From the Guidelines
Borderline Personality Disorder (BPD) is a mental health condition characterized by unstable emotions, relationships, self-image, and behavior, and is typically treated with Dialectical Behavior Therapy (DBT), which has been shown to reduce nonsuicidal and suicidal self-directed violence among patients with BPD. People with BPD often experience intense fear of abandonment, have difficulty regulating emotions, engage in impulsive behaviors, and struggle with maintaining stable relationships. According to a systematic review by Hawton and colleagues 1, DBT combines elements of cognitive-behavioral therapy (CBT), skills training, and mindfulness techniques to help patients develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance. This approach has been found to reduce posttreatment suicidal ideation and repetition of self-directed violence among patients with BPD. Some key characteristics of BPD include:
- Unstable emotions and relationships
- Difficulty regulating emotions
- Impulsive behaviors
- Struggles with maintaining stable relationships
- Intense fear of abandonment Treatment for BPD typically involves:
- Psychotherapy, particularly DBT
- Skills training groups
- Individual therapy
- Medications to address specific symptoms, such as antidepressants or low-dose antipsychotics It's worth noting that BPD develops from a combination of genetic vulnerability and environmental factors, particularly childhood trauma or invalidating environments, and affects about 1.6% of the population, significantly impacting daily functioning, but with proper treatment, many people with BPD experience substantial improvement in their symptoms and quality of life, as supported by the study by Leavey and Hawkins 1.
From the Research
Definition and Characteristics of Borderline Personality Disorder (BPD)
- Borderline personality disorder (BPD) is a complex psychiatric condition characterized by pervasive patterns of instability in emotions, interpersonal relationships, and self-image 2.
- The disorder is marked by symptoms such as instability of self-image, interpersonal relationships, and affects, as well as impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms 3.
- BPD is typically diagnosed by a mental health specialist using semi-structured interviews, and is associated with considerable functional impairment, intensive treatment utilization, and high societal costs 3, 4.
Prevalence and Comorbidities
- The lifetime prevalence of BPD in the general adult population has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services 3.
- BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders 3, 4, 5.
Etiology and Treatment
- The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse 3, 4, 5.
- Psychotherapy is the treatment of choice for BPD, with various approaches such as dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy showing empirical support in randomized controlled trials 2, 3, 4, 6.
- While pharmacotherapy may be useful for discrete and severe comorbid symptoms, there is no evidence that any psychoactive medication consistently improves core symptoms of BPD 3, 4, 5.