Borderline personality disorder

<h2 id="signs-and-symptoms">Signs and symptoms</h2>

Borderline personality disorder, as outlined in the <a href="/facts/DSM-5/kwhcSJcg">DSM-5</a>, manifests through nine distinct <a href="/facts/Symptoms/BzP6MrTN">symptoms</a>, with a <a href="/facts/Diagnosis/VcsPwshd">diagnosis</a> requiring at least five of the following criteria to be met:<a class="footnote-ref" id="fnref:40" href="#fn:40">40</a>

<ol><li>Frantic efforts to avoid real or imagined <a href="/facts/Abandonment_(emotional)/jgweM4P5">emotional abandonment</a>.</li>
<li>Unstable and chaotic interpersonal relationships, often characterized by a pattern of alternating between extremes of <a href="/facts/Idealization_and_devaluation/KWLrE3mz">idealization and devaluation</a>, also known as '<a href="/facts/Splitting_(psychology)/zjbuX456">splitting</a>'.<a class="footnote-ref" id="fnref:41" href="#fn:41">41</a></li>
<li>A markedly <a href="/facts/Identity_disturbance/c7a1azu3">disturbed sense of identity</a> and distorted <a href="/facts/Self-image/KWBfB7Yp">self-image</a>.<a class="footnote-ref" id="fnref:42" href="#fn:42">42</a></li>
<li><a href="/facts/Impulsive_(behavior)/WrjoEyg5">Impulsive</a> or reckless behaviors, including uncontrollable spending, unsafe sexual practices, substance use disorder, reckless driving, and <a href="/facts/Binge_eating/4KSgj3BV">binge eating</a>.</li>
<li>Recurrent <a href="/facts/Suicidal_ideation/fRd8YNjj">suicidal ideation</a> or behaviors involving self-harm.</li>
<li>Rapidly shifting intense <a href="/facts/Emotional_dysregulation/lyXjLExE">emotional dysregulation</a>.</li>
<li>Chronic feelings of <a href="/facts/Emptiness/UScqCMr9">emptiness</a>.</li>
<li>Inappropriate, intense anger that can be difficult to control.</li>
<li>Transient, stress-related <a href="/facts/Paranoid_ideation/Vytxdqa8">paranoid ideation</a> or severe <a href="/facts/Dissociation_(psychology)/MX81IGk3">dissociative</a> symptoms.</li></ol>
The distinguishing characteristics of BPD include a pervasive pattern of instability in one's interpersonal relationships and in one's self-image, with frequent oscillation between extremes of idealization and devaluation of others, alongside fluctuating moods and difficulty regulating intense emotional reactions. Dangerous or impulsive behaviors are commonly associated with BPD.
Additional symptoms may encompass uncertainty about one's <a href="/facts/Identity_(social_science)/hCR165VD">identity</a>, <a href="/facts/Values/f2RW9TXW">values</a>, <a href="/facts/Morals/CSjHHvff">morals</a>, and <a href="/facts/Belief/HbPvkGT6">beliefs</a>; experiencing paranoid thoughts under stress; episodes of <a href="/facts/Depersonalization/7xJIP7YC">depersonalization</a>; and, in moderate to severe cases, stress-induced breaks with reality or episodes of <a href="/facts/Psychosis/cVGd7MKK">psychosis</a>. It is also common for individuals with BPD to have <a href="/facts/Comorbidity/tX5TvuKJ">comorbid conditions</a> such as <a href="/facts/Depressive_disorder/Y0Mjq3QR">depressive</a> or <a href="/facts/Bipolar_disorders/aMDwXbV0">bipolar disorders</a>, <a href="/facts/Substance_use_disorders/pSbdzb6a">substance use disorders</a>, <a href="/facts/Eating_disorders/3GwQ71sD">eating disorders</a>, <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">post-traumatic stress disorder</a> (PTSD), and <a href="/facts/Attention-deficit_hyperactivity_disorder/uSqjIyhd">attention deficit hyperactivity disorder</a> (ADHD).<a class="footnote-ref" id="fnref:43" href="#fn:43">43</a>

<h3>Mood and affect</h3>
Further information: <a href="/facts/Emotional_dysregulation/lyXjLExE">Emotional dysregulation</a>
Individuals with BPD exhibit emotional dysregulation. Emotional dysregulation is characterized by an inability to flexibly respond to and manage <a href="/facts/Emotional_state/kvAr22wa">emotional states</a>, resulting in intense and prolonged emotional reactions that deviate from <a href="/facts/Social_norms/Qu2jGBz3">social norms</a>, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.<a class="footnote-ref" id="fnref:44" href="#fn:44">44</a><a class="footnote-ref" id="fnref:45" href="#fn:45">45</a><a class="footnote-ref" id="fnref:46" href="#fn:46">46</a><a class="footnote-ref" id="fnref:47" href="#fn:47">47</a>
A core characteristic of BPD is affective instability, which manifests as rapid and frequent shifts in <a href="/facts/Mood_(psychology)/mnozVozL">mood</a> of high <a href="/facts/Affect_(psychology)/jEQ6IWSm">affect</a> intensity and rapid onset of <a href="/facts/Emotion/kvAr22wa">emotions</a>, triggered by environmental stimuli. The return to a stable emotional state is notably delayed, exacerbating the challenge of achieving emotional equilibrium. This instability is further intensified by an acute sensitivity to <a href="/facts/Social_cue/GFs2n8Sa">psychosocial cues</a>, leading to significant challenges in managing emotions effectively.<a class="footnote-ref" id="fnref:48" href="#fn:48">48</a><a class="footnote-ref" id="fnref:49" href="#fn:49">49</a><a class="footnote-ref" id="fnref:50" href="#fn:50">50</a>
As the first component of emotional dysregulation, individuals with BPD are shown to have increased <a href="/facts/Emotional_sensitivity/VIsgQleL">emotional sensitivity</a>, especially towards negative mood states such as fear, anger, sadness, rejection, criticism, isolation, and perceived failure.<a class="footnote-ref" id="fnref:51" href="#fn:51">51</a><a class="footnote-ref" id="fnref:52" href="#fn:52">52</a> This increased sensitivity results in an intensified response to environmental cues, including the emotions of others.<a class="footnote-ref" id="fnref:53" href="#fn:53">53</a> Studies have identified a <a href="/facts/Negativity_bias/yzjNupkn">negativity bias</a> in those with BPD, showing a predisposition towards recognizing and reacting more strongly to negative emotions in others, along with an <a href="/facts/Attentional_bias/KVyb8pSn">attentional bias</a> towards processing negatively-<a href="/facts/Valence_(psychology)/Abghx5uQ">valenced</a> stimuli.<a class="footnote-ref" id="fnref:54" href="#fn:54">54</a> Without effective <a href="/facts/Coping_mechanisms/Seg3zu9m">coping mechanisms</a>, individuals might resort to self-harm, or suicidal behaviors to manage or escape from these intense negative emotions.<a class="footnote-ref" id="fnref:55" href="#fn:55">55</a><a class="footnote-ref" id="fnref:56" href="#fn:56">56</a> While conscious of the exaggerated nature of their emotional responses, individuals with BPD face challenges in regulating these emotions. To mitigate further distress, there may be an unconscious suppression of emotional awareness, which paradoxically hinders the recognition of situations requiring intervention.<a class="footnote-ref" id="fnref:57" href="#fn:57">57</a>
A second component of emotional dysregulation in BPD is high levels of <a href="/facts/Negative_affectivity/stGe4nqW">negative affectivity</a>, stemming directly from the individual's emotional sensitivity to negative emotions.<a class="footnote-ref" id="fnref:58" href="#fn:58">58</a> This negative affectivity causes emotional reactions that diverge from <a href="/facts/Social_norm/Qu2jGBz3">socially accepted norms</a>, in ways that are disproportionate to the environmental stimuli presented.<a class="footnote-ref" id="fnref:59" href="#fn:59">59</a> Those with BPD find it difficult to tolerate the distress that is encountered in daily life, and they are prone to engage in maladaptive strategies to try to reduce the distress experienced. Maladaptive coping strategies include <a href="/facts/Rumination_(psychology)/6mxwDtK2">rumination</a>, <a href="/facts/Thought_suppression/XdmWfB84">thought suppression</a>, <a href="/facts/Experiential_avoidance/pESSQboD">experiential avoidance</a>, <a href="/facts/Emotional_isolation/btRSkHaw">emotional isolation</a>, as well as impulsive and self-injurious behaviours.<a class="footnote-ref" id="fnref:60" href="#fn:60">60</a>
American psychologist <a href="/facts/Marsha_Linehan/89d9qWg4">Marsha Linehan</a> highlights that while the sensitivity, intensity, and duration of emotional experiences in individuals with BPD can have positive outcomes, such as exceptional enthusiasm, idealism, and capacity for joy and love, it also predisposes them to be overwhelmed by negative emotions.<a class="footnote-ref" id="fnref:61" href="#fn:61">61</a><a class="footnote-ref" id="fnref:62" href="#fn:62">62</a> This includes experiencing profound <a href="/facts/Grief/9Y3McC1V">grief</a> instead of mere sadness, intense shame instead of mild embarrassment, rage rather than annoyance, and panic over nervousness.<a class="footnote-ref" id="fnref:63" href="#fn:63">63</a> Research indicates that individuals with BPD endure chronic and substantial emotional suffering.<a class="footnote-ref" id="fnref:64" href="#fn:64">64</a>
Emotional dysregulation is a significant feature of BPD, yet Fitzpatrick et al. (2022) suggest that such dysregulation may also be observed in other disorders, like <a href="/facts/Generalized_anxiety_disorder/FJRBB4fM">generalized anxiety disorder</a> (GAD). Nonetheless, their findings imply that individuals with BPD particularly struggle with disengaging from negative emotions and achieving emotional equilibrium.<a class="footnote-ref" id="fnref:65" href="#fn:65">65</a>
<a href="/facts/Euphoria/u4cnbWC4">Euphoria</a>, or transient intense joy, can occur in those with BPD, but they are more commonly afflicted by <a href="/facts/Dysphoria/ltFryLsg">dysphoria</a> (a profound state of unease or dissatisfaction), depression, and pervasive distress. Zanarini et al. identified four types of dysphoria characteristic of BPD: intense emotional states, destructiveness or self-destructiveness, feelings of fragmentation or identity loss, and perceptions of <a href="/facts/Victimization/kc8gwTDX">victimization</a>.<a class="footnote-ref" id="fnref:66" href="#fn:66">66</a> A diagnosis of BPD is closely linked with experiencing feelings of betrayal, lack of control, and self-harm.<a class="footnote-ref" id="fnref:67" href="#fn:67">67</a>
Moreover, <a href="/facts/Emotional_lability/DxVloyc0">emotional lability</a>, indicating variability or fluctuations in emotional states, is frequent among those with BPD. Although emotional lability may imply rapid alternations between depression and elation, <a href="/facts/Mood_swing/NWYoAMyP">mood swings</a> in BPD are more commonly between anger and anxiety or depression and anxiety.<a class="footnote-ref" id="fnref:68" href="#fn:68">68</a>

<h3>Interpersonal relationships</h3>
Interpersonal relationships are significantly impacted in individuals with BPD, characterized by a heightened sensitivity to the behavior and actions of others. Individuals with BPD can be very conscious of and susceptible to their perceived or real treatment by others. Individuals may experience profound happiness and gratitude for perceived kindness, yet feel intense sadness or anger<a class="footnote-ref" id="fnref:69" href="#fn:69">69</a> towards perceived criticism or harm.<a class="footnote-ref" id="fnref:70" href="#fn:70">70</a> A notable feature of BPD is the tendency to engage in <a href="/facts/Idealization_and_devaluation/KWLrE3mz">idealization and devaluation</a> of others – that is to idealize and subsequently devalue others – oscillating between extreme admiration and profound mistrust or dislike.<a class="footnote-ref" id="fnref:71" href="#fn:71">71</a> This pattern, referred to as "<a href="/facts/Splitting_(psychology)/zjbuX456">splitting</a>", can significantly influence the dynamics of interpersonal relationships.<a class="footnote-ref" id="fnref:72" href="#fn:72">72</a><a class="footnote-ref" id="fnref:73" href="#fn:73">73</a> In addition to this external "splitting", patients with BPD typically have internal splitting, i.e. vacillation between considering oneself a good person who has been mistreated (in which case anger predominates) and a bad person whose life has no value (in which case self-destructive or even suicidal behavior may occur). This splitting is also evident in black-and-white or all-or-nothing dichotomous thinking.<a class="footnote-ref" id="fnref:74" href="#fn:74">74</a>
Despite a strong desire for intimacy, individuals with BPD may exhibit insecure, avoidant, ambivalent, or fearfully preoccupied <a href="/facts/Attachment_theory/8jpCPkWH">attachment styles</a> in relationships, complicating their interactions and connections with others.<a class="footnote-ref" id="fnref:75" href="#fn:75">75</a> Family members, including parents of adults with BPD, may find themselves in a cycle of being overly involved in the individual's life at times and, at other times, significantly detached,<a class="footnote-ref" id="fnref:76" href="#fn:76">76</a> contributing to a sense of alienation within the family unit.<a class="footnote-ref" id="fnref:77" href="#fn:77">77</a> Anthropologist Rebecca Lester argues that BPD is a disorder of relationships and communication, namely that a person with BPD lacks the communication skills and knowledge to interact effectively with others within their society and culture given their life experience.<a class="footnote-ref" id="fnref:78" href="#fn:78">78</a>
<a href="/facts/Personality_disorders/SxFnlSEW">Personality disorders</a>, including BPD, are associated with an increased incidence of <a href="/facts/Chronic_stress/lA8Xql58">chronic stress</a> and conflict, reduced satisfaction in romantic partnerships, <a href="/facts/Domestic_abuse/GcDSMDBe">domestic abuse</a>, and <a href="/facts/Unintended_pregnancies/no2vXnQW">unintended pregnancies</a>.<a class="footnote-ref" id="fnref:79" href="#fn:79">79</a> Research indicates variability in relationship patterns among individuals with BPD. A portion of these individuals may transition rapidly between relationships, a pattern metaphorically described as "butterfly-like," characterized by fleeting and transient interactions and "fluttering" in and out of relationships.<a class="footnote-ref" id="fnref:80" href="#fn:80">80</a> Conversely, a subgroup, referred to as "attached," tends to establish fewer but more intense and dependent relationships. These connections often form rapidly, evolving into deeply intertwined and tumultuous bonds.<a class="footnote-ref" id="fnref:81" href="#fn:81">81</a> In certain cases, BPD may be recognized as a <a href="/facts/Disability/vr9BPUxo">disability</a> within the workplace, particularly if the condition's severity results in behaviors that undermine relationships, involve engagement in risky activities, or manifest as intense anger, thereby inhibiting the individual's ability to perform their job role effectively.<a class="footnote-ref" id="fnref:82" href="#fn:82">82</a>
Individuals with BPD express higher levels of jealousy towards their partners in romantic relations.<a class="footnote-ref" id="fnref:83" href="#fn:83">83</a><a class="footnote-ref" id="fnref:84" href="#fn:84">84</a>

<h3>Behavior</h3>
Behavioral patterns associated with BPD frequently involve impulsive actions, which may manifest as substance use disorders, binge eating, unprotected sexual encounters, and self-injury among other self-harming practices.<a class="footnote-ref" id="fnref:85" href="#fn:85">85</a> These behaviors are a response to the intense emotional distress experienced by individuals with BPD, serving as an immediate but temporary alleviation of their <a href="/facts/Emotional_pain/kPaBoDH4">emotional pain</a>.<a class="footnote-ref" id="fnref:86" href="#fn:86">86</a> However, such actions typically result in feelings of shame and guilt, contributing to a recurrent cycle.<a class="footnote-ref" id="fnref:87" href="#fn:87">87</a> This cycle typically begins with emotional discomfort, followed by impulsive behavior aimed at mitigating this discomfort, only to lead to shame and guilt, which in turn exacerbates the emotional pain.<a class="footnote-ref" id="fnref:88" href="#fn:88">88</a> This escalation of emotional pain then intensifies the <a href="/facts/Compulsive_behavior/89bgqdzs">compulsion</a> towards impulsive behavior as a form of relief, creating a vicious cycle. Over time, these impulsive responses can become an automatic mechanism for coping with emotional pain.<a class="footnote-ref" id="fnref:89" href="#fn:89">89</a>

