Self-administered Survey for Borderline Personality Disorder From the DSM5

By completing the following survey, we can identify some impairments and traits that may be keeping us from living the life we want to live. We can give our-self a score between 1 and 10,  with 1 being “no problem” and 10 being “a major problem that is making my life difficult”. We can then make a note of those items where the score is five or higher. These are areas you may want to work on over the next few weeks as we look at ways to turn these negative problems into  positive solutions. 

1. Markedly impoverished, poorly developed, or unstable self-image,  ______
2. Excessive self-criticism;  ______
3. Chronic feelings of emptiness;  ______
4. Dissociative states under stress ______
5. Instability in goals, aspirations, value, or career plans   ______
6. Compromised ability to recognize the feelings and needs of others ______
7. interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); ______
8. Perceptions of others selectively biased toward negative attributes or vulnerabilities  _____
9. Intense, unstable, and conflicted close relationships;  ______
10. Marked by mistrust, neediness;  ______
11. Anxious preoccupation with real or imagined abandonment;  ______
12. Close relationships often viewed in extremes of idealization and devaluation;  ______
13. Alternating between over involvement and withdrawal. ______
14. Unstable emotional experiences and frequent mood changes;  ______
15. Emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. ______
16. Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; ______
17. Worry about the negative effects of past unpleasant experience and future negative possibilities;  _____
18. Feeling fearful, apprehensive, or threatened by uncertainty;  ______
19. Fears of falling apart or losing control;  ______
20. Pathological personality traits in negative affectivity;  ______
21. Fears of rejection by – and/or separation from – significant others;  ______
22. Fears of excessive dependency and complete loss of autonomy;  ______
23. Frequent feelings of being down, miserable, and/or hopeless; ______
24. Difficulty recovering from such moods;  ______
25. Pessimism about the future; ______
26. Pervasive shame; ______
27. Feeling of inferior self-worth;  ______
28. Thoughts of suicide and suicidal behaviour;   ______
29. Acting on the spur of the moment in response to immediate stimuli; ______
30. Acting on a momentary basis without a plan or consideration of outcomes;  ______
31. Difficulty establishing or following plans; ______
32. A sense of urgency and self-harming behavior under emotional distress;______
33. Engagement in dangerous, activities, unnecessarily and without regard to consequences;  ______
34. Lack of concern for one’s limitations;  ______
35. Denial of the reality of personal danger. ______
36. Persistent or frequent angry feelings;  ______
37. Anger or irritability in response to minor slights and insults. ______

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