Borderline Personality Disorder



Borderline personality disorder (BPD) is a psychiatric disorder characterized by consistent and pervasive pattern of emotional dysregulation including distorted sense of self, rapidly labile mood, unstable sense of self, impulsivity, and volatile or chaotic interpersonal relationships (1). It is often manifested during adolescence but is diagnosed in early adulthood.

  • Diagnostic criteria must include at least five of the following (2):
    • Significant discordant sense of identity and values
    • Unstable interpersonal relationships including “splitting,” alternating between idealizing and devaluing
    • Impulsive behavior including excessive spending, substance use, unsafe sex, other reckless behaviors
    • Repetitive self-harm or suicidal ideation
    • Suicide: ideation, history of attempts, plans
    • Chronic feelings of emptiness
    • Extreme anger out of proportion
    • Rapid and intense emotion shifts
    • Dissociative symptoms often transient
    • Frantic efforts to avoid perceived abandonment
  • Other associations:
    • High rate of associated comorbid psychiatric disorders such as depression, anxiety, panic disorder, and substance abuse (2)
    • Typically display little to no insight into their behavior
    • Overuse of emergency department services


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


  • 1.6% of general population (2),(3)
  • 6% of primary care population
  • 10% of outpatient psychiatric visits
  • 20% of inpatient psychiatric milieu

Etiology and Pathophysiology

Undetermined but generally accepted that BPD is multifactorial in etiology including (2),(3):

  • Genetic transmission
  • Environmental factors (i.e., history of childhood sexual and/or physical abuse, history of childhood neglect, ongoing conflict in home, maladaptive parenting styles)
  • Hypothesis includes serotoninergic dysfunction, reductions in key brain structures, and metabolism dysregulation in prefrontal region.
  • Overactivation of amygdala

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

Risk Factors

  • Childhood trauma, that is, sexual and/or physical abuse and neglect
  • Lack of secure parental attachment
  • Physical illness and external social stressors may exacerbate BPD.

General Prevention

Children, caregivers, and significant others should have some time and activities away from the borderline individual and set boundaries, which may protect their well-being.

Commonly Associated Conditions

Other psychiatric disorders such as depression, anxiety, and substance abuse (2)

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