Borderline personality disorder

Borderline personality disorder
Other names	Emotionally unstable personality disorder – impulsive or borderline type[1] Emotional intensity disorder[2] Hysteria[3] Hysteric personality – Hysteroid[4] Negative affectivity/neuroticism[5]
Idealization by Edvard Munch (1903), who is presumed to have had borderline personality disorder[6][7]
Specialty	Psychiatry, clinical psychology
Symptoms	Unstable relationships, distorted sense of self, and intense emotions; impulsivity; recurrent suicidal and self-harming behavior; fear of abandonment; chronic feelings of emptiness; inappropriate anger; dissociation[8][9]
Complications	Suicide, self-harm[8]
Usual onset	Early adulthood[9]
Duration	Long term[8]
Causes	Genetic, neurobiologic, psychosocial[10]
Diagnostic method	Based on reported symptoms[8]
Differential diagnosis	See § Differential diagnosis
Treatment	Behaviour therapy[8]
Prognosis	Improves over time,[9] remission occurs in 45% of patients over a wide range of follow-up periods[11][12][13][14][15]
Frequency	5.9% (lifetime prevalence)[8]

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses.^[9][16][17] People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline.^[18][19][20] Symptoms such as dissociation (a feeling of detachment from reality), a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.^[16]

The onset of BPD symptoms can be triggered by events that others might perceive as normal,^[16] with the disorder typically manifesting in early adulthood and persisting across diverse contexts.^[9] BPD is often comorbid with substance use disorders,^[21] depressive disorders, and eating disorders.^[16] BPD is associated with a substantial risk of suicide;^[9][16] an estimated 8 to 10 percent of people with BPD die by suicide, with women affected at twice the rate.^[22] Despite its severity, BPD faces significant stigmatization in both media portrayals and the psychiatric field, potentially leading to its underdiagnosis.^[23]

The causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development.^[8][24] A genetic predisposition is evident, with the disorder significantly more common in people with a family history of BPD, particularly immediate relatives.^[8] Psychosocial factors, particularly adverse childhood experiences, have been proposed.^[25] The American Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies BPD in the dramatic cluster of personality disorders.^[9] There is a risk of misdiagnosis, with BPD most commonly confused with a mood disorder, substance use disorder, or other mental health disorders.^[9]

Therapeutic interventions for BPD predominantly involve psychotherapy, with dialectical behavior therapy (DBT) and schema therapy the most effective modalities.^[8] Although pharmacotherapy cannot cure BPD, it may be employed to mitigate associated symptoms,^[8] with quetiapine and selective serotonin reuptake inhibitor (SSRI) antidepressants commonly prescribed even though their efficacy is unclear. A 2020 meta-analysis found the use of medications was still unsupported by evidence.^[26]

BPD has a point prevalence of 1.6% and a lifetime prevalence of 5.9% of the global population,^{[9][8][27][28]} with a higher incidence rate among women compared to men in the clinical setting of up to three times.^[9][27] Despite the high utilization of healthcare resources by people with BPD,^[29] up to half may show significant improvement over a ten-year period with appropriate treatment.^[9] The name of the disorder, particularly the suitability of the term borderline, is a subject of ongoing debate. Initially, the term reflected historical ideas of borderline insanity and later described patients on the border between neurosis and psychosis. These interpretations are now regarded as outdated and clinically imprecise.^[8][30]