F60.3·ICD-10-CM

Borderline Personality Disorder

Pervasive pattern of instability of interpersonal relationships, self-image, and affects, with marked impulsivity, beginning by early adulthood and present across a variety of contexts.

Recommended screener

Validated screener
McLean Screening for BPD (MSI-BPD)
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DSM-5-TR diagnostic criteria summary

BPD requires a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, with at least 5 of 9 criteria:

  • Frantic efforts to avoid real or imagined abandonment.
  • Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  • Identity disturbance: markedly and persistently unstable self-image or sense of self.
  • Impulsivity in at least 2 areas potentially self-damaging (spending, sex, substance use, reckless driving, binge eating).
  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  • Affective instability due to marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting hours, rarely more than a few days).
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or difficulty controlling anger.
  • Transient, stress-related paranoid ideation or severe dissociative symptoms.

Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 752–757.

Differential diagnosis

  • F31.81 Bipolar II Disorder, discrete hypomanic + depressive episodes (days-to-weeks); BPD affective instability is brief and reactive.
  • F33, F32 Major Depressive Disorder, common comorbidity; differential rests on whether mood instability is interpersonal-reactive (BPD) vs episodic (MDD).
  • F43.10 Post-Traumatic Stress Disorder, high comorbidity in BPD (often with extensive trauma history); differential important for treatment selection.
  • F60.81 Narcissistic Personality Disorder, F60.4 Histrionic PD, F60.7 Dependent PD, overlapping interpersonal patterns; often co-coded.
  • F90.0 ADHD, impulsivity and emotional dysregulation overlap; ADHD lacks the identity disturbance and abandonment fears central to BPD.
  • F25.x Schizoaffective Disorder, BPD's transient stress-related paranoid ideation is brief and reactive, not psychotic in the sustained sense.

Common comorbidities

BPD has very high lifetime psychiatric comorbidity (~85% of patients meet criteria for at least one other DSM-5-TR diagnosis). Common co-occurring conditions: Major Depressive Disorder (F33, F32, up to 80% lifetime), PTSD (F43.10, up to 60%), Substance Use Disorders (F10–F19), Generalized Anxiety Disorder (F41.1), Bipolar II (F31.81), Eating Disorders (F50.x), and ADHD (F90.x). Routinely co-administer PHQ-9, GAD-7, PCL-5, and AUDIT alongside BPD-specific screening.

Sources

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F60.3, p. 752–757.
  • Zanarini, M. C., et al. (2003). A screening measure for BPD: The McLean Screening for Borderline Personality Disorder. Journal of Personality Disorders, 17(6), 568–573.
  • Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.

Frequently asked questions

What is ICD-11 code F60.3?

F60.3 is the ICD-11-CM code for Borderline Personality Disorder (called 'Emotionally Unstable Personality Disorder' in ICD-11's original World Health Organization version). DSM-5-TR maintains the term Borderline Personality Disorder and lists F60.3 as the corresponding code in the U.S. ICD-11-CM crosswalk.

What are the diagnostic criteria for F60.3?

DSM-5-TR Borderline Personality Disorder requires a pervasive pattern of instability of interpersonal relationships, self-image, and affects, with marked impulsivity, beginning by early adulthood, with at least 5 of 9 criteria: frantic efforts to avoid abandonment, unstable intense relationships, identity disturbance, impulsivity, recurrent suicidal/self-harm behavior, affective instability, chronic emptiness, inappropriate intense anger, transient paranoid ideation/dissociation.

What scale is used to screen for F60.3?

The MSI-BPD (McLean Screening for BPD) is a brief 10-item self-report screener; ≥7 items endorsed is the standard cutoff with 81% sensitivity and 85% specificity. The Zanarini Rating Scale for BPD (ZAN-BPD) is a longer clinician-administered severity scale used in clinical trials and ongoing monitoring.

Can BPD be diagnosed in adolescents?

DSM-5-TR allows BPD diagnosis in individuals under 18 if symptoms have been present for at least one year and are pervasive, persistent, and unlikely to be limited to a developmental stage or another mental disorder. Earlier identification supports earlier intervention with effective treatments (DBT, MBT, TFP) and is increasingly favored in adolescent psychiatry.

What is the difference between F60.3 and Bipolar II Disorder?

F60.3 BPD is a personality disorder characterized by pervasive instability across self, relationships, and affect, affective shifts are typically brief (hours-to-days) and reactive to interpersonal triggers. F31.81 Bipolar II features discrete hypomanic and depressive episodes lasting days-to-weeks with sustained mood elevation. The two are commonly comorbid (~20%) but are diagnostically distinct.

Is F60.3 a billable ICD-11-CM code?

Yes, F60.3 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for Borderline Personality Disorder in U.S. ICD-11-CM. F60.3 stands at maximum specificity in its hierarchy with no further subdivisions; the original World Health Organization ICD-11 used the label Emotionally Unstable Personality Disorder for the same construct.

What are the symptoms of borderline personality disorder?

Borderline personality disorder produces a pervasive pattern of instability in relationships, self-image, and emotions, plus marked impulsivity. Core symptoms include frantic efforts to avoid abandonment, alternating between idealization and devaluation in relationships, unstable sense of self, impulsive behaviors (spending, sex, substance use, reckless driving, binge eating), recurrent suicidal or self-harm behavior, intense mood reactivity lasting hours to days, chronic emptiness, intense anger, and stress-related paranoid thoughts or dissociation. At least 5 of 9 criteria must be present.

How is borderline personality disorder diagnosed?

Borderline personality disorder is diagnosed by a clinician using DSM-5-TR criteria, which require at least 5 of 9 features as a pervasive long-standing pattern beginning by early adulthood and present across multiple contexts. Diagnosis typically follows a positive MSI-BPD screen (cutoff 7+), structured clinical interview such as the SCID-5-PD or DIPD-IV, and longitudinal assessment to distinguish from mood, anxiety, or trauma disorders that better explain the presentation.

What causes borderline personality disorder?

Borderline personality disorder arises from a combination of genetic, neurobiological, and developmental factors. Heritability estimates from twin studies range from 40% to 60%. Neurobiological contributors include amygdala hyperreactivity, reduced prefrontal regulation, altered serotonin signaling, and HPA axis dysregulation. Developmental contributors include early-life trauma, neglect, invalidating childhood environments, and disrupted attachment, often interacting with temperamental sensitivity to emotional stimuli.

Can borderline personality disorder be cured?

Borderline personality disorder responds well to evidence-based treatment, with most patients showing substantial and durable improvement. Long-term studies indicate roughly 85% of patients achieve symptomatic remission within 10 years, often sustained. First-line treatments include Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), Transference-Focused Psychotherapy (TFP), and Schema Therapy. Medications target specific symptoms (mood reactivity, impulsivity) but are not first-line.

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