DESCRIPTION

Borderline personality disorder (BPD) is a psychiatric disorder characterized by a consistent and pervasive pattern of emotional dysregulation including: distorted sense of self, rapidly labile mood, impulsive behaviors (including suicidality or self-injury), fear of abandonment, and volatile or chaotic interpersonal relationships. It is often manifested during adolescence but is typically diagnosed in early adulthood. It is considered a cluster B personality type.

EPIDEMIOLOGY

Onset during adolescence or early adulthood; however, may go undiagnosed for years

• More common among women in clinical settings (1)[C]
• Severity of symptoms often remits over time

ETIOLOGY AND PATHOPHYSIOLOGY

Undetermined but generally accepted that BPD is multifactorial in etiology including (1)[C]:

• Environmental factors (i.e., history of childhood sexual and/or physical abuse, history of childhood neglect, ongoing conflict in home, maladaptive parenting styles, socioeconomic status, parental substance use)
• Neuroimaging studies have shown hyperactivity of the amygdala, decreased prefrontal cortex activation, and decreased brain volumes/white matter connectivity in frontal and limbic structures.
• Dysregulation of various neurotransmitter systems, including serotonin, oxytocin, and endogenous opiates, may also play a role.

RISK FACTORS

• Childhood trauma (e.g., sexual and/or physical abuse and neglect)
• Lack of secure parental attachment beginning in early childhood, family adversity, maternal psychopathology
• Low socioeconomic status or parental substance abuse

COMMONLY ASSOCIATED CONDITIONS

High rate of associated comorbid psychiatric disorders such as depression, anxiety, bipolar, chronic pain, obesity, and substance use disorders (SUDs) (1)[C]