Borderline personality disorder (BPD) is a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV Personality Disorders 301.83[1]) that describes a prolonged disturbance of personality function characterized by depth and variability of moods.[2] The disorder typically involves unusual levels of instability in mood; "black and white" thinking, or "splitting"; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.[3] These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy.[4] Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time.[4] with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms.
As with other mental disorders, the causes of BPD are complex and unknown.[5] One finding is a history of childhood trauma (possibly child sexual abuse),[6] although researchers have suggested diverse possible causes, such as a genetic predisposition, neurobiological factors, environmental factors or brain abnormalities.[5] The prevalence of BPD in the United States has been calculated as 1 to 3 percent of the adult population,[5] with approximately 75% of those diagnosed being female, 25% male.[7] It has been found to account for 20 percent of psychiatric hospitalizations. Common comorbid (co-occurring) conditions are other mental disorders such as substance abuse, depression and other mood disorders, and other personality disorders. BPD is one of four diagnoses classified as "cluster B" ("dramatic-erratic") personality disorders typified by disturbances in impulse control and emotional dysregulation, the others being narcissistic, histrionic, and antisocial personality disorders.
The term borderline, although it was used in this context as early as the 17th century, was employed by Adolph Stern in 1938 to describe a condition as being on the borderline between neurosis and psychosis. Because the term no longer reflects current thinking, there is an ongoing debate concerning whether this disorder should be renamed.[5] There is related concern that the diagnosis stigmatizes people, usually women, and supports pejorative and discriminatory practices.
Difficulties in therapy
There can be unique challenges in the treatment of BPD, for example hospital care.[107] In psychotherapy, a client may be unusually sensitive to rejection and abandonment and may react negatively (e.g., by harming themselves or withdrawing from treatment) if they sense this. In addition, clinicians may emotionally distance themselves from individuals with BPD for self-protection or due to the stigma associated with the diagnosis, leading to a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist can contribute.[108]
Some psychotherapies, for example DBT, were developed partly to overcome problems with interpersonal sensitivity and maintaining a therapeutic relationship. Adherence to medication regimens is also a problem, due in part to adverse effects, with drop-out rates of between 50 percent and 88 percent in medication trials.[109] Comorbid disorders, particularly substance use disorders, can complicate attempts to achieve remission.[110]
