Which PD is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affect, with marked impulsivity?

• A. Histrionic
• B. Narcissistic
• C. Borderline
• D. Schizoid

Answer: (C)

The idea being tested is a pattern of instability across key areas of functioning, with impulsive behavior. This combination is most characteristic of Borderline Personality Disorder. People with this pattern typically have intense, stormy relationships that swing between idealization and devaluation, and they may fear abandonment so strongly that they engage in frantic efforts to avoid real or imagined separation. Their sense of self can be unstable, shifting or unclear at times, leading to a diffused or changing self-image. Affective instability means mood swings are rapid and intense, often in response to events. Marked impulsivity shows up in multiple domains, such as spending, substance use, risky sexual behavior, reckless driving, or binge eating, which can cause further problems in their lives. Additional features often seen include recurrent suicidal behavior or threats, self-harming actions, chronic feelings of emptiness, and intense anger or transient paranoid thoughts under stress. Taken together, these interwoven patterns across relationships, self-perception, mood, and behavior are the hallmark of this disorder.

In contrast, other personality disorders center on different core patterns: one emphasizes excessive emotionality and a need for attention, another on grandiosity and a need for admiration, and another on a pervasive detachment and limited emotional expression. None of these match the specific combination of pervasive instability and impulsivity described above.