<h3>Self-harm and suicide</h3>
Self-harm and suicidal behaviors are core diagnostic criteria for BPD as outlined in the DSM-5.<a class="footnote-ref" id="fnref:90" href="#fn:90">90</a> Between 50% and 80% of individuals diagnosed with BPD engage in self-harm, with <a href="/facts/Cutting/kuSSgehx">cutting</a> being the most common method.<a class="footnote-ref" id="fnref:91" href="#fn:91">91</a> Other methods, such as bruising, burning, head banging, or biting, are also prevalent.<a class="footnote-ref" id="fnref:92" href="#fn:92">92</a> It is hypothesized that individuals with BPD might experience a sense of emotional relief following acts of self-harm.<a class="footnote-ref" id="fnref:93" href="#fn:93">93</a>
Estimates of the lifetime risk of death by suicide among individuals with BPD range between 3% and 10%, varying with the method of investigation.<a class="footnote-ref" id="fnref:94" href="#fn:94">94</a><a class="footnote-ref" id="fnref:95" href="#fn:95">95</a><a class="footnote-ref" id="fnref:96" href="#fn:96">96</a> There is evidence that a significant proportion of males who die by suicide may have undiagnosed BPD.<a class="footnote-ref" id="fnref:97" href="#fn:97">97</a>
The motivations behind self-harm and <a href="/facts/Suicide_attempts/IR36s6vF">suicide attempts</a> among individuals with BPD are reported to differ.<a class="footnote-ref" id="fnref:98" href="#fn:98">98</a> Nearly 70% of individuals with BPD engage in self-harm without the intention of ending their lives. Motivations for self-harm include expressing anger, self-punishment, inducing normal feelings or feelings of normality in response to dissociative episodes, and distraction from emotional distress or challenging situations.<a class="footnote-ref" id="fnref:99" href="#fn:99">99</a>[non-primary source needed] Conversely, true suicide attempts by individuals with BPD frequently are motivated by the notion that others will be better off in their absence.<a class="footnote-ref" id="fnref:100" href="#fn:100">100</a>[non-primary source needed]

<h3>Sense of self and self-concept</h3>
Individuals diagnosed with BPD frequently experience significant difficulties in maintaining a stable <a href="/facts/Self-concept/Be0PEJAl">self-concept</a>.<a class="footnote-ref" id="fnref:101" href="#fn:101">101</a> This instability manifests as uncertainty in personal <a href="/facts/Values/f2RW9TXW">values</a>, <a href="/facts/Belief/HbPvkGT6">beliefs</a>, <a href="/facts/Preference/hWCEmfuX">preferences</a>, and interests.<a class="footnote-ref" id="fnref:102" href="#fn:102">102</a> They may also express confusion regarding their aspirations and objectives in terms of relationships and career paths. Such indeterminacy leads to feelings of emptiness and a profound sense of disorientation regarding their own <a href="/facts/Identity_(social_science)/hCR165VD">identity</a>.<a class="footnote-ref" id="fnref:103" href="#fn:103">103</a> Moreover, their <a href="/facts/Self-perception_theory/f3hlC8tm">self-perception</a> can fluctuate dramatically over short periods, oscillating between positive and negative evaluations. Consequently, individuals with BPD might adopt their sense of self based on their surroundings or the people they interact with, resulting in a chameleon-like adaptation of identity.<a class="footnote-ref" id="fnref:104" href="#fn:104">104</a>

<h3>Dissociation and cognitive challenges</h3>
The heightened emotional states experienced by individuals with BPD can impede their ability to concentrate and cognitively function.<a class="footnote-ref" id="fnref:105" href="#fn:105">105</a> Additionally, individuals with BPD may frequently <a href="/facts/Dissociation_(psychology)/MX81IGk3">dissociate</a>, which can be regarded as a mild to severe disconnection from physical and emotional experiences.<a class="footnote-ref" id="fnref:106" href="#fn:106">106</a> Observers may notice signs of dissociation in individuals with BPD through diminished expressiveness in their face or voice, or an apparent disconnection and insensitivity to emotional cues or stimuli.<a class="footnote-ref" id="fnref:107" href="#fn:107">107</a>

<h3>Psychotic symptoms</h3>
BPD is predominantly characterized as a disorder involving emotional dysregulation, yet psychotic symptoms frequently occur in individuals with BPD, with about 20–50% of patients reporting psychotic symptoms.<a class="footnote-ref" id="fnref:108" href="#fn:108">108</a> These manifestations have historically been labeled as "pseudo-psychotic" or "psychotic-like", implying a differentiation from symptoms observed in primary <a href="/facts/Psychotic_disorders/cVGd7MKK">psychotic disorders</a>. Studies conducted in the 2010s suggest a closer similarity between psychotic symptoms in BPD and those in recognized psychotic disorders than previously understood.<a class="footnote-ref" id="fnref:109" href="#fn:109">109</a><a class="footnote-ref" id="fnref:110" href="#fn:110">110</a> The distinction of pseudo-psychosis has faced criticism for its weak <a href="/facts/Construct_validity/exjLSRJI">construct validity</a> and the potential to diminish the perceived severity of these symptoms, potentially hindering accurate diagnosis and effective treatment. Consequently, there are suggestions from some in the research community to categorize these symptoms as genuine psychosis, advocating for the abolishment of the distinction between pseudo-psychosis and true psychosis.<a class="footnote-ref" id="fnref:111" href="#fn:111">111</a><a class="footnote-ref" id="fnref:112" href="#fn:112">112</a>
The DSM-5 identifies transient paranoia, exacerbated by stress, as a symptom of BPD.<a class="footnote-ref" id="fnref:113" href="#fn:113">113</a> Research has identified the presence of both <a href="/facts/Hallucination/5eUvLcnp">hallucinations</a> and <a href="/facts/Delusions/cNsg7R41">delusions</a> in individuals with BPD who do not possess an alternate diagnosis that would better explain these symptoms.<a class="footnote-ref" id="fnref:114" href="#fn:114">114</a> Further, <a href="/facts/Interpretative_phenomenological_analysis/UoWqdg8M">phenomenological analysis</a> indicates that <a href="/facts/Auditory_verbal_hallucinations/87K8Skts">auditory verbal hallucinations</a> in BPD patients are indistinguishable from those observed in <a href="/facts/Schizophrenia/FMP4lQ57">schizophrenia</a>.<a class="footnote-ref" id="fnref:115" href="#fn:115">115</a><a class="footnote-ref" id="fnref:116" href="#fn:116">116</a> This has led to suggestions of a potential shared <a href="/facts/Etiological/Bz8MAeSq">etiological</a> basis for hallucinations across BPD and other disorders, including psychotic and <a href="/facts/Affective_disorder/Y0Mjq3QR">affective disorders</a>.<a class="footnote-ref" id="fnref:117" href="#fn:117">117</a>

<h2 id="causes">Causes</h2>
The <a href="/facts/Etiology/Bz8MAeSq">etiology</a>, or causes, of BPD is multifaceted, with no consensus on a singular cause.<a class="footnote-ref" id="fnref:118" href="#fn:118">118</a> BPD may share a connection with <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">post-traumatic stress disorder</a> (PTSD), having both a traumatic substrate.<a class="footnote-ref" id="fnref:119" href="#fn:119">119</a> While childhood trauma is a recognized contributing factor, the roles of congenital brain abnormalities, genetics, <a href="/facts/Neurobiology/o5RV8Cas">neurobiology</a>, and non-traumatic environmental factors remain subjects of ongoing investigation.<a class="footnote-ref" id="fnref:120" href="#fn:120">120</a><a class="footnote-ref" id="fnref:121" href="#fn:121">121</a>

<h3>Genetics and heritability</h3>
Compared to other major psychiatric conditions, the exploration of genetic underpinnings in BPD remains novel.<a class="footnote-ref" id="fnref:122" href="#fn:122">122</a> Estimates suggest the <a href="/facts/Heritability/REQ3CfRe">heritability</a> of BPD ranges from 37% to 69%,<a class="footnote-ref" id="fnref:123" href="#fn:123">123</a> indicating that <a href="/facts/Human_genetic_variation/bgU0WXSf">human genetic variations</a> account for a substantial portion of the risk for BPD within the population. <a href="/facts/Twin_study/J1ykuTtW">Twin studies</a>, which often form the basis of these estimates, may overestimate the perceived influence of genetics due to the shared environment of twins, potentially skewing results.<a class="footnote-ref" id="fnref:124" href="#fn:124">124</a>
Certain studies propose that personality disorders are significantly shaped by genetics, more so than many <a href="/facts/Axis_I_disorders/pJ29wFmm">Axis I disorders</a>, such as depression and eating disorders, and even surpassing the genetic impact on broad <a href="/facts/Personality_traits/Iun5UFdX">personality traits</a>.<a class="footnote-ref" id="fnref:125" href="#fn:125">125</a> A twin study found that BPD ranks as the third most heritable among ten surveyed personality disorders.<a class="footnote-ref" id="fnref:126" href="#fn:126">126</a>
Research involving twin and sibling studies has shown a genetic component to traits associated with BPD, such as impulsive aggression; with the genetic contribution to behavior from <a href="/facts/Serotonin/EzY58q4a">serotonin</a>-related genes appearing to be modest.<a class="footnote-ref" id="fnref:127" href="#fn:127">127</a>
A study conducted by Trull et al. in the Netherlands, which included 711 sibling pairs and 561 parents, aimed to identify <a href="/facts/Genetic_marker/pRshdIBz">genetic markers</a> associated with BPD.<a class="footnote-ref" id="fnref:128" href="#fn:128">128</a> This research identified a linkage to genetic markers on <a href="/facts/Chromosome_9/8NB7HQad">chromosome 9</a> as relevant to BPD characteristics,<a class="footnote-ref" id="fnref:129" href="#fn:129">129</a> underscoring a significant genetic contribution to the <a href="/facts/Variability_(statistics)/xqevRHmz">variability</a> observed in BPD features.<a class="footnote-ref" id="fnref:130" href="#fn:130">130</a> Prior findings from this group indicated that 42% of BPD feature variability could be attributed to genetics, with the remaining 58% owing to environmental factors.<a class="footnote-ref" id="fnref:131" href="#fn:131">131</a>
Among specific genetic variants under scrutiny as of 2012, the <a href="/facts/DRD4_7-repeat_polymorphism/26otIqul">DRD4 7-repeat polymorphism</a> (of the <a href="/facts/Dopamine_receptor_D4/26otIqul">dopamine receptor D4</a>) located on <a href="/facts/Chromosome_11/cB1PGjm5">chromosome 11</a> has been linked to disorganized attachment, and in conjunction with the 10/10-repeat genotype of the <a href="/facts/Dopamine_transporter/V9I2Uy1p">dopamine transporter</a> (DAT), it has been associated with issues with <a href="/facts/Inhibitory_control/XD74uhFc">inhibitory control</a>, both of which are characteristic of BPD.<a class="footnote-ref" id="fnref:132" href="#fn:132">132</a> Additionally, potential links to <a href="/facts/Chromosome_5/wWp5Akno">chromosome 5</a> are being explored, further emphasizing the complex genetic landscape influencing BPD development and manifestation.<a class="footnote-ref" id="fnref:133" href="#fn:133">133</a><a class="footnote-ref" id="fnref:134" href="#fn:134">134</a>

<h3>Psychosocial factors</h3>
<a href="/facts/Empirical_studies/A6cy8Rcy">Empirical studies</a> have established a strong <a href="/facts/Correlation/egkluAEm">correlation</a> between <a href="/facts/Adverse_childhood_experiences/v7eRhPCV">adverse childhood experiences</a> such as <a href="/facts/Child_abuse/Ed2v0ujQ">child abuse</a>, particularly <a href="/facts/Child_sexual_abuse/JFt4u8Mv">child sexual abuse</a>, and the onset of BPD later in life.<a class="footnote-ref" id="fnref:135" href="#fn:135">135</a><a class="footnote-ref" id="fnref:136" href="#fn:136">136</a><a class="footnote-ref" id="fnref:137" href="#fn:137">137</a> Reports from individuals diagnosed with BPD frequently include narratives of extensive abuse and neglect during early childhood, though <a href="/facts/Causality/Swh496X7">causality</a> remains a subject of ongoing investigation.<a class="footnote-ref" id="fnref:138" href="#fn:138">138</a> These individuals are significantly more prone to recount experiences of verbal, emotional, physical, or sexual abuse by caregivers,<a class="footnote-ref" id="fnref:139" href="#fn:139">139</a> alongside a notable frequency of <a href="/facts/Incest/SR46k5AI">incest</a> and loss of caregivers in early childhood.<a class="footnote-ref" id="fnref:140" href="#fn:140">140</a>
Moreover, there have been consistent accounts of caregivers <a href="/facts/Emotional_validation/VrGC9unD">invalidating</a> the individuals' emotions and thoughts, neglecting physical care, failing to provide the necessary protection, and exhibiting emotional withdrawal and inconsistency.<a class="footnote-ref" id="fnref:141" href="#fn:141">141</a> Specifically, female individuals with BPD reporting past neglect or abuse by caregivers have a heightened likelihood of encountering sexual abuse from individuals outside their immediate family circle.<a class="footnote-ref" id="fnref:142" href="#fn:142">142</a> Research also indicates that neurodevelopment variations such as <a href="/facts/Autism/6MTwMNoJ">autism</a> spectrum traits, <a href="/facts/ADHD/uSqjIyhd">ADHD</a>, or <a href="/facts/Highly_sensitive_people/v8s0o4ru">highly sensitive people</a> (HSP) may increase vulnerability to trauma and subsequent borderline personality organization.<a class="footnote-ref" id="fnref:143" href="#fn:143">143</a>
The enduring impact of chronic maltreatment and difficulties in forming <a href="/facts/Secure_attachment/xEShjCrE">secure attachments</a> during childhood has been hypothesized to potentially contribute to the development of BPD.<a class="footnote-ref" id="fnref:144" href="#fn:144">144</a> <a href="/facts/Marsha_Linehan/89d9qWg4">Marsha Linehan</a>'s biosocial developmental theory posits that BPD arises from the interaction between a child's inherent emotional vulnerability and an invalidating environment – an environment characterized by the neglect, ridicule, dismissal, or discouragement of a child's emotions and needs.<a class="footnote-ref" id="fnref:145" href="#fn:145">145</a>

<h3>Brain and neurobiologic factors</h3>
Research employing <a href="/facts/Structural_neuroimaging/dA5Cteaf">structural neuroimaging</a> techniques, such as <a href="/facts/Voxel-based_morphometry/cbkfl9VV">voxel-based morphometry</a>, has reported variations in individuals diagnosed with BPD in specific <a href="/facts/Brain_regions/N8r44v6P">brain regions</a> that have been associated with the <a href="/facts/Psychopathology/QcHKDX2n">psychopathology</a> of BPD. Reductions in volume enclosed have been observed in the <a href="/facts/Hippocampus/X7CqbP8X">hippocampus</a>, <a href="/facts/Orbitofrontal_cortex/r61gtngW">orbitofrontal cortex</a>, <a href="/facts/Anterior_cingulate_cortex/gMBsA5EJ">anterior cingulate cortex</a>, and <a href="/facts/Amygdala/AAy2mHb5">amygdala</a>, among others, which are crucial for <a href="/facts/Emotional_self-regulation/xQBYE50B">emotional self-regulation</a> and <a href="/facts/Stress_management/ASuTfxLM">stress management</a>.<a class="footnote-ref" id="fnref:146" href="#fn:146">146</a>
In addition to structural imaging, a subset of studies utilizing <a href="/facts/Magnetic_resonance_spectroscopy/SFKgdthI">magnetic resonance spectroscopy</a> has investigated the neurometabolic profile within these affected regions. These investigations have focused on the concentrations of various neurometabolites, including <a href="/facts/N-acetylaspartate/TvKIUKal">N-acetylaspartate</a>, <a href="/facts/Creatine/xhBTBard">creatine</a>, compounds related to <a href="/facts/Glutamate/7oXbNcvu">glutamate</a>, and compounds containing <a href="/facts/Choline/wf9EVzfx">choline</a>. These studies aim to show the biochemical alterations that may underlie the symptomatology observed in BPD.<a class="footnote-ref" id="fnref:147" href="#fn:147">147</a>

