Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms of BPD may be triggered by events considered normal to others. BPD typically begins by early adulthood and occurs across a variety of situations. Substance use disorders, depression, and eating disorders are commonly associated with BPD. Some 8 to 10% of people affected by the disorder may die by suicide. The disorder is often stigmatized in both the media and the psychiatric field and as a result is often underdiagnosed.The causes of BPD are unclear but seem to involve genetic, neurological, environmental, and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events appear to also play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is recognized by the American Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.BPD is typically treated with psychotherapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT).
Clinical reluctance to diagnose BPD is a key barrier to the provision of effective treatment in adolescent populations.A BPD diagnosis in adolescence might predict that the disorder will continue into adulthood. Among individuals diagnosed with BPD during adolescence, there appears to be one group in which the disorder remains stable over time and another group in which the individuals move in and out of the diagnosis. Earlier diagnoses may be helpful in creating a more effective treatment plan for the adolescent. Family therapy is considered a helpful component of treatment for adolescents with BPD. Differential diagnosis and comorbidity
Lifetime comorbid (co-occurring) conditions are common in BPD. Compared to those diagnosed with other personality disorders, people with BPD showed a higher rate of also meeting criteria for
mood disorders, including major depression and bipolar disorder
anxiety disorders, including panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD)
other personality disorders, including schizotypal, antisocial and dependent personality disorder
substance use
eating disorders, including anorexia nervosa and bulimia
attention deficit hyperactivity disorder
somatic symptom disorders (formerly known as somatoform disorders: a category of mental disorders included in a number of diagnostic schemes of mental illness)
dissociative disordersA diagnosis of a personality disorder should not be made during an untreated mood episode/disorder, unless the lifetime history supports the presence of a personality disorder. Comorbid Axis I disorders
A 2008 study found that at some point in their lives, 75% of people with BPD meet criteria for mood disorders, especially major depression and bipolar I, and nearly 75% meet criteria for an anxiety disorder.