A 26-year-old female presents to the outpatient clinic after her third emergency department visit in 2 months for superficial self-cutting. She describes intense fear of being abandoned by her boyfriend, a pattern of idealizing new relationships then devaluing partners within weeks, chronic feelings of emptiness, reactive mood shifts lasting hours, explosive anger episodes followed by intense guilt, and an unstable self-image in which she 'doesn't know who she is.' She reports that these patterns have been present since adolescence and occur across multiple relationship and occupational contexts. Which of the following is required by the DSM-5-TR to diagnose borderline personality disorder?