According to the Diagnostic and Statistical Manual diagnostic framework, some key signs and symptoms may include: Frantic efforts to avoid real or imagined abandonment by friends and family. Unstable personal relationships that alternate between idealization. Distorted and unstable self-image, which affects moods, values, opinions, goals, and relationships. Impulsive behaviors can have dangerous outcomes, such as excessive spending, unsafe sex, reckless driving, or misuse or overuse of substances. Self-harming behavior includes suicidal threats or attempts. Periods of intense depressed mood, irritability, or anxiety lasting a few hours to a few days.