<h4>Neurological patterns</h4>
Research has shown changes in two <a href="/facts/Brain_circuits/pgngqMLf">brain circuits</a> implicated in the emotional dysregulation characteristic of BPD: firstly, an escalation in activity within brain circuits associated with experiencing severe emotional pain, and secondly, a decreased activation within circuits tasked with the regulation or suppression of these intense emotions. These dysfunctional activations predominantly occur within the <a href="/facts/Limbic_system/TelEk6Jl">limbic system</a>, though individual variances necessitate further neuroimaging research to explore these patterns in detail.<a class="footnote-ref" id="fnref:148" href="#fn:148">148</a>
Contrary to earlier findings, individuals with BPD exhibit decreased amygdala activation in response to heightened negative emotional stimuli compared to control groups. John Krystal, the editor of <a href="/facts/Biological_Psychiatry_(journal)/P9drHLST">Biological Psychiatry</a>, commented on these findings, suggesting they contribute to understanding the innate neurological predisposition of individuals with BPD to lead emotionally turbulent lives, which are not inherently negative or unproductive.<a class="footnote-ref" id="fnref:149" href="#fn:149">149</a> This emotional volatility is consistently linked to disparities in several brain regions, emphasizing the neurobiological underpinnings of BPD.<a class="footnote-ref" id="fnref:150" href="#fn:150">150</a>

<h3>Mediating and moderating factors</h3>
<h4>Executive function and social rejection sensitivity</h4>
High sensitivity to <a href="/facts/Social_rejection/sCEsYowW">social rejection</a> is linked to more severe symptoms of BPD, with <a href="/facts/Executive_function/QtflLj55">executive function</a> playing a mediating role.<a class="footnote-ref" id="fnref:151" href="#fn:151">151</a> Executive function—encompassing <a href="/facts/Planning/ckzCp5tv">planning</a>, <a href="/facts/Working_memory/kzeDD3KQ">working memory</a>, <a href="/facts/Attentional_control/gPbUhqSq">attentional control</a>, and <a href="/facts/Problem-solving/9cuLz5pH">problem-solving</a>—moderates how rejection sensitivity influences BPD symptoms. Studies demonstrate that individuals with lower executive function exhibit a stronger correlation between rejection sensitivity and BPD symptoms.<a class="footnote-ref" id="fnref:152" href="#fn:152">152</a> Conversely, higher executive function may mitigate the impact of rejection sensitivity, potentially offering protection against BPD symptoms.<a class="footnote-ref" id="fnref:153" href="#fn:153">153</a> 

<h2 id="diagnosis">Diagnosis</h2>
The clinical diagnosis of BPD can be made through a <a href="/facts/Psychiatric_assessment/GRe29V04">psychiatric assessment</a> conducted by a <a href="/facts/Mental_health_professional/DMHltcTu">mental health professional</a>, ideally a <a href="/facts/Psychiatrist/hS7EnAU6">psychiatrist</a> or <a href="/facts/Psychologist/J4l4QdX2">psychologist</a>. This comprehensive assessment integrates various sources of information to confirm the diagnosis, encompassing the patient's self-reported <a href="/facts/Clinical_history/P2xSfuYF">clinical history</a>, observations made by the clinician during interviews, and corroborative details obtained from family members, friends, and medical records. It is crucial to thoroughly assess patients for co-morbid mental health conditions, substance use disorders, suicidal ideation, and any self-harming behaviors.<a class="footnote-ref" id="fnref:154" href="#fn:154">154</a>
An effective approach involves presenting the criteria of the disorder to the individual and inquiring if they perceive these criteria as reflective of their experiences. Involving individuals in the diagnostic process may enhance their acceptance of the diagnosis. Despite the stigma associated with BPD and previous notions of its untreatability, disclosing the diagnosis to individuals is generally beneficial. It provides them with validation and directs them to appropriate treatment options.<a class="footnote-ref" id="fnref:155" href="#fn:155">155</a>
The <a href="/facts/Psychological_evaluation/laCeAYHv">psychological evaluation</a> for BPD typically explores the onset and intensity of symptoms and their impact on the individual's <a href="/facts/Quality_of_life/37ljmgAH">quality of life</a>. Critical areas of focus include suicidal thoughts, self-harm behaviors, and any thoughts of harming others.<a class="footnote-ref" id="fnref:156" href="#fn:156">156</a> The diagnosis relies on both the individual's self-reported symptoms and the clinician's observations.<a class="footnote-ref" id="fnref:157" href="#fn:157">157</a> To exclude other potential causes of the symptoms, additional assessments may include a <a href="/facts/Physical_examination/qzI0BK5P">physical examination</a> and <a href="/facts/Blood_test/zevsf3rC">blood tests</a>, to exclude thyroid disorders or substance use disorders.<a class="footnote-ref" id="fnref:158" href="#fn:158">158</a> The <a href="/facts/International_Classification_of_Diseases/mxID6rJp">International Classification of Diseases</a> (ICD-10) categorizes the condition as emotionally unstable personality disorder, with diagnostic criteria similar to those in the <a href="/facts/Diagnostic_and_Statistical_Manual_of_Mental_Disorders%2c_Fifth_Edition/kwhcSJcg">Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</a> (DSM-5), where the disorder's name remains unchanged from previous editions.<a class="footnote-ref" id="fnref:159" href="#fn:159">159</a>

<h3>DSM-5 diagnostic criteria</h3>
Further information: <a href="/facts/Personality_disorder/SxFnlSEW">Personality disorder § DSM-5</a>, and Alternative DSM-5 model for personality disorders
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has eliminated the <a href="/facts/Diagnostic_and_Statistical_Manual_of_Mental_Disorders/pJ29wFmm">multiaxial diagnostic system</a>, integrating all disorders, including personality disorders, into <a href="/facts/DSM-5/kwhcSJcg">Section II</a> of the manual. For a diagnosis of BPD, an individual must meet five out of nine specified diagnostic criteria.<a class="footnote-ref" id="fnref:160" href="#fn:160">160</a> The DSM-5 characterizes BPD as a pervasive pattern of instability in interpersonal relationships, self-image, affect, and a significant propensity towards impulsive behavior.<a class="footnote-ref" id="fnref:161" href="#fn:161">161</a> Moreover, the DSM-5 introduces alternative diagnostic criteria for BPD in <a href="/facts/DSM-5/kwhcSJcg">Section III</a>, titled Alternative DSM-5 Model for Personality Disorders (AMPD). These criteria are rooted in trait research and necessitate the identification of at least four out of seven maladaptive traits.<a class="footnote-ref" id="fnref:162" href="#fn:162">162</a> Marsha Linehan highlights the diagnostic challenges faced by mental health professionals in using the DSM criteria due to the broad range of behaviors they encompass.<a class="footnote-ref" id="fnref:163" href="#fn:163">163</a> To mitigate these challenges, Linehan categorizes BPD symptoms into five principal areas of dysregulation: emotions, behavior, interpersonal relationships, sense of self, and cognition.<a class="footnote-ref" id="fnref:164" href="#fn:164">164</a>

<h3>International Classification of Disease (ICD) diagnostic criteria</h3>
Further information: ICD-11 classification of personality disorders
The <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a>'s <a href="/facts/ICD-11/AAItcoCH">ICD-11</a> completely restructured its personality disorder section. It classifies BPD as Personality disorder, (<a href="https://icd.who.int/browse/latest-release/mms/en#941859884">6D10</a>) Borderline pattern, (<a href="https://icd.who.int/browse/latest-release/mms/en#2006821354">6D11.5</a>).<a class="footnote-ref" id="fnref:165" href="#fn:165">165</a> Previously, the ICD-10 (version 2019) had identified a condition akin to BPD, termed Emotionally unstable personality disorder (EUPD) (<a href="https://icd.who.int/browse10/2019/en#/F60.3">F60.3</a>).<a class="footnote-ref" id="fnref:166" href="#fn:166">166</a> The borderline pattern specifier is defined as a personality disturbance marked by instability in interpersonal relationships, self-image, and emotions, as well as impulsivity.

<blockquote>The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by five (or more) of the following:
<ul><li>Frantic efforts to avoid real or imagined abandonment.</li>
<li>A pattern of unstable and intense interpersonal relationships, which may be characterized by vacillations between idealization and devaluation, typically associated with both a strong desire for and fear of closeness and intimacy.</li>
<li>Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.</li>
<li>A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours (e.g., risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating).</li>
<li>Recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation).</li>
<li>Emotional instability due to marked reactivity of mood. Fluctuations of mood may be triggered either internally (e.g., by one's own thoughts) or by external events. As a consequence, the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days.</li>
<li>Chronic feelings of emptiness.</li>
<li>Inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights).</li>
<li>Transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.</li></ul>
Other manifestations of Borderline pattern, not all of which may be present in a given individual at a given time, include the following:

<ul><li>A view of the self as inadequate, bad, guilty, disgusting, and contemptible.</li>
<li>An experience of the self as profoundly different and isolated from other people; a painful sense of alienation and pervasive loneliness.</li>
<li>Proneness to rejection hypersensitivity; problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships; frequent misinterpretation of social signals.— <a href="https://icd.who.int/browse/2024-01/mms/en#2006821354%7C">6D11.5 Borderline pattern in ICD-11</a></li></ul></blockquote>
<h3>Millon's subtypes</h3>
Psychologist <a href="/facts/Theodore_Millon/x4WmNeN3">Theodore Millon</a> proposed four subtypes of BPD, where individuals with BPD would exhibit none, one, or multiple subtypes.<a class="footnote-ref" id="fnref:167" href="#fn:167">167</a>

<table><tbody><tr><th>Subtype</th><th>Features</th><th>Personality Traits</th></tr><tr><td>Discouraged borderline</td><td>Including <a href="/facts/Avoidant_personality_disorder/0oYpmo4J">avoidant</a>, <a href="/facts/Depressive_personality_disorder/tuJ6LYU8">depressive</a>, and <a href="/facts/Dependant_personality_disorder/s4g6ST3R">dependant</a> features</td><td>Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.</td></tr><tr><td>Impulsive borderline</td><td>Including <a href="/facts/Histrionic_personality_disorder/u2rtcQ81">histrionic</a> or <a href="/facts/Antisocial_personality_disorder/RK4jEtpT">antisocial</a> features</td><td>Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.</td></tr><tr><td>Petulant borderline</td><td>Including <a href="/facts/Passive-aggressive_personality_disorder/y4GfkFwh">negativistic</a> features</td><td>Negativistic, impatient, restless, as well as stubborn defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.</td></tr><tr><td>Self-destructive borderline</td><td>Including <a href="/facts/Depressive_personality_disorder/tuJ6LYU8">depressive</a> or <a href="/facts/Self-defeating_personality_disorder/EIoKW6jA">masochistic</a> features</td><td>Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide</td></tr></tbody></table>
<h3>Misdiagnosis</h3>
Main article: <a href="/facts/Misdiagnosis_of_borderline_personality_disorder/veu4P5Xl">Misdiagnosis of borderline personality disorder</a>
Individuals with BPD are subject to <a href="/facts/Misdiagnosis/1RyM0bdK">misdiagnosis</a> due to various factors, such as the overlap (comorbidity) of BPD symptoms with those of other disorders such as depression, PTSD, and bipolar disorder.<a class="footnote-ref" id="fnref:168" href="#fn:168">168</a><a class="footnote-ref" id="fnref:169" href="#fn:169">169</a> Misdiagnosis of BPD can lead to a range of adverse consequences. Diagnosis plays a crucial role in informing healthcare professionals about the patient's mental health status, guiding treatment strategies, and facilitating accurate reporting of successful interventions.<a class="footnote-ref" id="fnref:170" href="#fn:170">170</a> Consequently, misdiagnosis may deprive individuals of access to suitable psychiatric medications or evidence-based psychological interventions tailored to their specific disorders.<a class="footnote-ref" id="fnref:171" href="#fn:171">171</a>
Critics of the BPD diagnosis contend that it is indistinguishable from negative affectivity upon undergoing regression and factor analyses. They maintain that the diagnosis of BPD does not provide additional insight beyond what is captured by other diagnoses, positing that it may be redundant or potentially misleading.<a class="footnote-ref" id="fnref:172" href="#fn:172">172</a>

<h3>Adolescence and prodrome</h3>
The onset of BPD symptoms typically occurs during adolescence or early adulthood, with possible early signs in childhood.<a class="footnote-ref" id="fnref:173" href="#fn:173">173</a> Predictive symptoms in adolescents include <a href="/facts/Body_image/ep7HL7et">body image</a> issues, extreme sensitivity to rejection, behavioral challenges, <a href="/facts/Non-suicidal_self-injury/CKkaTnjK">non-suicidal self-injury</a>, seeking exclusive relationships, and profound shame.<a class="footnote-ref" id="fnref:174" href="#fn:174">174</a> Although many adolescents exhibit these symptoms without developing BPD, those who do are significantly more likely to develop the disorder and potentially face long-term social challenges.<a class="footnote-ref" id="fnref:175" href="#fn:175">175</a>
BPD is recognized as a stable and valid diagnosis during adolescence, supported by the DSM-5 and ICD-11.<a class="footnote-ref" id="fnref:176" href="#fn:176">176</a><a class="footnote-ref" id="fnref:177" href="#fn:177">177</a><a class="footnote-ref" id="fnref:178" href="#fn:178">178</a><a class="footnote-ref" id="fnref:179" href="#fn:179">179</a> Early detection and treatment of BPD in young individuals are emphasized in national guidelines across various countries, including the US, Australia, the UK, Spain, and Switzerland, highlighting the importance of early intervention.<a class="footnote-ref" id="fnref:180" href="#fn:180">180</a><a class="footnote-ref" id="fnref:181" href="#fn:181">181</a><a class="footnote-ref" id="fnref:182" href="#fn:182">182</a>
Historically, diagnosing BPD during adolescence was met with caution,<a class="footnote-ref" id="fnref:183" href="#fn:183">183</a><a class="footnote-ref" id="fnref:184" href="#fn:184">184</a><a class="footnote-ref" id="fnref:185" href="#fn:185">185</a> due to concerns about the accuracy of diagnosing young individuals,<a class="footnote-ref" id="fnref:186" href="#fn:186">186</a><a class="footnote-ref" id="fnref:187" href="#fn:187">187</a> the potential misinterpretation of normal adolescent behaviors, stigma, and the stability of personality during this developmental stage.<a class="footnote-ref" id="fnref:188" href="#fn:188">188</a> Despite these challenges, research has confirmed the validity and clinical utility of the BPD diagnosis in adolescents,<a class="footnote-ref" id="fnref:189" href="#fn:189">189</a><a class="footnote-ref" id="fnref:190" href="#fn:190">190</a><a class="footnote-ref" id="fnref:191" href="#fn:191">191</a><a class="footnote-ref" id="fnref:192" href="#fn:192">192</a> though misconceptions persist among mental health care professionals,<a class="footnote-ref" id="fnref:193" href="#fn:193">193</a><a class="footnote-ref" id="fnref:194" href="#fn:194">194</a><a class="footnote-ref" id="fnref:195" href="#fn:195">195</a> contributing to clinical reluctance in diagnosing and a key barrier to the provision of effective treatment BPD in this population.<a class="footnote-ref" id="fnref:196" href="#fn:196">196</a><a class="footnote-ref" id="fnref:197" href="#fn:197">197</a><a class="footnote-ref" id="fnref:198" href="#fn:198">198</a>
A diagnosis of BPD in adolescence can indicate the persistence of the disorder into adulthood,<a class="footnote-ref" id="fnref:199" href="#fn:199">199</a><a class="footnote-ref" id="fnref:200" href="#fn:200">200</a> with outcomes varying among individuals. Some maintain a stable diagnosis over time, while others may not consistently meet the diagnostic criteria.<a class="footnote-ref" id="fnref:201" href="#fn:201">201</a> Early diagnosis facilitates the development of effective treatment plans,<a class="footnote-ref" id="fnref:202" href="#fn:202">202</a><a class="footnote-ref" id="fnref:203" href="#fn:203">203</a> including family therapy, to support adolescents with BPD.<a class="footnote-ref" id="fnref:204" href="#fn:204">204</a>

<h3>Differential diagnosis and comorbidity</h3>
Lifetime <a href="/facts/Comorbidity/tX5TvuKJ">co-occurring</a> (comorbid) conditions are prevalent among individuals diagnosed with BPD. Individuals with BPD exhibit higher rates of comorbidity compared to those diagnosed with other personality disorders. These comorbidities include <a href="/facts/Mood_disorders/Y0Mjq3QR">mood disorders</a> (such as <a href="/facts/Major_depressive_disorder/l2lQeWqr">major depressive disorder</a> and <a href="/facts/Bipolar_disorder/aMDwXbV0">bipolar disorder</a>), <a href="/facts/Anxiety_disorder/wh9zFH1V">anxiety disorders</a> (including <a href="/facts/Panic_disorder/jRfhx14r">panic disorder</a>, <a href="/facts/Social_anxiety_disorder/25XIzJ0o">social anxiety disorder</a>, and <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">post-traumatic stress disorder</a> (PTSD)), other personality disorders (notably <a href="/facts/Schizotypal_personality_disorder/SJed1v2E">schizotypal</a>, <a href="/facts/Antisocial_personality_disorder/RK4jEtpT">antisocial</a>, and <a href="/facts/Dependent_personality_disorder/s4g6ST3R">dependent personality disorder</a>), substance use disorder, <a href="/facts/Eating_disorders/3GwQ71sD">eating disorders</a> (<a href="/facts/Anorexia_nervosa/00KSqEn7">anorexia nervosa</a> and <a href="/facts/Bulimia_nervosa/vha4lPpd">bulimia nervosa</a>), <a href="/facts/Attention_deficit_hyperactivity_disorder/uSqjIyhd">attention deficit hyperactivity disorder</a> (ADHD),<a class="footnote-ref" id="fnref:205" href="#fn:205">205</a> <a href="/facts/Somatic_symptom_disorder/UpmecJfr">somatic symptom disorder</a>, and the <a href="/facts/Dissociative_disorders/HgWW3vbp">dissociative disorders</a>.<a class="footnote-ref" id="fnref:206" href="#fn:206">206</a> It is advised that a personality disorder diagnosis should be made cautiously during untreated mood episodes or disorders unless a comprehensive lifetime history supports the existence of a personality disorder.<a class="footnote-ref" id="fnref:207" href="#fn:207">207</a>

<h4>Comorbid Axis I disorders</h4>
		Gender variations in lifetime prevalence of comorbid Axis I disorders among individuals diagnosed with BPD: A comparative study between 2008<a class="footnote-ref" id="fnref:208" href="#fn:208">208</a> and 1998<a class="footnote-ref" id="fnref:209" href="#fn:209">209</a><table>		<tbody><tr><th>Axis I diagnosis</th><th>Overall (%)</th><th>Male (%)</th><th>Female (%)</th></tr>	<tr><th>Mood disorders</th><th>75.0</th><th>68.7</th><th>80.2</th></tr>	<tr><td><a href="/facts/Major_depressive_disorder/l2lQeWqr">Major depressive disorder</a></td><td>32.1</td><td>27.2</td><td>36.1</td></tr>	<tr><td><a href="/facts/Dysthymia/bDUdlrQ5">Dysthymia</a></td><td>09.7</td><td>07.1</td><td>11.9</td></tr>	<tr><td><a href="/facts/Bipolar_I_disorder/YWtzmKGI">Bipolar I disorder</a></td><td>31.8</td><td>30.6</td><td>32.7</td></tr>	<tr><td><a href="/facts/Bipolar_II_disorder/KBjuwHyT">Bipolar II disorder</a></td><td>07.7</td><td>06.7</td><td>08.5</td></tr>	<tr><th>Anxiety disorders</th><th>74.2</th><th>66.1</th><th>81.1</th></tr>	<tr><td><a href="/facts/Panic_disorder/jRfhx14r">Panic disorder</a> with <a href="/facts/Agoraphobia/l56SJ75n">agoraphobia</a></td><td>11.5</td><td>07.7</td><td>14.6</td></tr>	<tr><td>Panic disorder without agoraphobia</td><td>18.8</td><td>16.2</td><td>20.9</td></tr>	<tr><td><a href="/facts/Social_phobia/25XIzJ0o">Social phobia</a></td><td>29.3</td><td>25.2</td><td>32.7</td></tr>	<tr><td><a href="/facts/Specific_phobia/rbzljeLQ">Specific phobia</a></td><td>37.5</td><td>26.6</td><td>46.6</td></tr>	<tr><td><a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">PTSD</a></td><td>39.2</td><td>29.5</td><td>47.2</td></tr>	<tr><td><a href="/facts/Generalized_anxiety_disorder/FJRBB4fM">Generalized anxiety disorder</a></td><td>35.1</td><td>27.3</td><td>41.6</td></tr>	<tr><td><a href="/facts/Obsessive%25E2%2580%2593compulsive_disorder/bIhDh4dz">Obsessive–compulsive disorder</a>**</td><td>15.6</td><td>–</td><td>–</td></tr>	<tr><th>Substance use disorders</th><th>72.9</th><th>80.9</th><th>66.2</th></tr>	<tr><td>Any <a href="/facts/Alcohol_use_disorder/KGPzpChp">alcohol use disorder</a></td><td>57.3</td><td>71.2</td><td>45.6</td></tr>	<tr><td>Any non-alcohol <a href="/facts/Substance_use_disorder/pSbdzb6a">substance use disorder</a></td><td>36.2</td><td>44.0</td><td>29.8</td></tr>	<tr><th>Eating disorders**</th><th>53.0</th><th>20.5</th><th>62.2</th></tr>	<tr><td><a href="/facts/Anorexia_nervosa/00KSqEn7">Anorexia nervosa</a>**</td><td>20.8</td><td>07 *</td><td>25 *</td></tr>	<tr><td><a href="/facts/Bulimia_nervosa/vha4lPpd">Bulimia nervosa</a>**</td><td>25.6</td><td>10 *</td><td>30 *</td></tr>	<tr><td><a href="/facts/Eating_disorder_not_otherwise_specified/fEmHy6MP">Eating disorder not otherwise specified</a>**</td><td>26.1</td><td>10.8</td><td>30.4</td></tr>	<tr><th>Somatoform disorders**</th><th>10.3</th><th>10 *</th><th>10 *</th></tr>	<tr><td><a href="/facts/Somatization_disorder/UJdEDK0d">Somatization disorder</a>**</td><td>04.2</td><td>–</td><td>–</td></tr>	<tr><td><a href="/facts/Hypochondriasis/5Pv5Jb1y">Hypochondriasis</a>**</td><td>04.7</td><td>–</td><td>–</td></tr>	<tr><td><a href="/facts/Psychogenic_pain/sRAr9hh8">Somatoform pain disorder</a>**</td><td>04.2</td><td>–</td><td>–</td></tr>	<tr><th><a href="/facts/Psychotic_disorders/cVGd7MKK">Psychotic disorders</a>**</th><th>01.3</th><th>01 *</th><th>01 *</th></tr>	<tr><td colspan="4">* Approximate values ** Values from 1998 study<a class="footnote-ref" id="fnref:210" href="#fn:210">210</a>– Value not provided by from both studies</td></tr></tbody></table>
A 2008 study stated that 75% of individuals with BPD at some point meet criteria for mood disorders, notably major depression and bipolar I, with a similar percentage for anxiety disorders.<a class="footnote-ref" id="fnref:211" href="#fn:211">211</a>[non-primary source needed] They found that 73% of individuals with BPD meet criteria for substance use disorders, and about 40% for PTSD.<a class="footnote-ref" id="fnref:212" href="#fn:212">212</a> A higher proportion of males meet criteria for substance use disorders, whereas females are more likely to have PTSD and eating disorders.<a class="footnote-ref" id="fnref:213" href="#fn:213">213</a> 38% of individuals with BPD were found to meet criteria for ADHD,<a class="footnote-ref" id="fnref:214" href="#fn:214">214</a> and 15% for <a href="/facts/Autism_spectrum_disorder/bzouRyMI">autism spectrum disorder</a> (ASD) in separate studies.<a class="footnote-ref" id="fnref:215" href="#fn:215">215</a>[non-primary source needed]

<h4>Mood disorders</h4>
Seventy-five percent (75%) of individuals with BPD concurrently experience mood disorders, notably major depressive disorder (MDD) or bipolar disorder (BD),<a class="footnote-ref" id="fnref:216" href="#fn:216">216</a> complicating diagnostic clarity due to overlapping symptoms.<a class="footnote-ref" id="fnref:217" href="#fn:217">217</a><a class="footnote-ref" id="fnref:218" href="#fn:218">218</a><a class="footnote-ref" id="fnref:219" href="#fn:219">219</a> Distinguishing BPD from BD is particularly challenging, as behaviors part of diagnostic criteria for both BPD and BD may emerge during depressive or <a href="/facts/Manic_episodes/qYV8BBbt">manic episodes</a> in BD. However, these behaviours are likely to subside as mood normalises in BD to <a href="/facts/Euthymia_(medicine)/IgWGjuQC">euthymia</a>, but typically are pervasive in BPD.<a class="footnote-ref" id="fnref:220" href="#fn:220">220</a>
Differences between BPD and BD mood swings include their duration, with BD episodes typically lasting for at least two weeks at a time,<a class="footnote-ref" id="fnref:221" href="#fn:221">221</a> in contrast to the rapid and transient mood shifts seen in BPD.<a class="footnote-ref" id="fnref:222" href="#fn:222">222</a><a class="footnote-ref" id="fnref:223" href="#fn:223">223</a><a class="footnote-ref" id="fnref:224" href="#fn:224">224</a> Additionally, BD mood changes are generally unresponsive to environmental stimuli, whereas BPD moods are. For example, a positive event might alleviate a depressive mood in BPD, responsiveness not observed in BD.<a class="footnote-ref" id="fnref:225" href="#fn:225">225</a> Furthermore, the <a href="/facts/Euphoria/u4cnbWC4">euphoria</a> in BPD lacks the <a href="/facts/Racing_thoughts/9UKtA4SE">racing thoughts</a> and reduced need for sleep characteristic of BD,<a class="footnote-ref" id="fnref:226" href="#fn:226">226</a> though sleep disturbances have been noted in BPD.<a class="footnote-ref" id="fnref:227" href="#fn:227">227</a>
Historically, BPD was considered a milder form of BD,<a class="footnote-ref" id="fnref:228" href="#fn:228">228</a><a class="footnote-ref" id="fnref:229" href="#fn:229">229</a> or part of the bipolar spectrum. However, distinctions in phenomenology, family history, disease progression, and treatment responses refute a singular underlying mechanism for both conditions.<a class="footnote-ref" id="fnref:230" href="#fn:230">230</a> Research indicates only a modest association between BPD and BD, challenging the notion of a close spectrum relationship.<a class="footnote-ref" id="fnref:231" href="#fn:231">231</a><a class="footnote-ref" id="fnref:232" href="#fn:232">232</a>

<h4>Premenstrual dysphoric disorder</h4>
BPD is a psychiatric condition distinguishable from <a href="/facts/Premenstrual_dysphoric_disorder/zmg0b1rX">premenstrual dysphoric disorder</a> (PMDD), despite some symptom overlap. BPD affects individuals persistently across all stages of the menstrual cycle, unlike PMDD, which is confined to the <a href="/facts/Luteal_phase/R9rpFdKT">luteal phase</a> and ends with <a href="/facts/Menstruation/7cv4HzLe">menstruation</a>.<a class="footnote-ref" id="fnref:233" href="#fn:233">233</a><a class="footnote-ref" id="fnref:234" href="#fn:234">234</a> While PMDD, affecting 3–8% of women,<a class="footnote-ref" id="fnref:235" href="#fn:235">235</a> includes mood swings, irritability, and anxiety tied to the <a href="/facts/Menstrual_cycle/AY6Y9xxM">menstrual cycle</a>, BPD presents a broader, constant emotional and behavioral challenge irrespective of hormonal changes.

<h4>Comorbid personality disorders</h4>
Approximately 74% of individuals with BPD also fulfill criteria for another personality disorder during their lifetime, according to research conducted in 2008.<a class="footnote-ref" id="fnref:236" href="#fn:236">236</a> The most prevalent co-occurring disorders are from Cluster A (paranoid, schizoid, and schizotypal personality disorders), affecting about half of those with BPD, with schizotypal personality disorder alone impacting one-third of individuals. Being part of Cluster B, BPD patients also commonly share characteristics with other Cluster B disorders (antisocial, histrionic, and narcissistic personality disorders), with nearly half of individuals with BPD showing signs of these conditions, and narcissistic personality disorder affecting roughly one-third.<a class="footnote-ref" id="fnref:237" href="#fn:237">237</a> Cluster C disorders (avoidant, dependent, and obsessive-compulsive personality disorders) have the least comorbidity with BPD, with just under a third of individuals with BPD meeting the criteria for a Cluster C disorder.<a class="footnote-ref" id="fnref:238" href="#fn:238">238</a>

<h2 id="management">Management</h2>
Main article: <a href="/facts/Management_of_borderline_personality_disorder/7LdC64gs">Management of borderline personality disorder</a>
The main approach to managing BPD is through <a href="/facts/Psychotherapy/n2hDjaop">psychotherapy</a>, tailored to the individual's specific needs rather than applying a one-size-fits-all model based on the diagnosis alone.<a class="footnote-ref" id="fnref:239" href="#fn:239">239</a> While medications do not directly treat BPD, they are beneficial in managing comorbid conditions like depression and anxiety.<a class="footnote-ref" id="fnref:240" href="#fn:240">240</a> Evidence states short-term hospitalization does not offer advantages over community care in terms of enhancing outcomes or in the long-term prevention of suicidal behavior among individuals with BPD.<a class="footnote-ref" id="fnref:241" href="#fn:241">241</a>

<h3>Psychotherapy</h3>
Long-term, consistent psychotherapy stands as the preferred method for treating BPD and engagement in any therapeutic approach tends to surpass the absence of treatment, particularly in diminishing self-harm impulses.<a class="footnote-ref" id="fnref:242" href="#fn:242">242</a> Among the effective psychotherapeutic approaches, dialectical behavior therapy (DBT), <a href="/facts/Schema_therapy/Ej4FPfb9">schema therapy</a>, and <a href="/facts/Psychodynamic/JIuNdo0E">psychodynamic</a> therapies have shown efficacy, although improvements may require extensive time, often years of dedicated effort.<a class="footnote-ref" id="fnref:243" href="#fn:243">243</a>
Available treatments for BPD include <a href="/facts/Dynamic_deconstructive_psychotherapy/HGKvQamN">dynamic deconstructive psychotherapy</a> (DDP),<a class="footnote-ref" id="fnref:244" href="#fn:244">244</a> <a href="/facts/Mentalization-based_treatment/1QEnz7KF">mentalization-based treatment</a> (MBT), <a href="/facts/Schema_therapy/Ej4FPfb9">schema therapy</a>, transference-focused psychotherapy, dialectical behavior therapy (DBT), and general psychiatric management.<a class="footnote-ref" id="fnref:245" href="#fn:245">245</a><a class="footnote-ref" id="fnref:246" href="#fn:246">246</a> The effectiveness of these therapies does not significantly vary between more intensive and less intensive approaches.<a class="footnote-ref" id="fnref:247" href="#fn:247">247</a>
<a href="/facts/Transference_focused_psychotherapy/nFd5YuVm">Transference-focused psychotherapy</a> is designed to mitigate absolutist thinking by encouraging individuals to express their interpretations of social interactions and their emotions, thereby fostering more nuanced and flexible categorizations.<a class="footnote-ref" id="fnref:248" href="#fn:248">248</a> <a href="/facts/Dialectical_behavior_therapy/jRwS2zQR">Dialectical behavior therapy</a> (DBT), on the other hand, focuses on developing skills in four main areas: interpersonal communication, distress tolerance, emotional regulation, and mindfulness, aiming to equip individuals with BPD with tools to manage intense emotions and improve interpersonal relationships.<a class="footnote-ref" id="fnref:249" href="#fn:249">249</a><a class="footnote-ref" id="fnref:250" href="#fn:250">250</a><a class="footnote-ref" id="fnref:251" href="#fn:251">251</a>
<a href="/facts/Cognitive_behavioral_therapy/LRALDkkU">Cognitive behavioral therapy</a> (CBT) targets the modification of behaviors and beliefs through problem identification related to BPD, showing efficacy in reducing anxiety, mood symptoms, suicidal ideation, and self-harming actions.<a class="footnote-ref" id="fnref:252" href="#fn:252">252</a>
<a href="/facts/Mentalization-based_treatment/1QEnz7KF">Mentalization-based therapy</a> and transference-focused psychotherapy draw from <a href="/facts/Psychodynamic/JIuNdo0E">psychodynamic</a> principles, while DBT is rooted in cognitive-behavioral principles and <a href="/facts/Mindfulness/3v40h59U">mindfulness</a>.<a class="footnote-ref" id="fnref:253" href="#fn:253">253</a> General psychiatric management integrates key aspects from these treatments and is seen as more accessible and less resource-intensive.<a class="footnote-ref" id="fnref:254" href="#fn:254">254</a> Studies suggest DBT and MBT may be particularly effective, with ongoing research into developing abbreviated forms of these therapies to enhance accessibility and reduce both financial and resource burdens on patients and providers.<a class="footnote-ref" id="fnref:255" href="#fn:255">255</a><a class="footnote-ref" id="fnref:256" href="#fn:256">256</a><a class="footnote-ref" id="fnref:257" href="#fn:257">257</a>
<a href="/facts/Schema_therapy/Ej4FPfb9">Schema therapy</a> considers <a href="/facts/List_of_maladaptive_schemas/NaFmAVhj">early maladaptive schemas</a>, conceptualized as organized patterns that recur throughout life in response to memories, emotions, bodily sensations, and cognitions associated with unmet childhood needs.<a class="footnote-ref" id="fnref:258" href="#fn:258">258</a>
Additionally, <a href="/facts/Mindfulness_meditation/3v40h59U">mindfulness meditation</a> has been associated with positive structural changes in the brain and improvements in BPD symptoms, with some participants in mindfulness-based interventions no longer meeting the diagnostic criteria for BPD after treatment.<a class="footnote-ref" id="fnref:259" href="#fn:259">259</a><a class="footnote-ref" id="fnref:260" href="#fn:260">260</a><a class="footnote-ref" id="fnref:261" href="#fn:261">261</a><a class="footnote-ref" id="fnref:262" href="#fn:262">262</a>

