Borderline personality disorder

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of intense and unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with dissociation, a feeling of emptiness, and a fear of abandonment.

Symptoms of BPD may be triggered by events considered normal to others. BPD typically begins by early adulthood and occurs across a variety of situations. Substance use disorders, depression, and eating disorders are commonly associated with BPD. Some 8 to 10% of people affected by the disorder may die by suicide, with the rate being twice as high in males as in females. The disorder is often stigmatized in both the media and the psychiatric field and as a result is often under-diagnosed.

The causes of BPD are unclear but seem to involve genetic, neurological, environmental, and social factors. It is five times more likely to occur in a person who has one or more affected immediate relatives. Adverse life events appear to also play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is classified in the American Diagnostic and Statistical Manual of Mental Disorders (DSM) as a cluster B personality disorder, along with antisocial, histrionic, and narcissistic personality disorder. BPD (and other personality disorders) can be misdiagnosed as a mood disorder, substance use disorder, or other disorder.

BPD is typically treated with psychotherapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). Therapy for BPD can occur one-on-one or in a group. While medications cannot cure BPD, they may be used to help with the associated symptoms. Quetiapine and SSRI antidepressants are widely prescribed for the condition, but their efficacy is unclear. A 2002 study found fluvoxamine (an SSRI) significantly decreased rapid mood shifts in female borderline patients, while more recent meta-analysis found the use of medications still unsupported by evidence. Severe cases of the disorder may require hospital care.

About 1.6% of people have BPD, with some estimates as high as 5.9%. Women are diagnosed about three times as often as men. Up to half of those with BPD improve over a ten-year period with treatment. Those affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline—the term originally referred to borderline insanity, and later to patients on the border between neurosis and psychosis, an interpretation of the disorder now considered outdated and clinically inaccurate.