April 24, 2014

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BPD Overview

About Borderline Personality Disorder (BPD)

Brief Overview

Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood.

Most people who have BPD suffer from:

  • Problems regulating their emotions and thoughts
  • Impulsive and sometimes reckless behavior
  • Unstable relationships

Incidence

  • BPD affects 5.9% of adults (about 14 million Americans) at some time in their life
  • BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%).
  • BPD affects 20% of patients admitted to psychiatric hospitals
  • BPD affects 10% of people in outpatient mental health treatment

Prognosis
Research has shown that outcomes can be quite good for people with BPD, particularly if they are engaged in treatment. With specialized therapy, most people with borderline personality disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviors and suffering. Under stress, some symptoms may come back.  When this happens, people with BPD should  return to therapy and other kinds of support.

Many individuals with BPD experience a decrease in their impulsive behavior in their 40’s.

The Diagnosis

Overview

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on

  • An in-person interview to discuss symptoms
  • Input from a family or close friend that adds to the information provided by the individual coming for treatment.

A careful and thorough medical exam can help rule out other possible causes of symptoms.

Making for Diagnosis

Unfortunately, BPD is too often misdiagnosed. Some people who have borderline personality disorder are misdiagnosed with bipolar disorder. There are important differences between these conditions but both involve unstable moods. For the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and are often within a day.

To be diagnosed with BPD, a person must experience at least five of the following symptoms:

  1. Fear of abandonment
  2. Unstable or changing relationships
  3. Unstable self-image; struggles with identity or sense of self
  4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
  5. Suicidal behavior or self-injury
  6. Varied or random mood swings
  7. Constant feelings of worthlessness or sadness
  8. Problems with anger, including frequent loss of temper or physical fights
  9. Stress-related paranoia or loss of contact with reality

Causes of Borderline Personality Disorder

Research on the causes and risk factors for BPD is still in its early stages. However, scientists generally agree that genetic and environmental influences are likely to be involved.

Imaging studies in people with BPD have shown abnormalities in brain structure and function, evidence that biology is a factor.  In people with BPD, more activity than usual has been seen in the parts of the brain that control feeling and expressing emotions.

Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.

 Co-morbidities

Borderline personality disorder often occurs with other illnesses. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.

According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also suffer from another mental illness.5

Most of these are listed below, followed by the estimated percent of people with BPD who have them:

  • Major Depressive Disorder – 60%
  • Dysthymia (a chronic type of depression) – 70%
  • Substance abuse – 35%
  • Eating disorders (such as anorexia, bulimia, binge eating) – 25%
  • Bipolar disorder – 15%
  • Antisocial Personality Disorder – 25%
  • Narcissistic Personality Disorder – 25%
  • Self-Injury – 55%-85%

Research on Borderline Personality Disorder

Recent neuroimaging studies show differences in brain structure and function between people with BPD and people who do not have this illness. 1 Some research suggests that brain areas involved in emotional responses become overactive in people with BPD when they perform tasks that they see as negative. 2 People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods seen in BPD.3

Another study showed that, when looking at emotionally negative pictures, people with BPD used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues. 4

What does the name “Borderline Personality Disorder” mean?

Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful. The term “borderline” also has a history of misuse and prejudice—BPD is a clinical diagnosis, not a judgment.

Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image.  Some people refer to BPD as “Emotional Disregulation.”


  1. Emotion-Regulating Circuit Weakened in Borderline Personality Disorder. (ed)^(eds).www.nimh.nih.gov/science-news/2008/emotion-regulating-circuit-weakened-in-borderline-personality-disorder.shtml. Accessed on Oct 10, 2008.   King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science. 2008 Aug 8; 321(5890): 806–10.
  2. Kernberg OF, Michels R. Borderline personality disorder. Am J Psychiatry. 2009 May; 166(5): 505–8.
  3. Lis E, Greenfield B, Henry M, Guile JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci. 2007 May; 32(3): 162–73;  Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, Brendel G, Pan H, Beutel M, Pavony MT, Epstein J, Lenzenweger MF, Thomas KM, Posner MI, Stern E. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry. 2007 Dec; 164(12): 1832–41.
  4. Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, Cheng H, Flory J, Prohovnik I. Neural correlates of emotion processing in borderline personality disorder.Psychiatry Res. 2009 Jun 30;172(3):192–9.
  5. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15; 62(6): 553–64.
  6. Zanarini MC, Barison LK, Frankenburg FR, Reich DB, Hudson JI. Family history study of the familial coaggregation of borderline personality disorder with Axis I and non-borderline dramatic cluster Axis II disorders. Journal of Personality Disorders.2009; 23:357–369.  [PubMed]