Main Symptoms
Borderline personality disorder* is a mental disorder that results in four groups of behavioral symptoms, also referred to as domains:
- excessive, unstable and poorly regulated emotional responses, especially anger;
- impulsive behaviors that are harmful to you or to others, such as spending sprees, excessive use of alcohol or drugs, self-injurious acts, and sexual indiscretions;
- suspiciousness, misperceptions, an unstable self-image, a poor sense of your identity, and difficulty in reasoning under stress; and
- tumultuous relationships that vary from extreme fear of abandonment to episodes of excessive anger directed towards a person very close to you, and the desire to get away from that person.
*The term borderline disorder is used on this websitebecausethere is ongoing debate about the scientificbasis of this terminology among leading scientistsin the field. Also, many patients and family members find the inclusion of the word “personality” in the name of the disorder to be stigmatizing and offensive.
Age of Onset
The symptoms of borderline personality disorder usually first occur in the teenage years and early twenties. However, onset may occur in some adults after the age of thirty, and behavioral precursors are evident in some children.
The Effects
Borderline disorder often results in devastating effects for those who suffer from it, as well as for their families and friends. The behaviors associated with borderline personality disorder may be extremely disruptive to your life in many ways, and to your family as well, resulting in frequent arguments, fights, running away, absences from and poor performance at school and work, frequent job changes and divorces. The children of a parentwith borderline personality disorder are especially affected.
Prevalence
The results of a large, well-conducted study funded by theNational Institute of Mental Health21 suggests that the lifetime prevalence rate of borderline disorderisabout 6%of the general population, and appears to occur equally in men and women. These resultsare in contrast to those of former, much smaller studies, which reported prevalences of 1 to 2%,and rates threetimes more common in women than in men. To place these numbers in perspective, at this rate, approximately 1 in every 17 individuals would suffer from the disorder. Therefore, most people personally know more than one person with borderline disorder, and about one family in four has someone in their family with the disorder.
Complications
People with borderline disorder are much more likely to seek medical help for physical and emotional symptoms than other people in the general population. For example, a disproportionately large number ofpatients seen in primary care settings suffer from borderline disorder. Ten percent of all psychiatric outpatients and 20% of psychiatric inpatients suffer from borderline disorder, though the diagnosis is often missed or not recorded.
Borderline disorder is also associated with a much higher rate of other psychiatric disorders, such as depression, anxiety disorders, substance abuse, and ADHD,than the prevalence of these disorders in the general population.
Tragically, about 9% of people with borderline disorder commit suicide, among them a significant number of adolescents and young adults. Many of them have not received treatment, or have been misdiagnosed, resulting in treatment failure.
Risk Factors
There are biological and environmental factors that increase the risk of someone developing borderline disorder. The most common biological risk factors are transmitted genetically and have a heritability of 60%.10 The importance of biological risk factors in borderline disorder is indicated, in part, by the findings of numerous neuroimaging (brain scan) and other neurobiological studies. These have shown significant abnormalities in specific pathways in the brains of people with borderline disorder compared to people in the general population. Neglectful parenting, and repeated physical, emotional and sexual abuse, and abandonmentinchildhood are very common environmental risk factors that contribute to the severity ofborderline disorder inthose individuals whopossess genetic risk factors. It is common, but not essential, thatgeneticand environmental factors interact toincreasethe severity of the disorder. individuals with a high genetic risk for the disorder may become symptomatic in the absence of environmental contributory factors. The reverse has not been shown to occur.
Treatments
Effective treatments are now available for people who suffer from borderline disorder. The main treatments utilized are medications in combination with borderline disorder-specificindividual and group psychotherapies. It is now increasingly well recognized that structured family involvement in the treatment process substantially improves the results and shortens the durationof intensive treatment.
Prognosis
With effective treatment, most people with borderline disorder experience a significant reduction in symptoms and improvement in their lives.8 At this time, because of itsgenetic predisposition, there are no complete cures for the disorder. The periods of improvement are often referred to as partial remissions, because all of the symptoms may not improve entirely, and symptoms that have been relieved may return to some degree, most often under stress. This recurrence and significant worsening of symptoms, referred to as a relapse, usually requires brief periods of additional medications, therapy and other supportive measures.
Resources
The ability to find sufficient, valid information about the disorder, as well as to locate experienced, effective professionaltreatment, remainsdifficult for people with borderline disorder, and the people who love them. However, with increasing awareness of and growing research on the disorder, those in need are now finding it less difficult to locate psychiatrists and other mental health professionals who are experienced in properly diagnosing and effectively treating the disorder. Sources of additional information about borderline disorder, and guidelines for locating effective care, are provided on this website. Click here for borderline disorder resources.
Myths About Borderline Disorder
In spite of a considerable amount of sound research evidence to the contrary, there are a number of popular myths about borderline disorder. Unfortunately, these myths increase the stigma associated with the disorder and discourage people with it from seeking effective care. These myths are presented and discussed on this website.
What is BPD >
