Borderline personality disorder
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD) or borderline pattern personality disorder is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms of BPD may be triggered by events considered normal to others. BPD typically begins by early adulthood and occurs across a variety of situations. Substance use disorders, depression, and eating disorders are commonly associated with BPD. Approximately 10% of people affected with the disorder die by suicide. The disorder is stigmatized in both the media and the psychiatric field and as a result is often underdiagnosed.
|Borderline personality disorder|
|Despair by Edvard Munch (1894), presumed to have lived with borderline personality disorder.|
|Symptoms||Unstable relationships, sense of self, and emotions; impulsivity; recurrent suicidal behavior and self-harm; fear of abandonment; chronic feelings of emptiness; inappropriate anger; feeling detached from reality|
|Usual onset||Early adulthood|
|Risk factors||Family history, trauma, abuse|
|Diagnostic method||Based on reported symptoms|
|Differential diagnosis||Identity disorder, mood disorders, post traumatic stress disorder, C-PTSD, substance use disorders, histrionic, narcissistic, or antisocial personality disorder|
|Prognosis||Improves over time|
|Frequency||Estimations at ca. 1.6% of people in a given year|
|Cluster A (odd)|
|Cluster B (dramatic)|
|Cluster C (anxious)|
|Not otherwise specified|
The causes of BPD are unclear but seem to involve genetic, neurological, environmental, and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events appear to also play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.
BPD is typically treated with psychotherapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). DBT may reduce the risk of suicide in the disorder. Therapy for BPD can occur one-on-one or in a group. While medications cannot cure BPD, they may be used to help with the associated symptoms. Despite no evidence of their effectiveness, SSRI antidepressants and quetiapine remain widely prescribed for the condition. Severe cases of the disorder may require hospital care.
About 1.6% of people have BPD in a given year, with some estimates as high as 6%. Women are diagnosed about three times as often as men. The disorder appears to become less common among older people. Up to half of those with BPD improve over a ten-year period. Those affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline.