DBT may reduce the risk of suicide in the disorder. 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 remain widely prescribed for the condition, though there is no evidence regarding the efficacy of the latter class of drugs. Severe cases of the disorder may require hospital care.About 1.6% of people have BPD in a given year, with some estimates as high as 6%. Women are diagnosed about three times as often as men. The disorder appears to become less common among older people. Up to half of those with BPD improve over a ten-year period. 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. Signs and symptoms
BPD is characterized by nine signs and symptoms. To be diagnosed, a person must meet at least five of the following:
Frantic efforts to avoid real or imagined abandonment
Unstable and chaotic interpersonal relationships, often characterized by alternating between extremes of idealization and devaluation, also known as "splitting"
Markedly disturbed sense of identity and distorted self-image. Impulsive or reckless behaviors (e.g., impulsive or uncontrollable spending, unsafe sex, substance use disorders, reckless driving, binge eating). Recurrent suicidal ideation or self harm. Rapidly shifting intense emotional dysregulation. Chronic feelings of emptiness. Inappropriate, intense anger that can be difficult to control.
These two neural networks are seen to be dysfunctionally operative in the limbic system, but the specific regions vary widely in individuals, which calls for the analysis of more neuroimaging studies.Also (contrary to the results of earlier studies) those with BPD showed less activation in the amygdala in situations of increased negative emotionality than the control group. John Krystal, editor of the journal Biological Psychiatry, wrote that these results "[added] to the impression that people with borderline personality disorder are set-up by their brains to have stormy emotional lives, although not necessarily unhappy or unproductive lives". Their emotional instability has been found to correlate with differences in several brain regions. Mediating and moderating factors
Executive function
While high rejection sensitivity is associated with stronger symptoms of borderline personality disorder, executive function appears to mediate the relationship between rejection sensitivity and BPD symptoms. That is, a group of cognitive processes that include planning, working memory, attention, and problem-solving might be the mechanism through which rejection sensitivity impacts BPD symptoms. A 2008 study found that the relationship between a persons rejection sensitivity and BPD symptoms was stronger when executive function was lower and that the relationship was weaker when executive function was higher. This suggests that high executive function might help protect people with high rejection sensitivity against symptoms of BPD. A 2012 study found that problems in working memory might contribute to greater impulsivity in people with BPD. Family environment
Family environment mediates the effect of child sexual abuse on the development of BPD.