<h3>Medications</h3>
A 2010 <a href="/facts/Cochrane_(organisation)/UlmdJ1H8">Cochrane</a> review found that no medications were effective for the core symptoms of BPD, such as chronic feelings of emptiness, identity disturbances, and fears of abandonment. Some medications might impact isolated symptoms of BPD or those of comorbid conditions.<a class="footnote-ref" id="fnref:263" href="#fn:263">263</a> A 2017 systematic review<a class="footnote-ref" id="fnref:264" href="#fn:264">264</a> and a 2020 Cochrane review<a class="footnote-ref" id="fnref:265" href="#fn:265">265</a> confirmed these findings.<a class="footnote-ref" id="fnref:266" href="#fn:266">266</a><a class="footnote-ref" id="fnref:267" href="#fn:267">267</a> This 2020 Cochrane review found that while some medications, like mood stabilizers and second-generation antipsychotics, showed some benefits, <a href="/facts/SSRI/L6jjcmEH">SSRIs</a> and <a href="/facts/SNRI/PSr56Vxh">SNRIs</a> lacked high-level evidence of effectiveness.<a class="footnote-ref" id="fnref:268" href="#fn:268">268</a> The review concluded that stabilizers and second-generation antipsychotics may effectively treat some symptoms and associated psychopathology of BPD, but these drugs are not effective for the overall severity of BPD; as such, pharmacotherapy should target specific symptoms.<a class="footnote-ref" id="fnref:269" href="#fn:269">269</a>
Specific medications have shown varied effectiveness on BPD symptoms: <a href="/facts/Haloperidol/ue4TJKmu">haloperidol</a> and <a href="/facts/Flupenthixol/lx3rT6tU">flupenthixol</a> for anger and suicidal behavior reduction; <a href="/facts/Aripiprazole/A6g2UwMz">aripiprazole</a> for decreased impulsivity and interpersonal problems;<a class="footnote-ref" id="fnref:270" href="#fn:270">270</a> and <a href="/facts/Olanzapine/8BhqJuPM">olanzapine</a> and quetiapine for reducing affective instability, anger, and anxiety, though olanzapine showed less benefit for suicidal ideation than a placebo.<a class="footnote-ref" id="fnref:271" href="#fn:271">271</a><a class="footnote-ref" id="fnref:272" href="#fn:272">272</a> Mood stabilizers like <a href="/facts/Valproate/q31XYzd9">valproate</a> and <a href="/facts/Topiramate/Bv5gScRt">topiramate</a> showed some improvements in depression, impulsivity, and anger, but the effect of <a href="/facts/Carbamazepine/Hd1By1Mj">carbamazepine</a> was not significant. Of the <a href="/facts/Antidepressant/N62ND3Fa">antidepressants</a>, <a href="/facts/Amitriptyline/7YGkJGfr">amitriptyline</a> may reduce depression, but <a href="/facts/Mianserin/pV7Q1lnL">mianserin</a>, <a href="/facts/Fluoxetine/U28lM3Pm">fluoxetine</a>, <a href="/facts/Fluvoxamine/1wmv6FLh">fluvoxamine</a>, and <a href="/facts/Phenelzine/lwCH0IDJ">phenelzine</a> sulfate showed no effect. <a href="/facts/Omega-3_fatty_acid/X72Ynqov">Omega-3 fatty acid</a> may ameliorate suicidality and improve depression. As of 2017, trials with these medications had not been replicated and the effect of long-term use had not been assessed.<a class="footnote-ref" id="fnref:273" href="#fn:273">273</a><a class="footnote-ref" id="fnref:274" href="#fn:274">274</a> <a href="/facts/Lamotrigine/mRmmMuj2">Lamotrigine</a><a class="footnote-ref" id="fnref:275" href="#fn:275">275</a> and other medications like IV ketamine<a class="footnote-ref" id="fnref:276" href="#fn:276">276</a><a class="footnote-ref" id="fnref:277" href="#fn:277">277</a> for unresponsive depression require further research for their effects on BPD.
<a href="/facts/Quetiapine/hI3hPqEH">Quetiapine</a> showed some benefits for BPD severity, psychosocial impairment, aggression, and manic symptoms at doses of 150 mg/day to 300 mg/day,<a class="footnote-ref" id="fnref:278" href="#fn:278">278</a> but the evidence is mixed.<a class="footnote-ref" id="fnref:279" href="#fn:279">279</a>
Despite the lack of solid evidence, <a href="/facts/SSRI/L6jjcmEH">SSRIs</a> and <a href="/facts/SNRI/PSr56Vxh">SNRIs</a> are prescribed off-label for BPD<a class="footnote-ref" id="fnref:280" href="#fn:280">280</a><a class="footnote-ref" id="fnref:281" href="#fn:281">281</a> and are typically considered adjunctive to psychotherapy.<a class="footnote-ref" id="fnref:282" href="#fn:282">282</a>
Given the weak evidence and potential for serious side effects, the UK <a href="/facts/National_Institute_for_Health_and_Clinical_Excellence/83vtP8Lk">National Institute for Health and Clinical Excellence</a> (NICE) recommends against using drugs specifically for BPD or its associated behaviors and symptoms. Medications may be considered for treating comorbid conditions within a broader treatment plan.<a class="footnote-ref" id="fnref:283" href="#fn:283">283</a> Reviews suggest minimizing the use of medications for BPD to very low doses and short durations, emphasizing the need for careful evaluation and management of drug treatment in BPD.<a class="footnote-ref" id="fnref:284" href="#fn:284">284</a><a class="footnote-ref" id="fnref:285" href="#fn:285">285</a>

<h3>Health care services</h3>
The disparity between those benefiting from treatment and those receiving it, known as the "treatment gap," arises from several factors. These include reluctance to seek treatment, healthcare providers' underdiagnosis, and limited availability and accessibility to advanced treatments.<a class="footnote-ref" id="fnref:286" href="#fn:286">286</a> Furthermore, establishing clear pathways to services and medical care remains a challenge, complicating access to treatment for individuals with BPD. Despite efforts, many healthcare providers lack the training or resources to address severe BPD effectively, an issue acknowledged by both affected individuals and medical professionals.<a class="footnote-ref" id="fnref:287" href="#fn:287">287</a>
In the context of psychiatric hospitalizations, individuals with BPD constitute approximately 20% of admissions.<a class="footnote-ref" id="fnref:288" href="#fn:288">288</a> While many engage in outpatient treatment consistently over several years, reliance on more restrictive and expensive treatment options, such as inpatient admission, tends to decrease over time.<a class="footnote-ref" id="fnref:289" href="#fn:289">289</a>
Service experiences vary among individuals with BPD.<a class="footnote-ref" id="fnref:290" href="#fn:290">290</a> Assessing suicide risk poses a challenge for clinicians, with patients underestimating the lethality of self-harm behaviors. The suicide risk among people with BPD is significantly higher than that of the general population, characterized by a history of multiple suicide attempts during crises.<a class="footnote-ref" id="fnref:291" href="#fn:291">291</a> About half of all individuals who commit suicide are diagnosed with a personality disorder, with BPD being the most common association.<a class="footnote-ref" id="fnref:292" href="#fn:292">292</a>

<h2 id="prognosis">Prognosis</h2>
With treatment, the majority of people with BPD can find relief from distressing symptoms and achieve <a href="/facts/Remission_(medicine)/8HuMct73">remission</a>, defined as a consistent relief from symptoms for at least two years.<a class="footnote-ref" id="fnref:293" href="#fn:293">293</a><a class="footnote-ref" id="fnref:294" href="#fn:294">294</a> Remission rates are about 50 to 70% over the course of five years.<a class="footnote-ref" id="fnref:295" href="#fn:295">295</a> The remission rate is estimated to be around 50% at 10 years, with 93% of people being able to achieve a 2-year remission and 86% achieving at least a 4-year remission, with a 30% risk of relapse over 10 years.<a class="footnote-ref" id="fnref:296" href="#fn:296">296</a> 
Patient personality can play an important role during the therapeutic process, leading to better clinical outcomes. Recent research has shown that BPD patients undergoing <a href="/facts/Dialectical_behavior_therapy/jRwS2zQR">dialectical behavior therapy</a> (DBT) exhibit better clinical outcomes correlated with higher levels of the trait of <a href="/facts/Agreeableness/92jTWuny">agreeableness</a> in the patient, compared to patients either low in agreeableness or not being treated with DBT. This association was mediated through the strength of a <a href="/facts/Working_alliance/6qM0fvxw">working alliance</a> between patient and therapist; that is, more agreeable patients developed stronger working alliances with their therapists, which in turn, led to better clinical outcomes.<a class="footnote-ref" id="fnref:297" href="#fn:297">297</a>
In addition to recovering from distressing symptoms, people with BPD can also achieve high levels of <a href="/facts/Psychosocial/qKrrEQrD">psychosocial</a> functioning. A longitudinal study tracking the social and work abilities of participants with BPD found that six years after diagnosis, 56% of participants had good function in work and social environments, compared to 26% of participants when they were first diagnosed. Vocational achievement was generally more limited, even compared to those with other personality disorders. However, those whose symptoms had remitted were significantly more likely to have good relationships with a romantic partner and at least one parent, good performance at work and school, a sustained work and school history, and good psychosocial functioning overall.<a class="footnote-ref" id="fnref:298" href="#fn:298">298</a>

<h2 id="epidemiology">Epidemiology</h2>
BPD has a <a href="/facts/Point_prevalence/6UTuTGTH">point prevalence</a> of 1.6%<a class="footnote-ref" id="fnref:299" href="#fn:299">299</a> and a <a href="/facts/Lifetime_prevalence/6UTuTGTH">lifetime prevalence</a> of 5.9% of the global population.<a class="footnote-ref" id="fnref:300" href="#fn:300">300</a><a class="footnote-ref" id="fnref:301" href="#fn:301">301</a><a class="footnote-ref" id="fnref:302" href="#fn:302">302</a><a class="footnote-ref" id="fnref:303" href="#fn:303">303</a><a class="footnote-ref" id="fnref:304" href="#fn:304">304</a> Within clinical settings, the occurrence of BPD is 6.4% among urban primary care patients,<a class="footnote-ref" id="fnref:305" href="#fn:305">305</a> 9.3% among psychiatric <a href="/facts/Outpatients/b0SWyyVD">outpatients</a>,<a class="footnote-ref" id="fnref:306" href="#fn:306">306</a> and approximately 20% among psychiatric <a href="/facts/Inpatients/b0SWyyVD">inpatients</a>.<a class="footnote-ref" id="fnref:307" href="#fn:307">307</a> Utilization of healthcare resources by individuals with BPD is high.<a class="footnote-ref" id="fnref:308" href="#fn:308">308</a> Up to half may show significant improvement in their condition, resulting in ineligibility for diagnosis of BPD, following a ten-year period with appropriate treatment.<a class="footnote-ref" id="fnref:309" href="#fn:309">309</a>
Regarding gender distribution, women are diagnosed with BPD three times more frequently than men in clinical environments.<a class="footnote-ref" id="fnref:310" href="#fn:310">310</a><a class="footnote-ref" id="fnref:311" href="#fn:311">311</a> Nonetheless, <a href="/facts/Epidemiological_research/wgTmxoMA">epidemiological research</a> in the United States indicates no significant gender difference in the lifetime prevalence of BPD within the general population.<a class="footnote-ref" id="fnref:312" href="#fn:312">312</a><a class="footnote-ref" id="fnref:313" href="#fn:313">313</a> The relationship between BPD and ethnicity continues to be ambiguous, with divergent findings reported in the United States.<a class="footnote-ref" id="fnref:314" href="#fn:314">314</a> The overall prevalence of BPD in the U.S. prison population is thought to be 17%.<a class="footnote-ref" id="fnref:315" href="#fn:315">315</a> 

