A Cluster B personality disorder, Borderline Personality Disorder (BPD) first of all features high drama, emotions, and erratic behavior. What distinguishes this patient from others in Cluster B is the tumultuousness of her life. That is, the pattern characteristic of Cluster B is punctuated by stormy, unstable relationships, suicidal threats and/or attempts, incidents of self-mutilation, and turbulent emotional outbursts. She romanticizes about “ideal love.” Criteria for diagnosis of BPD are the following:

• pervasive pattern of instability
• marked impulsivity, including self-dangerous impulsivity (e.g., substance abuse, sex, reckless driving, gambling, spending, binge eating/drinking)
• frantic efforts to avoid real and imagined abandonment
• pattern of unstable and intense interpersonal relationships
• identity disturbance or diffusion
• persistently unstable self-image or sense of self
• recurrent suicidal behavior, gestures, or threats; self-mutilation
• emotional instability
• intense episodes of dysphoria, irritability, or anxiety
• chronic feelings of boredom and emptiness
• inappropriate and intense anger; difficulty controlling anger
• transient stress-related paranoia or severe dissociative symptoms

These individuals do seek treatment, unlike some of the other Cluster B personalities. There has been some success found in treating these patients with a cognitive behavioral therapy (CBT) protocol called dialectical behavior therapy (DBT) whereby a “first things first” approach is used. They initially work on behaviors related to self-harm, then move on to those involved with non-compliance (with therapy), and finally those associated with the patient’s quality of life.