An individual’s personality is their unique way of thinking, feeling, and acting. Many factors can shape it, including their experiences, environment, and genetic traits. Generally, a person’s personality remains consistent over time, but can evolve and change due to various life experiences and developmental stages. A personality disorder, however, is when an individual’s typical patterns of thinking, feeling, and behaving differ significantly from what are considered to be cultural norms, leading to distress or difficulties in functioning that persist over time.
Personality disorders can be complex and challenging to understand, especially when they share similar tendencies and diagnostic criteria. This article explores the relationship between Borderline Personality Disorder (BPD) and Emotionally Unstable Personality Disorder (EUPD). Terms that are often used interchangeably. While these conditions do have many overlapping characteristics, they are not necessarily one and the same.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 10th edition of the International Classification of Diseases (ICD-10) provide diagnostic criteria for various health conditions, including personality disorders. Clinicians may use either term (BPD or EUPD) based on their geographical context and familiarity with the respective manual. Regardless of terminology, clinicians focus on assessing symptoms, providing accurate diagnoses, and tailoring treatment plans to address emotional dysregulation, impulsivity, and other challenges associated with these disorders.
Defining Borderline Personality Disorder
American psychoanalyst Adolph Stern introduced the term “borderline’ into psychiatric language in 1938. Stern used it to describe patients whose symptoms were not completely in line with the existing definitions of neurotic or psychotic disorders at that time, indicating that they were ‘on the border’ between psychosis and neurosis. As the years passed and clinical knowledge and diagnostic practices evolved, the term ‘borderline’ has become associated with BPD.
Today, the American Psychiatric Association (APA) defines BPD as a personality disorder characterised by “a long-standing pattern of instability in mood, interpersonal relationships, and self-image. This instability is severe enough to cause extreme distress or interfere with social and occupational functioning.”
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) includes this definition too. According to the APA, manifestations of BPD include:
- Self-damaging behaviour, such as gambling, overeating, substance use or other impulsive behaviour;
- Intense but unstable relationships, characterised by extreme highs and lows along with challenges in maintaining stability, are frequently
- Uncontrollable temper outbursts of anger that can strain relationships and impact daily functioning
- Fragmented sense of self and uncertainty about identity and life goals;
- Shifting moods can lead to unpredictable reactions;
- Self-defeating behaviour, such as fights, suicidal gestures, or self-mutilation; and
- Chronic feelings of emptiness and boredom.
For more detailed information, visit the APA website.
Understanding the term: Emotionally Unstable Personality Disorder
The International Classification of Diseases, Tenth Revision (ICD-10), published by the World Health Organisation (WHO), originally defined the term EUPD as follows:
“A personality disorder characterised by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored.”
Unlike the DSM-5-TR definition of BPD, the ICD-10 categorises EUPD into two subtypes: ‘impulsive’ and ‘borderline’. This dual categorisation underlines a perceived distinction within the disorder based on predominant symptoms:
- The impulsive type: Characterised predominantly by emotional instability and a lack of impulse control.
- The borderline type: Characterised in addition by disturbances in self-image, chronic feelings of emptiness; intense and unstable interpersonal relationships; and by a tendency toward self-destructive behaviour, including suicide gestures and attempts.
It could be said that the borderline type above closely corresponds to what is known as Borderline Personality Disorder in the DSM-5-TR.
The ICD-11 takes a new approach
The 11th revision of the International Classification of Disease (ICD-11), which came into effect in January 2022, has taken a different approach to categorising personality disorders, incorporating new dimensional elements. Under the ICD-11, rather than strictly categorising personality disorders as discrete types, disorders are first assessed on a scale of severity – ‘mild’, ‘moderate’, ‘severe’ or ‘severity unspecified’. This approach also specificies personality trait domains, and in this way provides a more detailed profile of the personality dysfunction. The goal here is to allow for personalised assessment and tailored treatment planning.
The ICD-11 does not define EUPD as a standalone diagnosis. Instead, characteristics that might have previously been diagnosed as EUPD may now be captured within the new dimensional framework. Options include the ‘Borderline Pattern’ specifier, which may be applied to individuals who exhibit “a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity.”
A Borderline Pattern, according to the ICD-11, is indicated by five (or more) of the following:
- Frantic efforts to avoid abandonment;
- A pattern of unstable and intense interpersonal relationships;
- Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self;
- A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours, such as risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating;
- Recurrent episodes of self-harm, such as suicide attempts or self-mutilation;
- Emotional instability due to marked reactivity of mood – triggered internally or externally;
- Chronic feelings of emptiness;
- Inappropriate intense anger; and
- Transient dissociative symptoms in high affect situations. Other manifestations of borderline pattern, which may only be present some of the time, include:
- A view of the self as inadequate, bad, guilty, disgusting, and unworthy;
- An experience of the self as profoundly different and isolated from other people; and
- Proneness to rejection hypersensitivity, problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships, and frequent misinterpretation of social signals
For more detail on these manifestations and the differences between the ICD-10 and ICD-11 approaches to personality disorders, please refer to this diagnostic manual from the WHO.
Understanding BPD and EUPD in the unfolding landscape of mental health
In the past, some may have used the terms BPD and EUPD interchangeably, and this practice might still exist. However, a closer examination of the DSM and ICD definitions reveals distinctions between them, which continue to evolve based on emerging evidence and clinical experience. As the various approaches to defining these conditions change, this can impact how BPD and EUPD – and personality disorders in general – are understood, diagnosed, and treated.
At the same time, the spectrum of tendencies associated with each disorder is extensive, and not all listed symptoms need to be present for a diagnosis to be made. Therefore, a diagnosis of BPD, for example, does not reflect a one-size-fits-all condition. Rather, it encompasses a range of individuals who may exhibit quite different patterns of behaviour and challenges.
Reflecting on these issues helps in understanding how diagnostic terms might influence the care and support available to affected individuals. The implications of these labels are profound: they can validate an individual’s experiences, fostering a sense of community and informing tailored treatment approaches. Conversely, they can also carry stigma or result in individuals feeling pigeonholed, potentially overshadowing the unique experiences and needs of the individual.
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