<h2 id="history">History</h2>

The coexistence of intense, divergent moods within an individual was recognized by <a href="/facts/Homer/Xw8Ur53U">Homer</a>, <a href="/facts/Hippocrates/lXUElFQD">Hippocrates</a>, and <a href="/facts/Aretaeus_of_Cappadocia/YJ0fvC48">Aretaeus</a>, the latter describing the vacillating presence of impulsive anger, <a href="/facts/Melancholia/mkmzB0wy">melancholia</a>, and <a href="/facts/Mania/qYV8BBbt">mania</a> within a single person. The concept was revived by Swiss physician Théophile Bonet in 1684 who, using the term folie maniaco-mélancolique,<a class="footnote-ref" id="fnref:316" href="#fn:316">316</a> described the phenomenon of unstable moods that followed an unpredictable course. Other writers noted the same pattern, including the American psychiatrist Charles H. Hughes in 1884 and J. C. Rosse in 1890, who called the disorder "borderline insanity".<a class="footnote-ref" id="fnref:317" href="#fn:317">317</a> In 1921, <a href="/facts/Emil_Kraepelin/tlEHWQUb">Emil Kraepelin</a> identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.<a class="footnote-ref" id="fnref:318" href="#fn:318">318</a>
The idea that there were forms of disorder that were neither psychotic nor simply neurotic began to be discussed in psychoanalytic circles in the 1930s.<a class="footnote-ref" id="fnref:319" href="#fn:319">319</a> The first formal definition of borderline disorder is widely acknowledged to have been written by <a href="/facts/Adolph_Stern/I0a3QKyc">Adolph Stern</a> in 1938.<a class="footnote-ref" id="fnref:320" href="#fn:320">320</a><a class="footnote-ref" id="fnref:321" href="#fn:321">321</a> He described a group of patients who he felt to be on the borderline between <a href="/facts/Neurosis/7yWMUTXk">neurosis</a> and <a href="/facts/Psychosis/cVGd7MKK">psychosis</a>, who very often came from family backgrounds marked by trauma. He argued that such patients would often need more active support than that provided by classical psychoanalytic techniques.
The 1960s and 1970s saw a shift from thinking of the condition as <a href="/facts/Pseudoneurotic_schizophrenia/a7eNyU0h">borderline schizophrenia</a> to thinking of it as a borderline affective disorder (mood disorder), on the fringes of bipolar disorder, <a href="/facts/Cyclothymia/rkMeAubX">cyclothymia</a>, and <a href="/facts/Dysthymia/bDUdlrQ5">dysthymia</a>. In the <a href="/facts/DSM-II/pJ29wFmm">DSM-II</a>, stressing the intensity and variability of moods, it was called <a href="/facts/Cyclothymic_personality/rkMeAubX">cyclothymic personality</a> (affective personality).<a class="footnote-ref" id="fnref:322" href="#fn:322">322</a> While the term "borderline" was evolving to refer to a distinct category of disorder, psychoanalysts such as <a href="/facts/Otto_Kernberg/dRbHlXhg">Otto Kernberg</a> were using it to refer to a broad <a href="/facts/Spectrum_disorder/ltEzWjDE">spectrum</a> of issues, describing an intermediate level of personality organization<a class="footnote-ref" id="fnref:323" href="#fn:323">323</a> between neurosis and psychosis.<a class="footnote-ref" id="fnref:324" href="#fn:324">324</a>
After standardized criteria were developed by <a href="/facts/John_G._Gunderson/n4RnMY6m">John Gunderson</a><a class="footnote-ref" id="fnref:325" href="#fn:325">325</a> to distinguish it from mood disorders and other Axis I disorders, BPD became a personality disorder diagnosis in 1980 with the publication of the <a href="/facts/Diagnostic_and_Statistical_Manual_of_Mental_Disorders/pJ29wFmm">DSM-III</a>.<a class="footnote-ref" id="fnref:326" href="#fn:326">326</a> The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder".<a class="footnote-ref" id="fnref:327" href="#fn:327">327</a> The DSM-IV Axis II Work Group of the American Psychiatric Association finally decided on the name "borderline personality disorder", which is still in use by the DSM-5.<a class="footnote-ref" id="fnref:328" href="#fn:328">328</a> However, the term "borderline" has been described as uniquely inadequate for describing the symptoms characteristic of this disorder.<a class="footnote-ref" id="fnref:329" href="#fn:329">329</a>
Psychodynamic theorists have historically offered the most comprehensive theoretical models of BPD. Gunderson stressed the patient's fundamental interpersonal hypersensitivity, which he viewed as partially genetic.<a class="footnote-ref" id="fnref:330" href="#fn:330">330</a> Kernberg sees the disorder as one involving disturbed <a href="/facts/Object_relations_theory/mSP7Kcox">object relations</a>, marked by an excess of aggression and use of primitive defenses, such as splitting, projection, and projective identification.<a class="footnote-ref" id="fnref:331" href="#fn:331">331</a> Gerald Adler, writing from a <a href="/facts/Self_psychology/M8NFeztu">self psychology</a> perspective, viewed the disorder as resulting from the failure of evocative memory and characterized by an intolerance of aloneness.<a class="footnote-ref" id="fnref:332" href="#fn:332">332</a> <a href="/facts/James_F._Masterson/No5s7LVR">Masterson</a> hypothesized that the disorder resulted from core developmental problems with <a href="/facts/Margaret_Mahler/JnTwh4PX">separation-individuation</a>.<a class="footnote-ref" id="fnref:333" href="#fn:333">333</a> More recently, Mark L. Ruffalo has advanced the hypothesis that BPD is fundamentally a disorder of paradox or self-contradiction.<a class="footnote-ref" id="fnref:334" href="#fn:334">334</a>

<h3>Etymology</h3>
Earlier versions of the DSM—before the multiaxial diagnosis system—classified most people with mental health problems into two categories: the <a href="/facts/Psychosis/cVGd7MKK">psychotics</a> and the <a href="/facts/Neurosis/7yWMUTXk">neurotics</a>. Clinicians noted a certain class of neurotics who, when in crisis, appeared to straddle the borderline into psychosis.<a class="footnote-ref" id="fnref:335" href="#fn:335">335</a> The term "borderline personality disorder" was coined in American psychiatry in the 1960s. It became the preferred term over a number of competing names, such as "emotionally unstable character disorder" and "borderline schizophrenia" during the 1970s.<a class="footnote-ref" id="fnref:336" href="#fn:336">336</a><a class="footnote-ref" id="fnref:337" href="#fn:337">337</a> Borderline personality disorder was included in DSM-III (1980) despite not being universally recognized as a valid diagnosis.<a class="footnote-ref" id="fnref:338" href="#fn:338">338</a>

<h2 id="controversies">Controversies</h2>
<h3>Credibility and validity of testimony</h3>
The credibility of individuals with personality disorders has been questioned at least since the 1960s.<a class="footnote-ref" id="fnref:339" href="#fn:339">339</a>: 2  Two concerns are the incidence of <a href="/facts/Dissociation_(psychology)/MX81IGk3">dissociation episodes</a> among people with BPD and the belief that lying is not uncommon in those diagnosed with the condition.<a class="footnote-ref" id="fnref:340" href="#fn:340">340</a>

<h4>Dissociation</h4>
Researchers disagree about whether dissociation or a sense of <a href="/facts/Emotional_detachment/0Ym1LMh7">emotional detachment</a> and physical experiences, impact the ability of people with BPD to recall the specifics of past events. A 1999 study reported that the specificity of <a href="/facts/Autobiographical_memory/mHQaGzzz">autobiographical memory</a> was decreased in BPD patients.<a class="footnote-ref" id="fnref:341" href="#fn:341">341</a> The researchers found that decreased ability to recall specifics was correlated with patients' levels of dissociation, which "may help them to avoid <a href="/facts/Episodic_memory/1QIEM9gQ">episodic</a> information that would evoke acutely negative <a href="/facts/Affect_(psychology)/jEQ6IWSm">affect</a>".<a class="footnote-ref" id="fnref:342" href="#fn:342">342</a><a class="footnote-ref" id="fnref:343" href="#fn:343">343</a>

<h3>Gender</h3>
See also: <a href="/facts/Gender_differences_in_suicide/UPbfjcgQ">Gender differences in suicide</a>
In a clinic, up to 80% of patients are women, but this might not necessarily reflect the gender distribution in the entire population.<a class="footnote-ref" id="fnref:344" href="#fn:344">344</a> According to Joel Paris, the primary reason for gender disparities in clinical settings is that women are more likely to develop symptoms that prompt them to seek help. Statistics indicate that twice as many women as men in the community experience depression. Conversely, men more frequently meet criteria for <a href="/facts/Substance_use_disorder/pSbdzb6a">substance use disorder</a> and <a href="/facts/Psychopathy/ES1HW8bu">psychopathy</a>, but tend not to seek treatment as often. Additionally, men and women with similar symptoms may manifest them differently. Men often exhibit behaviors such as increased alcohol consumption and criminal activity, while women may internalize anger, leading to conditions like depression and self-harm, such as cutting or overdosing. Hence, the gender gap observed in <a href="/facts/Antisocial_personality_disorder/RK4jEtpT">antisocial personality disorder</a> and borderline personality disorder, which may share similar underlying pathologies but present different symptoms influenced by gender. In a study examining completed suicides among individuals aged 18 to 35, 30% of the suicides were attributed to people with BPD, with a majority being men and almost none receiving treatment. Similar findings were reported in another study.<a class="footnote-ref" id="fnref:345" href="#fn:345">345</a>
Among men diagnosed with BPD there is also evidence of a higher suicide rate: "men are more than twice as likely as women—18 percent versus 8 percent"—to die by suicide.<a class="footnote-ref" id="fnref:346" href="#fn:346">346</a>
There are also sex differences in personality traits and Axis I and II comorbidity.<a class="footnote-ref" id="fnref:347" href="#fn:347">347</a> Men with BPD are more likely to recreationally use substances, have explosive temper, high levels of <a href="/facts/Novelty_seeking/LaeB4zVX">novelty seeking</a> and have (especially) antisocial, <a href="/facts/Narcissism/Q2bT0HUY">narcissistic</a>, passive-aggressive or sadistic personality traits (male BPD being characterised by antisocial overtones<a class="footnote-ref" id="fnref:348" href="#fn:348">348</a>). Women with BPD are more likely to have eating, mood, anxiety, and post-traumatic stress disorders.<a class="footnote-ref" id="fnref:349" href="#fn:349">349</a>

<h3>Manipulative behavior</h3>
<a href="/facts/Manipulation_(psychology)/RLqHuGzV">Manipulative behavior</a> to obtain nurturance is considered by the <a href="/facts/Diagnostic_and_statistical_manual_of_mental_disorders/pJ29wFmm">DSM-IV-TR</a> and many mental health professionals to be a defining characteristic of borderline personality disorder.<a class="footnote-ref" id="fnref:350" href="#fn:350">350</a> In one research study, 88% of therapists reported that they have experienced manipulation attempts from patient(s).<a class="footnote-ref" id="fnref:351" href="#fn:351">351</a> <a href="/facts/Marsha_Linehan/89d9qWg4">Marsha Linehan</a> has argued that doing so relies upon the assumption that people with BPD who communicate intense pain, or who engage in self-harm and suicidal behavior, do so with the intention of influencing the behavior of others.<a class="footnote-ref" id="fnref:352" href="#fn:352">352</a> The impact of such behavior on others—often an intense emotional reaction in concerned friends, family members, and therapists—is thus assumed to have been the person's intention.<a class="footnote-ref" id="fnref:353" href="#fn:353">353</a>
According to Linehan, their frequent expressions of intense pain, self-harming, or suicidal behavior may instead represent a method of mood regulation or an escape mechanism from situations that feel unbearable, however, making their assumed manipulative behavior an involuntary and unintentional response.<a class="footnote-ref" id="fnref:354" href="#fn:354">354</a>

<h3>Stigma</h3>
See also: <a href="/facts/Social_stigma/HXG8pDsF">Social stigma</a>
The features of BPD include emotional instability, intense and unstable interpersonal relationships, a need for intimacy, and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms to describe people with BPD, such as "difficult", "treatment resistant", "manipulative", "demanding", and "<a href="/facts/Attention_seeking/sUua7TJb">attention seeking</a>", are often used and may become a <a href="/facts/Self-fulfilling_prophecy/peQYRjlP">self-fulfilling prophecy</a>, as the negative treatment of these individuals may trigger further self-destructive behavior.<a class="footnote-ref" id="fnref:355" href="#fn:355">355</a>
Since BPD can be a stigmatizing diagnosis even within the mental health community, some survivors of childhood abuse who are diagnosed with BPD are re-traumatized by the negative responses they receive from healthcare providers.<a class="footnote-ref" id="fnref:356" href="#fn:356">356</a> One camp[who?] argues that it would be better to diagnose these people with post-traumatic stress disorder (PTSD), as this would acknowledge the impact of abuse on their behavior. Critics of the PTSD diagnosis argue that it medicalizes abuse rather than addressing the root causes in society.<a class="footnote-ref" id="fnref:357" href="#fn:357">357</a> Regardless, a diagnosis of PTSD does not encompass all aspects of the disorder (see brain abnormalities and terminology).

<h4>Physical violence</h4>
The stigma surrounding borderline personality disorder includes the belief that people with BPD are prone to violence toward others.<a class="footnote-ref" id="fnref:358" href="#fn:358">358</a> While movies and visual media often sensationalize people with BPD by portraying them as violent, the majority of researchers agree that people with BPD are unlikely to physically harm others.<a class="footnote-ref" id="fnref:359" href="#fn:359">359</a> Although people with BPD often struggle with experiences of intense anger, a defining characteristic of BPD is that they direct it inward toward themselves.<a class="footnote-ref" id="fnref:360" href="#fn:360">360</a>
One 2020 study found that BPD is individually associated with psychological, physical, and sexual forms of intimate partner violence (IPV), especially amongst men.<a class="footnote-ref" id="fnref:361" href="#fn:361">361</a>[non-primary source needed] In terms of the AMPD trait facets, hostility (negative affectivity), suspiciousness (negative affectivity) and risk-taking (disinhibition) were most strongly associated with IPV perpetration for the total sample.<a class="footnote-ref" id="fnref:362" href="#fn:362">362</a>
In addition, adults with BPD have often experienced abuse in childhood, so many people with BPD adopt a "no-tolerance" policy toward expressions of anger of any kind.<a class="footnote-ref" id="fnref:363" href="#fn:363">363</a> Their extreme aversion to violence can cause many people with BPD to overcompensate and experience difficulties being assertive and expressing their needs.<a class="footnote-ref" id="fnref:364" href="#fn:364">364</a> This is one reason why people with BPD often choose to harm themselves over potentially causing harm to others.<a class="footnote-ref" id="fnref:365" href="#fn:365">365</a><a class="footnote-ref" id="fnref:366" href="#fn:366">366</a><a class="footnote-ref" id="fnref:367" href="#fn:367">367</a>

<h4>Mental health care providers</h4>
People with BPD are considered to be among the most challenging groups of patients to work with in therapy, requiring a high level of skill and training for the psychiatrists, therapists, and nurses involved in their treatment.<a class="footnote-ref" id="fnref:368" href="#fn:368">368</a> A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with and more difficult than other client groups.<a class="footnote-ref" id="fnref:369" href="#fn:369">369</a>[non-primary source needed] This largely negative view of BPD can result in people with BPD being terminated from treatment early, being provided harmful treatment, not being informed of their diagnosis of BPD, or being misdiagnosed.<a class="footnote-ref" id="fnref:370" href="#fn:370">370</a> With healthcare providers contributing to the stigma of a BPD diagnosis, seeking treatment can often result in the perpetuation of BPD features.<a class="footnote-ref" id="fnref:371" href="#fn:371">371</a> Efforts are ongoing to improve public and staff attitudes toward people with BPD.<a class="footnote-ref" id="fnref:372" href="#fn:372">372</a><a class="footnote-ref" id="fnref:373" href="#fn:373">373</a>
Some clients feel the diagnosis is helpful, allowing them to understand that they are not alone and to connect with others with BPD who have developed helpful coping mechanisms. However, others experience the term "borderline personality disorder" as a <a href="/facts/Pejorative/UId8vPsx">pejorative</a> <a href="/facts/Labeling_theory/MqYazmt7">label</a> rather than an informative diagnosis. They report concerns that their self-destructive behavior is incorrectly perceived as manipulative and that the stigma surrounding this disorder limits their access to health care.<a class="footnote-ref" id="fnref:374" href="#fn:374">374</a> Indeed, mental health professionals frequently refuse to provide services to those who have received a BPD diagnosis.<a class="footnote-ref" id="fnref:375" href="#fn:375">375</a>

<h3>Terminology</h3>
Because of concerns around stigma, and because of a move away from the original theoretical basis for the term (see history), there is ongoing debate about renaming borderline personality disorder. While some clinicians agree with the current name, others argue that it should be changed,<a class="footnote-ref" id="fnref:376" href="#fn:376">376</a> since many who are labelled with borderline personality disorder find the name unhelpful, stigmatizing, or inaccurate.<a class="footnote-ref" id="fnref:377" href="#fn:377">377</a><a class="footnote-ref" id="fnref:378" href="#fn:378">378</a>
Alternative suggestions for names include emotional regulation disorder or emotional dysregulation disorder. Impulse disorder and interpersonal regulatory disorder are other valid alternatives, according to <a href="/facts/John_G._Gunderson/n4RnMY6m">John G. Gunderson</a> of <a href="/facts/McLean_Hospital/q0olAwgK">McLean Hospital</a> in the United States.<a class="footnote-ref" id="fnref:379" href="#fn:379">379</a> Another term suggested by psychiatrist <a href="/facts/Carolyn_Quadrio/coxLGJPE">Carolyn Quadrio</a> is post-traumatic personality disorganization (PTPD), reflecting the condition's status as (often) both a form of chronic post-traumatic stress disorder (PTSD) as well as a personality disorder.<a class="footnote-ref" id="fnref:380" href="#fn:380">380</a> However, although many with BPD do have traumatic histories, some do not report any kind of traumatic event, which suggests that BPD is not necessarily a trauma spectrum disorder.<a class="footnote-ref" id="fnref:381" href="#fn:381">381</a>
The Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned unsuccessfully to change the name and designation of BPD in DSM-5, published in May 2013, in which the name "borderline personality disorder" remains unchanged and it is not considered a trauma- and stressor-related disorder.<a class="footnote-ref" id="fnref:382" href="#fn:382">382</a>

<h2 id="society-and-culture">Society and culture</h2>
<h3>Literature</h3>
In literature, characters believed to exhibit signs of BPD include Catherine in <a href="/facts/Wuthering_Heights/HcLBDQlg">Wuthering Heights</a> (1847), Smerdyakov in <a href="/facts/The_Brothers_Karamazov/XI1WwFgA">The Brothers Karamazov</a> (1880), and Harry Haller in <a href="/facts/Steppenwolf_(novel)/PApH5fxl">Steppenwolf</a> (1927).<a class="footnote-ref" id="fnref:383" href="#fn:383">383</a><a class="footnote-ref" id="fnref:384" href="#fn:384">384</a><a class="footnote-ref" id="fnref:385" href="#fn:385">385</a>

