Understanding Personality Disorders: Borderline, Histrionic, Narcissistic, and Avoidant

Posted on Mar 27, 2025 in Psychology and Sociology

F60.3 Borderline Personality Disorder (301.83)

A pervasive pattern of instability in interpersonal relationships, self-image and affect, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following items:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior if covered in Criterion 5.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: self-image or sense of self markedly and persistently unstable.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior if covered in Criterion 5.
  5. Recurrent suicidal behavior, attempts, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

F60.4 Histrionic Personality Disorder (301.50)

A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following items:

  1. Feels uncomfortable in situations in which they are not the center of attention.
  2. Interaction with others is often characterized by sexually seductive or provocative behavior.
  3. Shows rapidly shifting and shallow expression of emotions.
  4. Consistently uses physical appearance to draw attention to themselves.
  5. Has a style of speech that is excessively impressionistic and lacking in detail.
  6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
  7. Is suggestible, i.e., easily influenced by others or circumstances.
  8. Considers relationships to be more intimate than they actually are.

F60.8 Narcissistic Personality Disorder (301.81)

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following items:

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations.
  6. Is interpersonally exploitative, i.e., takes advantage of others to achieve their own ends.
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  8. Is often envious of others or believes that others are envious of them.
  9. Shows arrogant, haughty behaviors or attitudes.

F60.6 Avoidant Personality Disorder (301.82)

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following items:

  1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
  2. Is unwilling to get involved with people unless certain of being liked.
  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
  4. Is preoccupied with being criticized or rejected in social situations.
  5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
  6. Views self as socially inept, personally unappealing, or inferior to others.
  7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.