Borderline Personality Pattern Screener

Clinical use note: This tool is a DSM-5-TR–grounded screener for borderline personality pattern features. It is not a diagnosis. A formal diagnosis requires clinical interview, longitudinal pattern review, functional impairment assessment, differential diagnosis, and risk assessment.

Rate each domain based on a persistent pattern across time and contexts, not just one crisis, one relationship, or one bad week.

Scoring: 0 = absent/minimal, 1 = mild/occasional, 2 = clinically significant, 3 = severe/pervasive. Ratings of 2 or 3 count as screen-positive for that criterion.

1. Abandonment sensitivity
Frantic or intense efforts to avoid real or perceived abandonment, rejection, separation, or being left.
2. Unstable/intense relationships
Relationships tend to be intense, unstable, or polarized, with shifts between idealizing and devaluing others.
3. Identity disturbance
Markedly unstable self-image, sense of self, values, goals, roles, or identity continuity.
4. Potentially self-damaging impulsivity
Impulsivity in at least two potentially harmful areas, such as spending, sex, substances, reckless driving, binge eating, or other high-risk behaviors. Do not count self-harm here; that is rated separately below.
5. Suicidal behavior or self-injury
Recurrent suicidal behavior, suicidal threats/gestures, or nonsuicidal self-injury.
6. Affective instability
Rapid, intense mood reactivity, such as episodes of dysphoria, irritability, shame, anger, or anxiety that often last hours to a few days.
7. Chronic emptiness
Persistent or recurring feelings of emptiness, inner deadness, hollowness, or lack of stable internal grounding.
8. Intense anger or anger-control difficulty
Inappropriate, intense, or hard-to-control anger, including frequent temper outbursts, resentment, verbal aggression, or conflict escalation.
9. Stress-related paranoia or dissociation
During high stress, the person experiences transient suspiciousness, paranoia-like fears, derealization, depersonalization, dissociation, or feeling unreal/disconnected.

Clinical pattern check

A. Pervasive pattern
Are these patterns present across multiple contexts, such as intimate relationships, family, work/school, self-care, crisis states, and internal self-experience?
B. Duration / developmental pattern
Do these patterns appear longstanding, typically beginning by adolescence or early adulthood, rather than being limited to a single recent episode?
C. Impairment or distress
Do these patterns cause clinically significant distress, relationship disruption, occupational/academic impairment, safety concerns, or repeated crises?
Please answer every item before scoring.

Screening result

Safety flag: Self-harm or suicidal behavior was endorsed at a clinically significant level. This warrants direct risk assessment, safety planning, and appropriate level-of-care evaluation. If there is imminent danger, contact local emergency services or go to the nearest emergency department.

Positive domains

    Clinical cautions / differential diagnosis

    • This screener does not rule out complex PTSD, bipolar spectrum conditions, ADHD, autism, substance-related dysregulation, OCD, dissociative disorders, attachment trauma, or acute situational crisis.
    • Do not diagnose from a single relationship story. Look for a stable, cross-context, longitudinal pattern.
    • Assess suicidality/self-harm directly when criterion 5 is endorsed.
    • Consider whether symptoms are better explained by mania/hypomania, intoxication/withdrawal, psychosis, medical illness, or trauma-state activation.