<h3>Film</h3>
Films have also attempted to portray BPD, with characters in <a href="/facts/Margot_at_the_Wedding/6BRYMfoh">Margot at the Wedding</a> (2007), <a href="/facts/Mr._Nobody_(film)/mSnmRR2X">Mr. Nobody</a> (2009), <a href="/facts/Cracks_(film)/vje2wxty">Cracks</a> (2009),<a class="footnote-ref" id="fnref:386" href="#fn:386">386</a> <a href="/facts/Truth_(2013_film)/vdQdqxFm">Truth</a> (2013), <a href="/facts/Wounded_(2013_film)/rBPVtnJf">Wounded</a> (2013), <a href="/facts/Welcome_to_Me/EH8CuuQS">Welcome to Me</a> (2014),<a class="footnote-ref" id="fnref:387" href="#fn:387">387</a><a class="footnote-ref" id="fnref:388" href="#fn:388">388</a> and <a href="/facts/Tamasha_(2015_film)/jbujPomV">Tamasha</a> (2015)<a class="footnote-ref" id="fnref:389" href="#fn:389">389</a> all suggested to show traits of the disorder. The behavior of Theresa Dunn in <a href="/facts/Looking_for_Mr._Goodbar_(novel)/zRFKMyxt">Looking for Mr. Goodbar</a> (1975) is consistent with BPD, as suggested by Robert O. Friedel.<a class="footnote-ref" id="fnref:390" href="#fn:390">390</a> Films like <a href="/facts/Play_Misty_for_Me/FW7XJgfc">Play Misty for Me</a> (1971)<a class="footnote-ref" id="fnref:391" href="#fn:391">391</a> and <a href="/facts/Girl%2c_Interrupted_(film)/FgQyUXS3">Girl, Interrupted</a> (1999, based on the <a href="/facts/Girl%2c_Interrupted/4DkcP0qz">memoir of the same name</a>) suggest emotional instability characteristic of BPD,<a class="footnote-ref" id="fnref:392" href="#fn:392">392</a> while <a href="/facts/Single_White_Female/5v0ChNdy">Single White Female</a> (1992) highlights aspects such as identity disturbance and fear of abandonment.<a class="footnote-ref" id="fnref:393" href="#fn:393">393</a>: 235  Clementine in <a href="/facts/Eternal_Sunshine_of_the_Spotless_Mind/zVwHF44K">Eternal Sunshine of the Spotless Mind</a> (2004) is noted to show classic BPD behavior,<a class="footnote-ref" id="fnref:394" href="#fn:394">394</a><a class="footnote-ref" id="fnref:395" href="#fn:395">395</a> and <a href="/facts/Carey_Mulligan/XFDdXYx3">Carey Mulligan</a>'s portrayal in <a href="/facts/Shame_(2011_film)/d9KfKFp7">Shame</a> (2011) is praised for its accuracy regarding BPD characteristics by psychiatrists.<a class="footnote-ref" id="fnref:396" href="#fn:396">396</a>

<h3>Television</h3>
Television series like <a href="/facts/Crazy_Ex-Girlfriend_(TV_series)/XWSwbYfb">Crazy Ex-Girlfriend</a> (2015) and the miniseries <a href="/facts/Maniac_(miniseries)/8UetaY73">Maniac</a> (2018) depict characters with BPD.<a class="footnote-ref" id="fnref:397" href="#fn:397">397</a> Traits of BPD and narcissistic personality disorders are observed in characters like <a href="/facts/Cersei_Lannister/GSHBw4zU">Cersei</a> and <a href="/facts/Jaime_Lannister/RlUSJjvJ">Jaime Lannister</a> from <a href="/facts/A_Song_of_Ice_and_Fire/EPRfHx4b">A Song of Ice and Fire</a> (1996) and its TV adaptation <a href="/facts/Game_of_Thrones/2jU7dXDT">Game of Thrones</a> (2011).<a class="footnote-ref" id="fnref:398" href="#fn:398">398</a> In <a href="/facts/The_Sopranos/xHHM8t5q">The Sopranos</a> (1999), <a href="/facts/Livia_Soprano/Ym80E42s">Livia Soprano</a> is diagnosed with BPD,<a class="footnote-ref" id="fnref:399" href="#fn:399">399</a> and even the portrayal of <a href="/facts/Bruce_Wayne/6ybzEQsH">Bruce Wayne</a>/Batman in the show <a href="/facts/Titans_(2018_TV_series)/sPeAoTqu">Titans</a> (2018) is said to include aspects of the disorder.<a class="footnote-ref" id="fnref:400" href="#fn:400">400</a> The animated series <a href="/facts/BoJack_Horseman/Nug9wc11">BoJack Horseman</a> (2014) also features a main character with symptoms of BPD.<a class="footnote-ref" id="fnref:401" href="#fn:401">401</a>

<h3>Awareness</h3>
Awareness of BPD has been growing, with the <a href="/facts/U.S._House_of_Representatives/cdBPb9pY">U.S. House of Representatives</a> declaring May as Borderline Personality Disorder Awareness Month in 2008.<a class="footnote-ref" id="fnref:402" href="#fn:402">402</a> People with BPD will share their personal experiences of living with the disorder on social media to raise awareness of the condition.<a class="footnote-ref" id="fnref:403" href="#fn:403">403</a>
Public figures like South Korean singer-songwriter <a href="/facts/Lee_Sun-mi/x9zk1Crt">Lee Sun-mi</a> have opened up about their personal experiences with the disorder, bringing further attention to its impact on individuals' lives.<a class="footnote-ref" id="fnref:404" href="#fn:404">404</a>

<h2 id="see-also">See also</h2>
<ul>
<li>Psychology portal</li></ul>
<ul><li><a href="/facts/Affective_empathy/Pak5Dvfh">Affective empathy</a></li>
<li><a href="/facts/Obsessive_love_disorder/sfGEpyQJ">Obsessive love disorder</a></li>
<li><a href="/facts/Pseudohallucination/v6qSp4Yq">Pseudohallucination</a></li></ul>
<h2 id="notes">Notes</h2>

<h2 id="citations">Citations</h2>

<h2 id="general-bibliography">General bibliography</h2>

<ul><li><a href="/facts/American_Psychiatric_Association/xn9juNST">American Psychiatric Association</a> (2000). <a href="/facts/Diagnostic_and_Statistical_Manual_of_Mental_Disorders/pJ29wFmm">Diagnostic and Statistical Manual of Mental Disorders</a> (4th ed.). American Psychiatric Association. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-89042-025-6.</li>
<li>American Psychiatric Association (2013). <a href="/facts/Diagnostic_and_Statistical_Manual_of_Mental_Disorders/pJ29wFmm">Diagnostic and Statistical Manual of Mental Disorders</a> (5th ed.). American Psychiatric Publishing. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-89042-555-8.</li>
<li>Chapman AL, Gratz KL (2007). The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD. Oakland, CA: <a href="/facts/New_Harbinger_Publications/qX6rDRmb">New Harbinger Publications</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-1-57224-507-5.</li>
<li><a href="/facts/Marsha_M._Linehan/89d9qWg4">Linehan MM</a>, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. (July 2006). <a href="https://doi.org/10.1001%2Farchpsyc.63.7.757">"Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder"</a>. Archives of General Psychiatry. 63 (7): 757–66. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1001%2Farchpsyc.63.7.757">10.1001/archpsyc.63.7.757</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/16818865">16818865</a>.</li>
<li><a href="/facts/Marsha_M._Linehan/89d9qWg4">Linehan M</a> (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: <a href="/facts/Guilford_Press/7wEUMF9u">Guilford Press</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-89862-183-9.</li>
<li>Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-1-59385-607-6.</li>
<li><a href="/facts/Theodore_Millon/x4WmNeN3">Millon T</a> (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: <a href="/facts/John_Wiley_%2526_Sons/53g3LqJc">John Wiley & Sons</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-471-01186-6.</li>
<li><a href="/facts/Theodore_Millon/x4WmNeN3">Millon T</a> (2004). Personality Disorders in Modern Life. Wiley. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-471-32355-6.</li>
<li><a href="/facts/Theodore_Millon/x4WmNeN3">Millon T</a>, Grossman S, Meagher SE (2004). Masters of the mind: exploring the story of mental illness from ancient times to the new millennium. <a href="/facts/John_Wiley_%2526_Sons/53g3LqJc">John Wiley & Sons</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-471-46985-8.</li>
<li><a href="/facts/Theodore_Millon/x4WmNeN3">Millon T</a> (2006). <a href="https://web.archive.org/web/20101104162306/http://www.millon.net/taxonomy/summary.htm">"Personality Subtypes"</a>. Institute for Advanced Studies in Personology and Psychopathology. Dicandrien, Inc. Archived from <a href="http://millon.net/taxonomy/summary.htm">the original</a> on 4 November 2010. Retrieved 1 November 2010.</li></ul>

<h2 id="external-links">External links</h2>

Wikimedia Commons has media related to Borderline personality disorder.

<ul><li><a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml">"Borderline personality disorder"</a>. <a href="/facts/National_Institute_of_Mental_Health/EqxY3XXy">National Institute of Mental Health</a>.</li>
<li><a href="https://www.bpdfamily.com/content/borderline-personality-disorder">APA DSM 5 Definition of Borderline personality disorder</a></li>
<li><a href="https://div12.org/psychological-treatments/disorders/borderline-personality-disorder/">APA Division 12 treatment page for Borderline personality disorder</a></li>
<li><a href="https://icd.who.int/browse/2024-01/mms/en#2006821354">ICD-11 definition of Personality disorder, Borderline pattern by the World Health Organization</a></li>
<li><a href="https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/">NHS</a></li>
<li><a href="https://borderlinesupport.org.uk">"Borderline Support UK"</a>.</li></ul>

