Personality disorders or mood disorders in relatives
Substance use or suicide in family
7. Social History
Living situation
Education and employment
Relationships and support systems
Legal issues
Cultural and spiritual background
Mental Status Examination (MSE)
Domain Description
Appearance May be disheveled or overly groomed
Behavior Agitated, impulsive, or cooperative
Mood Labile, anxious, depressed
Affect Intense, rapidly shifting
Speech Pressured or normal
Thought Process Tangential, disorganized, or goal-directed
Thought Content Suicidal ideation, paranoia, identity disturbance
Perception May include transient dissociation
Cognition Alert, oriented, but may have impaired attention
Insight Often limited or fluctuating
Judgment Frequently impaired during emotional distress
Risk Assessment
Suicidal ideation or intent
Self-injurious behavior (e.g., cutting)
Impulsivity and risky behaviors
Substance use
History of trauma or abuse
Diagnostic Criteria (DSM-5)
To diagnose BPD, at least five of the following criteria must be met:
Frantic efforts to avoid real or imagined abandonment
Unstable and intense interpersonal relationships
Identity disturbance
Impulsivity in at least two areas (e.g., spending, sex, substance use)
Recurrent suicidal behavior or self-harm
Affective instability
Chronic feelings of emptiness
Inappropriate, intense anger
Transient stress-related paranoia or dissociation
Formulation
A biopsychosocial summary integrating biological, psychological, and social factors.
Example: “Patient’s emotional instability and fear of abandonment appear rooted in early childhood trauma and are exacerbated by current relationship stress and lack of coping skills.”
Treatment Plan
Psychotherapy
Dialectical Behavior Therapy (DBT): gold standard for BPD
Cognitive Behavioral Therapy (CBT)
Mentalization-Based Therapy (MBT)
Schema Therapy
Group therapy and skills training
Pharmacological Support
No medications specifically approved for BPD
SSRIs for mood and anxiety symptoms
Mood stabilizers or antipsychotics for impulsivity and aggression
Safety Planning
Crisis hotline numbers
Removal of harmful objects
Emergency contacts
Hospitalization if necessary
Referrals
Psychotherapy specialists
Community mental health services
Support groups
Documentation Tips
Use clear, objective language
Include direct quotes from the patient
Document emotional and behavioral patterns
Ensure confidentiality and informed consent
Conclusion
Borderline Personality Disorder is a serious and treatable condition that requires a compassionate, structured, and evidence-based approach. A comprehensive psychiatric evaluation helps clinicians understand the full scope of symptoms, identify underlying causes, and develop a treatment plan that promotes emotional regulation, interpersonal stability, and long-term recovery.