Borderline Personality Disorder

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A psychiatric disorder that begins no later than adolescence or early adulthood, borderline personality disorder (BPD) is a consistent and pervasive pattern of unstable and reactive moods and sense of self, impulsivity, and volatile interpersonal relationships (1):

  • Common behaviors and variations:
    • Self-mutilation: pinching, scratching, cutting
    • Suicide: ideation, history of attempts, plans
    • Splitting: idealizing then devaluing others
    • Presentation of helplessness or victimization
    • High utilization of emergency department and resultant inpatient hospitalizations for psychiatric treatment
  • High rate of associated mental disorders
  • Typically display little insight into behavior

Geriatric Considerations
Illness (both acute and chronic) may exacerbate BPD and may lead to intense feelings of fear and helplessness.

Pediatric Considerations
Diagnosis is rarely made in children. Axis I disorders and general medical conditions (GMCs) are more probable.

Pregnancy Considerations
Physical, emotional, and social concerns may transiently mimic symptoms of BPD: Consider delay in diagnosis until pregnancy completed. Pregnancy may also induce stress or increased fears, resulting in escalation of borderline behaviors.


Predominant age: onset no later than adolescence or early adulthood (may go undiagnosed for years)

  • General population: 0.5–5.9% of U.S. population
  • May be over represented in primary care
  • 10% of all psychiatric outpatients and between 15% and 25% of patients in psychiatry inpatient settings have BPD (2).

Etiology and Pathophysiology

Undetermined but generally accepted that BPD is due to a combination of the following:

  • Hereditary temperamental traits
  • Environment (i.e., history of childhood sexual and/or physical abuse, history of childhood neglect, ongoing conflict in home)
  • Neurobiologic research suggests that stress exerts damaging effects on the brain, specifically the hippocampus (2). Other findings demonstrate heightened activity in brain circuits involved in the experience of negative emotions and reduced activation that normally suppresses negative emotion once it is generated.

First-degree relatives are at greater risk for this disorder (undetermined if due to genetic or psychosocial factors).

Risk Factors

  • Genetic factors contribute; however, no specific genes have yet been identified.
  • Childhood sexual and/or physical abuse and neglect
  • Disrupted family life
  • Physical illness and external social factors may exacerbate BPD.

General Prevention

  • Tends to be a multigenerational problem
  • Children, caregivers, and significant others should have some time and activities away from the borderline individual, which may protect them.

Commonly Associated Conditions

Other psychiatric disorders, including:

  • Co-occurring personality disorders, frequent
  • Mood disorders, common
  • Anxiety disorders, common
  • Substance-related disorders, common
  • Eating disorders, common
  • Posttraumatic stress disorder, common
  • BPD does not appear to be independently associated with increased risk of violence.

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