Borderline personality disorder

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, acute fear of abandonment, and intense emotional outbursts. People with BPD frequently exhibit self-harming behaviors and engage in risky activities, primarily caused by difficulties in regulating emotions. Symptoms such as dissociation, a pervasive sense of emptiness, and distorted sense of self are prevalent.

Onset of symptoms can be triggered by events others perceive as normal, with the disorder typically manifesting in early adulthood and persisting across diverse contexts. BPD is often comorbid with substance use disorders, depressive disorders, and eating disorders. Studies estimate up to 10 percent of people with BPD die by suicide. BPD faces significant stigmatization in media portrayals and the psychiatric field, leading to underdiagnosis and insufficient treatment.

Causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development. The current hypothesis suggests BPD is caused by an interaction between genetic factors and adverse childhood experiences. BPD is significantly more common in people with a family history of BPD, particularly immediate relatives, suggesting genetic predisposition. There is a risk of misdiagnosis, with BPD commonly confused with a mood disorder, substance use disorder, or other mental health disorders. Therapeutic interventions predominantly involve psychotherapy, with dialectical behavior therapy (DBT) and schema therapy being the most effective. Although pharmacotherapy cannot cure BPD, it may be employed to mitigate symptoms, with atypical antipsychotics and selective serotonin reuptake inhibitor (SSRI) antidepressants commonly prescribed. Medications are used cautiously, show limited efficacy, and have minimal impact on neural function. Despite the high utilization of healthcare resources by people with BPD, up to half may show significant improvement over ten years with appropriate treatment.

Estimation of BPD's prevalence varies. In the US, around 1% of the population are diagnosed with it. BPD is more prevalent among adolescents and young adults than elderly, and symptoms may remit with age. The term ‘borderline’ is debated, as it referred to concepts of borderline insanity and patients on the border between neurosis and psychosis, which are now considered clinically imprecise.