The Who, What, Why of Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) refers to a cluster of behaviors and psychiatric symptoms characterized by instability and impulsivity.


People with this disorder may report chronic feelings of emptiness, fear of abandonment, unpredictable mood swings, unstable relationships and frequent changes in their values, life goals or self-perception. They often engage in impulsive behaviors such as self-harm, spending sprees, sexual promiscuity, and substance-use.


BPD, like other personality disorders, cannot be diagnosed before the age of 18. Therefore, while children may identify with many of the characteristics, they will likely not be given a formal diagnosis until adulthood. That said, many studies do find that many aspects of the disorder first present in adolescence.It can take several appointments over the course of years to be certain a person meets the criteria.


How common is it?

Current estimates suggest that 1.6% of US adults suffer from BPD. However, in patients seeking treatment for other psychiatric disorders, the rate of BPD is as high as 20%.[1] Many studies suggest this diagnosis is more common in women, but recent research indicates there is no gender difference.[2]



What causes it?

The cause is multifactorial with biological, social and psychological components converging to increase an individual’s risk. BPD has a very strong genetic basis and fMRI studies have shown hyperactivation of limbic structures like the amygdala[3], which play a role in forming and regulating emotion. The strongest predictive factor is childhood trauma. Depending on the study, anywhere from 40-76% of patients with BPD have reported a history of sexual abuse. A much larger percentage (92%) report a history of emotional abuse in childhood.[4]



How is it treated?

First-line treatment for BPD is a form of psychotherapy known as Dialectical-Behavior Therapy (DBT). Other forms of therapy have shown benefit in specific patients and the choice of modality should be made in consultation with a physician and/or a therapist.


Because mood symptoms, emotional instability and even psychotic symptoms are frequently associated with this disorder, there is often a role for medication. These may include antidepressants, anxiolytics, mood stabilizers or even anti-psychotics (which treat both mood instability and psychotic features).


Patients with BPD should recognize that this disorder places them at higher risk for other psychiatric illnesses such as major depression, bipolar disorder, and – importantly – substance-use disorders. The risk of suicide is approximately 10%,[5] which is about fifty times higher than the general population and must be taken very seriously. Patients should be careful to maintain a healthy and balanced lifestyle and have regular follow-up in order to minimize this risk. It is important to have a healthy diet, sleep 7-8 hours a night, and avoid the use of addictive substances including alcohol.




Does it ever go away?

Unlike many other personality disorders or psychiatric illnesses, BPD may, in fact, improve with time. Multiple studies have shown that patients who meet 8 or more of the diagnostic criteria for this disease will likely meet as few as only 1 or 2 criteria at a 10-year follow-up. 85% of people with BPD achieve remission for 12 months or longer.[6] Some patients may experience a recurrence of symptoms after remission, but the rates at which this occurs are less widely known (ranging from 10% – 36% depending on the study).


Have you or a family member been affected BPD? What has your experience been. What advice do you have for others? Please share your comments, questions and advice below.




[1] Biskin, Robert. The Lifetime Course of Borderline Personality Disorder. Canadian Journal of Psychiatry. (2015)

[2] Leichsenring, Falk et al. Borderline personality disorder. Lancet. 377. (2011)

[3] Leichsenring, Falk et al. Borderline personality disorder. Lancet. 377. (2011)

[4] Schroeder, K. et al. Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical managementCurrent Opinion in Psychiatry. 2013

[5] Leichsenring, Falk et al. Borderline personality disorderLancet. 377. (2011)

[6] Biskin, Robert. The Lifetime Course of Borderline Personality Disorder. Canadian Journal of Psychiatry. (2015)


Aryeh Goldberg MD MA
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