PRIMEVIEW

BORDERLINE PERSONALITY DISORDER

For the Primer, visit doi:10.1038/nrdp.2018.29

Borderline personality disorder (BPD) QUALITY OF LIFE

DIAGNOSIS COGNITIVE
is characterized by interpersonal AND/OR
instability, an unstable sense of self, SELF DISTURBANCE Patients with BPD have substantial functional
impulsive behaviours and emotional
The symptoms of BPD can be impairment, including employment,
sensitivity. Patients with BPD have high
classified under four phenotypes social and vocational functioning.
morbidity and often face severe stigma.
However, functional
Paranoid BPD impairment is unstable
ideation or is frequently and can improve with
EPIDEMIOLOGY dissociative comorbid with remission. In one study,
AFFECTIVE symptoms other psychiatric
~85% of patients had
The lifetime prevalence of BPD is 5.9%. Prevalence AND/OR disorders, including
remission for ≥1 year
is substantially higher in treatment settings; EMOTIONAL major depressive
within 10 years.
patients with BPD comprise ~15–28% of patients DYSREGULATION Identity disorder, anxiety and
Predictors of remission
! ... disturbance trauma-related
in psychiatric include younger age,
disorders
outpatient clinics # ? less‑severe symptoms and
or hospitals, 6% of an absence of childhood
primary care Feelings of
abuse, among other factors.
emptiness
visits and 10–15%
of emergency Impulsivity
room visits. Mood MANAGEMENT
instability Suicidal or
self harming
behaviours The first-line treatment for patients with BPD
MECHANISMS BEHAVIOURAL is psychological therapy, such as dialectical
Anger DYSREGULATION
behavioural therapy (DBT), mentalization-
The aetiology of BPD is the interaction Unstable based treatment (MBT) and transference
of genetic and environmental The assessment or intense focused psychotherapy (TFP). DBT focuses
factors, leading to alterations of individuals relationships on treating the observable symptoms of BPD
in brain development. Genes with suspected BPD whereas MBT and TFP focus on improving the
implicated in the aetiology is carried out by clinical patient’s own understanding of their motives
Avoidance of
of BPD overlap with those interview. As personality and feelings. Less-intensive generalist models
abandonment
for major depression, bipolar changes can affect how of treatment are emerging, and can address the
disorder and schizophrenia. patients see themselves, serious unavailability of the intensive specialist
Environmental risk factors diagnosis can INTERPERSONAL models. BPD can interfere with the treatment of
be challenging. INSTABILITY
include adverse childhood trauma comorbid conditions such as depression or panic
or maltreatment, abnormal caregiver disorder, whereas
attachment and childhood or adolescent other comorbid
psychopathology. Alterations in neural circuits conditions such as Psychoactive
are speculated to underlie the symptoms of BPD. OUTLOOK substance abuse medications are
Affected brain areas include regions involved in and antisocial frequently prescribed
understanding the mental state of others and the BPD comprises <1% of the National disorder in clinical problem and increasing personality for BPD despite little
self, in addition to the pain network, the reward Institute for Mental Health-funded settings, high morbidity public awareness and disorder can evidence supporting
network and the limbic system, which has a role research in the United States, and the financial burden. BPD is increasing investment in research interfere with the their efficacy
in the regulation of emotions and behaviours. despite the high prevalence of this an unaddressed major public health are necessary. treatment of BPD.

Written by Louise Adams; designed by Laura Marshall Article number: 18030; doi:10.1038/nrdp.2018.30; published online 24 May 2018
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