Borderline personality disorder

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD)[10] 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.[5][6][11] Those affected often engage in self-harm and other dangerous behaviors.[12] They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality.[5] Symptoms of BPD may be triggered by events considered normal to others.[5] BPD typically begins by early adulthood and occurs across a variety of situations.[6] Substance use disorders, depression, and eating disorders are commonly associated with BPD.[5] Approximately 10% of people affected with the disorder die by suicide.[5][6] The disorder is stigmatized in both the media and the psychiatric field and as a result is often underdiagnosed.[13]

Borderline personality disorder
Other names
  • Emotionally unstable personality disorder – impulsive or borderline type[1]
  • Emotional intensity disorder[2]
Despair by Edvard Munch (1894), presumed to have lived with borderline personality disorder.[3][4]
SpecialtyPsychiatry
SymptomsUnstable 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[5][6]
ComplicationsSuicide[5]
Usual onsetEarly adulthood[6]
DurationLong term[5]
CausesUnclear[7]
Risk factorsFamily history, trauma, abuse[5][8]
Diagnostic methodBased on reported symptoms[5]
Differential diagnosisIdentity disorder, mood disorders, post traumatic stress disorder, C-PTSD, substance use disorders, histrionic, narcissistic, or antisocial personality disorder[6][9]
TreatmentBehavioral therapy[5]
PrognosisImproves over time[6]
FrequencyEstimations at ca. 1.6% of people in a given year[5]

The causes of BPD are unclear but seem to involve genetic, neurological, environmental, and social factors.[5][7] It occurs about five times more often in a person who has an affected close relative.[5] Adverse life events appear to also play a role.[8] The underlying mechanism appears to involve the frontolimbic network of neurons.[8] BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.[6] The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.[6]

BPD is typically treated with psychotherapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT).[5] DBT may reduce the risk of suicide in the disorder.[5] Therapy for BPD can occur one-on-one or in a group.[5] While medications cannot cure BPD, they may be used to help with the associated symptoms.[5] Despite no evidence of their effectiveness, SSRI antidepressants and quetiapine remain widely prescribed for the condition.[14] Severe cases of the disorder may require hospital care.[5]

About 1.6% of people have BPD in a given year, with some estimates as high as 6%.[5][6][15] Women are diagnosed about three times as often as men.[6] The disorder appears to become less common among older people.[6] Up to half of those with BPD improve over a ten-year period.[6] Those affected typically use a high amount of healthcare resources.[6] There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline.[5]