From the Guidelines
Borderline Personality Disorder (BPD) is a complex mental health condition characterized by unstable emotions, behaviors, self-image, and relationships, and is typically treated with psychotherapy, particularly Dialectical Behavior Therapy (DBT), which has been shown to reduce suicidality in adults with BPD 1.
Description of BPD
People with BPD experience intense emotional swings, fear of abandonment, impulsive behaviors, and difficulty maintaining stable relationships. They often have a distorted self-image, chronic feelings of emptiness, and may engage in self-harming behaviors or suicidal thoughts. BPD typically begins in early adulthood and affects how a person thinks and feels about themselves and others. The condition is believed to result from a combination of genetic factors, neurobiological differences in brain structure and function, and environmental factors such as childhood trauma or neglect.
Treatment of BPD
Treatment usually involves psychotherapy, particularly DBT, which teaches skills for emotional regulation, distress tolerance, and interpersonal effectiveness 1. DBT is based on a biosocial theory in which suicidal behaviors are considered to be maladaptive solutions to painful negative emotions. The treatment involves developing problem-oriented strategies to increase distress tolerance, emotion regulation, interpersonal effectiveness, and the use of both rational and emotional input to make more balanced decisions.
- The treatment comprises four components or modules:
- A Core Mindfulness Skills module to diminish identity confusion and self-dysregulation
- An Interpersonal Effectiveness Skills module to enable interpersonal problem-solving through assertiveness training
- A Distress Tolerance module to reduce impulsivity by teaching acceptance and tolerance of painful situations
- An Emotion Regulation Skills module to identify emotions, reduce emotional vulnerability, and increase positive events Medications may be prescribed to address specific symptoms like depression, anxiety, or mood instability, though no medication specifically treats BPD itself. With proper treatment, many people with BPD show significant improvement in their symptoms and quality of life over time. DBT has been shown to be effective in reducing suicidality in adults with BPD, and a modified version of DBT for adolescents (DBT-A) has also been developed and shown to be acceptable to teenagers and reduce rates of psychiatric hospitalization 1.
From the Research
Borderline Personality Disorder Description
- Borderline personality disorder (BPD) is a complex psychiatric condition characterized by pervasive patterns of instability in emotions, interpersonal relationships, and self-image 2, 3.
- The disorder is characterized by instability of self-image, interpersonal relationships and affects, impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms 2.
- BPD is associated with considerable functional impairment, intensive treatment utilization, and high societal costs, with a high risk of self-mutilation and suicide 2.
- 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 2.
Key Symptoms and Characteristics
- Instability of self-image, interpersonal relationships, and affects 2, 3.
- Impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior 2.
- Transient stress-related paranoid ideation or severe dissociative symptoms 2.
- Unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors 4.
Comorbidities and Associations
- 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 2.
- Obesity and binge-eating disorders are common comorbidities in those diagnosed with borderline personality disorder 5.
- There is an established correlation between borderline personality disorder and increased suicide risk 5.