Borderline Personality Disorder: The Ten-Question Test

An essential point first

The ten questions

What borderline personality disorder actually is

Borderline personality disorder is a diagnosis describing a long-standing pattern of instability in three places at once: in mood, in relationships, and in the sense of who one is. The DSM-5 lists nine criteria and requires five of them. They cover frantic efforts to avoid abandonment, relationships that alternate between idealisation and devaluation, an unstable self-image, impulsivity, self-harm or suicidal behaviour, mood that shifts within hours, chronic emptiness, intense anger, and transient paranoid or dissociative states under stress.

Five of nine means two people can hold the same diagnosis and share only one criterion. That is worth knowing before anyone treats the label as a description of a person.

Why the name is wrong, and why the diagnosis is argued about

The word borderline is an accident of history. It was coined when clinicians thought they were describing patients on a border between neurosis and psychosis. That framework is long gone; the name stayed. ICD-11 now takes a different approach, describing personality difficulty dimensionally by severity and retaining borderline only as a pattern qualifier.

Two criticisms of the diagnosis are worth taking seriously rather than dismissing.

The first is about who receives it. In clinical settings it is given to women far more often than men, in a ratio frequently cited as around three to one, yet community surveys that sample the general population rather than the clinic have found the rates much closer to even. That gap is not a fact about women. It is a fact about who gets noticed, who gets referred, and what gets written down.

The second is about trauma. A large proportion of people who meet these criteria describe childhood adversity, and for many of them the pattern reads less like a disordered personality than like an entirely sensible adaptation to an unsafe start, carried into a context where it no longer helps. Some clinicians would prefer the language of complex trauma for exactly that reason. That argument is unresolved, and you are allowed to hold the diagnosis loosely while still getting help.

Men and this diagnosis

Men meeting these criteria are routinely given a different label. The impulsivity gets read as antisocial, the drinking as the primary problem, the rage as character rather than distress. The underlying picture goes unnamed, and the man is treated for the thing that shows.

This is the same pattern I found in my doctoral research on male eating disorders: a presentation that does not match what the clinician expects to see in front of them, and so is not seen. It is worth knowing if you are a man reading this and recognising yourself in the ten questions above.

What an assessment actually involves

It is a conversation, not a test, and usually more than one. A clinician will ask about the pattern over time rather than the last fortnight, about childhood and adolescence, about relationships, about how distress is managed and what has happened when it could not be. There is no blood test and no questionnaire that settles it. Where the picture is unclear, a reasonable clinician says so rather than reaching for the nearest label.

A diagnosis is useful when it opens a door to the right treatment. It is not useful as an identity, and you are entitled to ask what it is being used for.

What treatment works

This is where the picture has changed most, and where the old pessimism was simply wrong.

Several structured psychological therapies have good evidence here: dialectical behaviour therapy, mentalisation-based treatment, schema therapy and transference-focused psychotherapy. They differ considerably in theory and in style, which is itself informative. What they share is structure, a clear frame, attention to the therapeutic relationship, and a therapist who does not disappear when things get difficult. NICE guidance in the UK recommends structured psychological therapy rather than medication as the primary treatment.

In my own practice the work is analytic and relational, and the part that does the most is rarely the technique. It is the experience of a relationship that survives being tested, week after week, without retaliating and without leaving.

The prognosis, which is better than you have been told

The belief that borderline personality disorder is a life sentence is the single most damaging thing attached to this diagnosis, and the longitudinal evidence does not support it. The McLean Study of Adult Development, which followed patients over many years, found that the large majority achieved remission of symptoms, and that once remission was reached relapse was relatively uncommon. Recovery in the fuller sense, including stable work and relationships, proved harder and slower than symptom remission, which is an honest finding rather than a discouraging one.

What that means practically: the symptoms that feel permanent at thirty are frequently not present at forty-five, particularly with treatment. If you have been told otherwise, you were told something out of date.

What your answers mean

The count is a prompt, not a verdict, and certainly not a diagnosis, no arrangement of ten answers amounts to one. If several of these questions sound like you and the suffering is real, the right step is an assessment with a clinician. This is precisely a suffering that responds to treatment, and the prognosis is far better than was believed for most of the last century.

What comes next

For the understanding, and for the hope: the essay on borderline personality disorder. On the fear underneath it: the fear of abandonment. And if you want to talk: a first conversation is confidential and without commitment.

Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Professional Doctorate in Analytical Psychology at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.

Other tests: codependency, highly sensitive person, am I with a narcissist.

If you want the work rather than the questions: borderline personality disorder treatment.