<h2 id="references">References</h2>

<ol>
<li id="fn:1">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:1" class="footnote-back-ref">↩</a></li>
<li id="fn:2">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></li>
<li id="fn:3">Chapman AL (August 2019). "Borderline personality disorder and emotion dysregulation". Development and Psychopathology. 31 (3). Cambridge University Press: 1143–1156. doi:10.1017/S0954579419000658. PMID 31169118. S2CID 174813414. Archived from the original on 4 December 2020. Retrieved 5 April 2020. <a href="https://www.cambridge.org/core/product/identifier/S0954579419000658/type/journal_article" target="_blank">https://www.cambridge.org/core/product/identifier/S0954579419000658/type/journal_article</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></li>
<li id="fn:4">Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S (23 September 2021). "The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective". Frontiers in Psychiatry. 12: 721361. doi:10.3389/fpsyt.2021.721361. PMC 8495240. PMID 34630181. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495240" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495240</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></li>
<li id="fn:5">Cattane N, Rossi R, Lanfredi M, Cattaneo A (June 2017). "Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms". BMC Psychiatry. 17 (1): 221. doi:10.1186/s12888-017-1383-2. PMC 5472954. PMID 28619017. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></li>
<li id="fn:6">"Borderline Personality Disorder". The National Institute of Mental Health. December 2017. Archived from the original on 29 March 2023. Retrieved 25 February 2021. Other signs or symptoms may include: [...] Impulsive and often dangerous behaviors [...] Self-harming behavior [...]. Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public. <a href="https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></li>
<li id="fn:7">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></li>
<li id="fn:8">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></li>
<li id="fn:9">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:9" class="footnote-back-ref">↩</a></li>
<li id="fn:10">Helle AC, Watts AL, Trull TJ, Sher KJ (2019). "Alcohol Use Disorder and Antisocial and Borderline Personality Disorders". Alcohol Research: Current Reviews. 40 (1): arcr.v40.1.05. doi:10.35946/arcr.v40.1.05. PMC 6927749. PMID 31886107. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927749" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927749</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></li>
<li id="fn:11">Trull TJ, Freeman LK, Vebares TJ, Choate AM, Helle AC, Wycoff AM (19 September 2018). "Borderline personality disorder and substance use disorders: an updated review". Borderline Personality Disorder and Emotion Dysregulation. 5 (1): 15. doi:10.1186/s40479-018-0093-9. ISSN 2051-6673. PMC 6145127. PMID 30250740. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145127" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145127</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></li>
<li id="fn:12">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></li>
<li id="fn:13">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:13" class="footnote-back-ref">↩</a></li>
<li id="fn:14">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></li>
<li id="fn:15">Kreisman J, Strauss H (2004). Sometimes I Act Crazy. Living With Borderline Personality Disorder. Wiley & Sons. p. 206. ISBN 978-0-471-22286-6. <a href="978-0-471-22286-6" target="_blank">978-0-471-22286-6</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></li>
<li id="fn:16">Kaurin A, Dombrovski A, Hallquist M, Wright A (10 December 2020). "Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder". Psychological Medicine. 52 (13): 2702–2712. doi:10.1017/S0033291720004791. PMC 8190164. PMID 33298227. People diagnosed with borderline personality disorder (BPD) are at high risk of dying by suicide: almost all report chronic suicidal ideation, 84% of patients with BPD engage in suicidal behavior, 70% attempt suicide, with a mean of 3.4 lifetime attempts per individual, and 5–10% die by suicide (Black et al., 2004; McGirr et al., 2007; Soloff et al., 1994). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190164" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190164</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></li>
<li id="fn:17">Aviram RB, Brodsky BS, Stanley B (2006). "Borderline personality disorder, stigma, and treatment implications" (PDF). Harvard Review of Psychiatry. 14 (5): 249–256. doi:10.1080/10673220600975121. PMID 16990170. S2CID 23923078. Retrieved 24 December 2024. The stigmatization of BPD is likely to be a result of several characteristics of the BPD syndrome. [... Pejorative] terms such as "difficult," "treatment resistant," "manipulative," "demanding," and "attention seeking" [are used to describe such individuals. This] can have an impact upon the treater's a priori expectations. [... Such] stigmatization is likely to be a result of several [behaviour characteristics of individuals with BPD, and the fact that] psychotherapy with [them] may involve disturbing and frightening behavior, including intense anger, chronic suicidal ideation, self-injury, and suicide attempts. [... Clinicians, under the stigma, may] see lower levels of [their patient's] functioning as deliberate and within [ones] control, or as manipulation, or as a rejection of help, [and may therefore respond] in unintentially damaging ways, [possibly by withdrawing] physically and emotionally. [...] It has been found that when one person has negative expectations of another, the former changes his or her behavior toward the latter. These interpersonal situations have been described as self-fulfilling prophecies. <a href="https://static1.squarespace.com/static/5e7bbc0adb05de74ea06f6a0/t/5ea1c293f38c3a5c41f7ed9e/1587659411794/Aviram+BPD+and+Stigma+Har+Rev+Psychiatry.pdf" target="_blank">https://static1.squarespace.com/static/5e7bbc0adb05de74ea06f6a0/t/5ea1c293f38c3a5c41f7ed9e/1587659411794/Aviram+BPD+and+Stigma+Har+Rev+Psychiatry.pdf</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></li>
<li id="fn:18">Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S (2017). "Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice". Journal of Psychotherapy Integration. 27 (4): 425–438. doi:10.1037/int0000044. PMC 5842953. PMID 29527105. [Clinicians] may hesitate to [provide treatment for BPD patients] due to discomfort working with the high-risk behaviours and intense interpersonal and emotional dysregulation typical of [the disorder. Treatments supported by empirical evidences include Dialectical behavior therapy, Mentalization-based treatment, Transference-focused psychotherapy, Schema-focused therapy, and General Psychiatric Magement... On the psychopathology side, it's possible that] emotional reactivity may be [more] pronounced [...] in response to social stressors and in interpersonal and self-conscious emotions (e.g., anger, shame) [...] Emotional vulnerability in BPD may also vary across specific emotions, [to which] sadness, hostility, and fear [are particularly damaging]. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></li>
<li id="fn:19">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></li>
<li id="fn:20">Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne: National Health and Medical Research Council. 2013. pp. 40–41. ISBN 978-1-86496-564-3. In addition to the evidence identified by the systematic review, the Committee also considered a recent narrative review of studies that have evaluated biological and environmental factors as potential risk factors for BPD (including prospective studies of children and adolescents, and studies of young people with BPD) <a href="978-1-86496-564-3" target="_blank">978-1-86496-564-3</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></li>
<li id="fn:21">Chapman J, Jamil RT, Fleisher C, Torrico TJ (2025), "Borderline Personality Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28613633, retrieved 10 June 2025, The current hypothesis is that BPD is caused by an interaction between genetic factors and adverse childhood experiences affecting brain development via neuropeptides and hormones. The relative importance of these factors is unclear. <a href="http://www.ncbi.nlm.nih.gov/books/NBK430883/" target="_blank">http://www.ncbi.nlm.nih.gov/books/NBK430883/</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></li>
<li id="fn:22">Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (January 2011). "Borderline personality disorder". Lancet. 377 (9759): 74–84. doi:10.1016/s0140-6736(10)61422-5. PMID 21195251. S2CID 17051114. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in [BPD] patients [... As of 2011,] there is no evidence to suggest that one specific form of psychotherapy is more effective than another. <a href="/wiki/Lancet_(journal)" target="_blank">/wiki/Lancet_(journal)</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></li>
<li id="fn:23">Amad A, Ramoz N, Thomas P, Jardri R, Gorwood P (1 March 2014). "Genetics of borderline personality disorder: Systematic review and proposal of an integrative model". Neuroscience & Biobehavioral Reviews. 40: 6–19. doi:10.1016/j.neubiorev.2014.01.003. ISSN 0149-7634. PMID 24456942. [We] performed a systematic review of the literature concerning the genetics of BPD, including familial and twin studies, association studies, and gene–environment interaction studies. [...] Familial and twin studies largely support the potential role of a genetic vulnerability at the root of BPD, with an estimated heritability of approximately 40%. [There] is evidence for both gene–environment interactions and correlations. However, association studies for BPD are sparse, making it difficult to draw clear conclusions. <a href="https://www.sciencedirect.com/science/article/pii/S0149763414000062" target="_blank">https://www.sciencedirect.com/science/article/pii/S0149763414000062</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></li>
<li id="fn:24">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:24" class="footnote-back-ref">↩</a></li>
<li id="fn:25">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:25" class="footnote-back-ref">↩</a></li>
<li id="fn:26">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></li>
<li id="fn:27">Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S (2017). "Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice". Journal of Psychotherapy Integration. 27 (4): 425–438. doi:10.1037/int0000044. PMC 5842953. PMID 29527105. [Clinicians] may hesitate to [provide treatment for BPD patients] due to discomfort working with the high-risk behaviours and intense interpersonal and emotional dysregulation typical of [the disorder. Treatments supported by empirical evidences include Dialectical behavior therapy, Mentalization-based treatment, Transference-focused psychotherapy, Schema-focused therapy, and General Psychiatric Magement... On the psychopathology side, it's possible that] emotional reactivity may be [more] pronounced [...] in response to social stressors and in interpersonal and self-conscious emotions (e.g., anger, shame) [...] Emotional vulnerability in BPD may also vary across specific emotions, [to which] sadness, hostility, and fear [are particularly damaging]. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></li>
<li id="fn:28">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></li>
<li id="fn:29">Stoffers-Winterling J, Storebø OJ, Lieb K (2020). "Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies" (PDF). Current Psychiatry Reports. 22 (37): 37. doi:10.1007/s11920-020-01164-1. PMC 7275094. PMID 32504127. Archived (PDF) from the original on 4 May 2022. Retrieved 30 May 2021. [To evaluate continued drug treatments in people with a diagnosis of BPD,] we identified seven new RCTs [randomized controlled trials] and newly available data for an older RCT [...] The new findings do not support fluoxetine as a treatment option for suicide and self-harm prevention. A large effectiveness study did not detect beneficial effects of lamotrigine in routine care. The prevalent use of medications in BPD is still not reflected or supported by the current evidence. More research is needed regarding [...] SSRIs [and] quetiapine, but also with respect to [individuals with BPD and other] distinct comorbid conditions. <a href="https://link.springer.com/content/pdf/10.1007/s11920-020-01164-1.pdf" target="_blank">https://link.springer.com/content/pdf/10.1007/s11920-020-01164-1.pdf</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></li>
<li id="fn:30">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:30" class="footnote-back-ref">↩</a></li>
<li id="fn:31">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></li>
<li id="fn:32">"Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis". UpToDate. Wolters Kluwer. Archived from the original on 6 January 2009. Retrieved 13 March 2024. <a href="https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis" target="_blank">https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></li>
<li id="fn:33">"NIMH " Personality Disorders". nimh.nih.gov. Archived from the original on 18 June 2022. Retrieved 20 May 2021. <a href="https://www.nimh.nih.gov/health/statistics/personality-disorders" target="_blank">https://www.nimh.nih.gov/health/statistics/personality-disorders</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></li>
<li id="fn:34">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:34" class="footnote-back-ref">↩</a></li>
<li id="fn:35">"Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis". UpToDate. Wolters Kluwer. Archived from the original on 6 January 2009. Retrieved 13 March 2024. <a href="https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis" target="_blank">https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></li>
<li id="fn:36">Bourke J, Murphy A, Flynn D, Kells M, Joyce M, Hurley J (September 2021). "Borderline personality disorder: resource utilisation costs in Ireland". Irish Journal of Psychological Medicine. 38 (3): 169–176. doi:10.1017/ipm.2018.30. hdl:10468/7005. PMID 34465404. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></li>
<li id="fn:37">American Psychiatric Association 2013, pp. 645, 663–6 - American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8. <a href="#fnref:37" class="footnote-back-ref">↩</a></li>
<li id="fn:38">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></li>
<li id="fn:39">Gunderson JG (May 2009). "Borderline personality disorder: ontogeny of a diagnosis". The American Journal of Psychiatry. 166 (5): 530–539. doi:10.1176/appi.ajp.2009.08121825. PMC 3145201. PMID 19411380. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145201" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145201</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></li>
<li id="fn:40">"Diagnostic criteria for 301.83 Borderline Personality Disorder – Behavenet". behavenet.com. Archived from the original on 28 March 2019. Retrieved 23 March 2019. A pervasive pattern of instability of interpersonal relationships, self-image, and affects [...] indicated by five (or more) of the following: [...] <a href="https://behavenet.com/diagnostic-criteria-30183-borderline-personality-disorder" target="_blank">https://behavenet.com/diagnostic-criteria-30183-borderline-personality-disorder</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></li>
<li id="fn:41">Fertuck EA, Fischer S, Beeney J (December 2018). "Social Cognition and Borderline Personality Disorder: Splitting and Trust Impairment Findings". The Psychiatric Clinics of North America. 41 (4): 613–632. doi:10.1016/j.psc.2018.07.003. PMID 30447728. S2CID 53948600 – via Elsevier Science Direct. BPO [Borderline Personality Organization] is rooted in psychoanalytic object relations theory (ORT) which conceptualizes BPD and BPO to exhibit a propensity to view significant others as either idealized or persecutory (splitting) and a trait-like paranoid view of interpersonal relations. From the ORT model, those with BPD think that they will ultimately be betrayed, abandoned, or neglected by significant others, despite periodic idealizations. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0193953X18311328" target="_blank">https://www.sciencedirect.com/science/article/abs/pii/S0193953X18311328</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></li>
<li id="fn:42">"Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016. <a href="http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></li>
<li id="fn:43">DSM-5 Task Force (2013). Diagnostic and Statistical Manual of Mental Disorders : DSM-5. American Psychiatric Association. ISBN 978-0-89042-554-1. OCLC 863153409. Archived from the original on 4 December 2020. Retrieved 23 September 2020. <a href="978-0-89042-554-1" target="_blank">978-0-89042-554-1</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></li>
<li id="fn:44">Austin MP, Highet N, Expert Working Group (2017). Mental Health Care in the Perinatal Period. Melbourne: Centre of Perinatal Excellence. <a href="#fnref:44" class="footnote-back-ref">↩</a></li>
<li id="fn:45">Linehan 1993, p. 43 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:45" class="footnote-back-ref">↩</a></li>
<li id="fn:46">Manning 2011, p. 36 - Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. ISBN 978-1-59385-607-6. <a href="#fnref:46" class="footnote-back-ref">↩</a></li>
<li id="fn:47">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></li>
<li id="fn:48">Hooley J, Butcher JM, Nock MK (2017). Abnormal Psychology (17th ed.). London, England: Pearson Education. p. 359. ISBN 978-0-13-385205-9. <a href="978-0-13-385205-9" target="_blank">978-0-13-385205-9</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></li>
<li id="fn:49">Linehan 1993, p. 45 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:49" class="footnote-back-ref">↩</a></li>
<li id="fn:50">Dick AM, Suvak MK (July 2018). "Borderline personality disorder affective instability: What you know impacts how you feel". Personality Disorders: Theory, Research, and Treatment. 9 (4): 369–378. doi:10.1037/per0000280. ISSN 1949-2723. PMC 6033624. PMID 29461071. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033624" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033624</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></li>
<li id="fn:51">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></li>
<li id="fn:52">Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M (May 2005). "Aversive tension in patients with borderline personality disorder: a computer-based controlled field study". Acta Psychiatrica Scandinavica. 111 (5): 372–9. doi:10.1111/j.1600-0447.2004.00466.x. PMID 15819731. S2CID 30951552. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:52" class="footnote-back-ref">↩</a></li>
<li id="fn:53">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:53" class="footnote-back-ref">↩</a></li>
<li id="fn:54">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></li>
<li id="fn:55">Brown MZ, Comtois KA, Linehan MM (February 2002). "Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder". Journal of Abnormal Psychology. 111 (1): 198–202. doi:10.1037/0021-843X.111.1.198. PMID 11866174. S2CID 4649933. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:55" class="footnote-back-ref">↩</a></li>
<li id="fn:56">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:56" class="footnote-back-ref">↩</a></li>
<li id="fn:57">Linehan 1993, p. 45 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:57" class="footnote-back-ref">↩</a></li>
<li id="fn:58">Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S (2017). "Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice". Journal of Psychotherapy Integration. 27 (4): 425–438. doi:10.1037/int0000044. PMC 5842953. PMID 29527105. [Clinicians] may hesitate to [provide treatment for BPD patients] due to discomfort working with the high-risk behaviours and intense interpersonal and emotional dysregulation typical of [the disorder. Treatments supported by empirical evidences include Dialectical behavior therapy, Mentalization-based treatment, Transference-focused psychotherapy, Schema-focused therapy, and General Psychiatric Magement... On the psychopathology side, it's possible that] emotional reactivity may be [more] pronounced [...] in response to social stressors and in interpersonal and self-conscious emotions (e.g., anger, shame) [...] Emotional vulnerability in BPD may also vary across specific emotions, [to which] sadness, hostility, and fear [are particularly damaging]. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842953</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></li>
<li id="fn:59">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></li>
<li id="fn:60">Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973423</a> <a href="#fnref:60" class="footnote-back-ref">↩</a></li>
<li id="fn:61">Linehan 1993, p. 45 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:61" class="footnote-back-ref">↩</a></li>
<li id="fn:62">Linehan 1993, p. 44 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:62" class="footnote-back-ref">↩</a></li>
<li id="fn:63">Linehan 1993, p. 44 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:63" class="footnote-back-ref">↩</a></li>
<li id="fn:64">DSM-5 Task Force (2013). Diagnostic and Statistical Manual of Mental Disorders : DSM-5. American Psychiatric Association. ISBN 978-0-89042-554-1. OCLC 863153409. Archived from the original on 4 December 2020. Retrieved 23 September 2020. <a href="978-0-89042-554-1" target="_blank">978-0-89042-554-1</a> <a href="#fnref:64" class="footnote-back-ref">↩</a></li>
<li id="fn:65">Fitzpatrick S, Varma S, Kuo JR (September 2022). "Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm". Psychological Medicine. 52 (12): 2319–2331. doi:10.1017/S0033291720004225. PMID 33198829. S2CID 226988308. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></li>
<li id="fn:66">Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG (1998). "The pain of being borderline: dysphoric states specific to borderline personality disorder". Harvard Review of Psychiatry. 6 (4): 201–7. doi:10.3109/10673229809000330. PMID 10370445. S2CID 10093822. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:66" class="footnote-back-ref">↩</a></li>
<li id="fn:67">Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG (1998). "The pain of being borderline: dysphoric states specific to borderline personality disorder". Harvard Review of Psychiatry. 6 (4): 201–7. doi:10.3109/10673229809000330. PMID 10370445. S2CID 10093822. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:67" class="footnote-back-ref">↩</a></li>
<li id="fn:68">Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, et al. (May 2002). "Characterizing affective instability in borderline personality disorder". The American Journal of Psychiatry. 159 (5): 784–8. doi:10.1176/appi.ajp.159.5.784. PMID 11986132. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:68" class="footnote-back-ref">↩</a></li>
<li id="fn:69">Hepp J, Lane SP, Carpenter RW, Niedtfeld I, Brown WC, Trull TJ (2017). "Interpersonal Problems and Negative Affect in Borderline Personality and Depressive Disorders in Daily Life". Clinical Psychological Science. 5 (3). Sage Publishing: 470–484. doi:10.1177/2167702616677312. PMC 5436804. PMID 28529826. [We] assessed the relations between momentary negative affect (hostility, sadness, fear) and interpersonal problems (rejection, disagreement) in a sample of 80 BPD and 51 depressed outpatients at 6 time-points over 28 days [...] Results revealed a mutually reinforcing relationship between disagreement and hostility, rejection and hostility, and between rejection and sadness in both groups, at the momentary and day level. The mutual reinforcement between hostility and rejection/disagreement was significantly stronger in the BPD group. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436804" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436804</a> <a href="#fnref:69" class="footnote-back-ref">↩</a></li>
<li id="fn:70">Arntz A (September 2005). "Introduction to special issue: cognition and emotion in borderline personality disorder". Journal of Behavior Therapy and Experimental Psychiatry. 36 (3): 167–72. doi:10.1016/j.jbtep.2005.06.001. PMID 16018875. <a href="/wiki/Journal_of_Behavior_Therapy_and_Experimental_Psychiatry" target="_blank">/wiki/Journal_of_Behavior_Therapy_and_Experimental_Psychiatry</a> <a href="#fnref:70" class="footnote-back-ref">↩</a></li>
<li id="fn:71">Linehan 1993, p. 146 - Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9. <a href="#fnref:71" class="footnote-back-ref">↩</a></li>
<li id="fn:72">"What Is BPD: Symptoms". National Education Alliance for Borderline Personality Disorder. Archived from the original on 10 February 2013. Retrieved 31 January 2013. <a href="https://web.archive.org/web/20130210110927/http://www.borderlinepersonalitydisorder.com/understading-bpd/" target="_blank">https://web.archive.org/web/20130210110927/http://www.borderlinepersonalitydisorder.com/understading-bpd/</a> <a href="#fnref:72" class="footnote-back-ref">↩</a></li>
<li id="fn:73">Robinson DJ (2005). Disordered Personalities. Rapid Psychler Press. pp. 255–310. ISBN 978-1-894328-09-8. <a href="978-1-894328-09-8" target="_blank">978-1-894328-09-8</a> <a href="#fnref:73" class="footnote-back-ref">↩</a></li>
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<li id="fn:75">Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF (2005). "Attachment and borderline personality disorder: implications for psychotherapy". Psychopathology. 38 (2): 64–74. doi:10.1159/000084813. PMID 15802944. S2CID 10203453. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:75" class="footnote-back-ref">↩</a></li>
<li id="fn:76">Allen DM, Farmer RG (1996). "Family relationships of adults with borderline personality disorder". Comprehensive Psychiatry. 37 (1): 43–51. doi:10.1016/S0010-440X(96)90050-4. PMID 8770526. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:76" class="footnote-back-ref">↩</a></li>
<li id="fn:77">Gunderson JG (May 2011). "Clinical practice. Borderline personality disorder". The New England Journal of Medicine. 364 (21): 2037–2042. doi:10.1056/NEJMcp1007358. hdl:10150/631040. PMID 21612472. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:77" class="footnote-back-ref">↩</a></li>
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<li id="fn:103">Manning 2011, p. 23 - Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. ISBN 978-1-59385-607-6. <a href="#fnref:103" class="footnote-back-ref">↩</a></li>
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<li id="fn:106">Manning 2011, p. 24 - Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. ISBN 978-1-59385-607-6. <a href="#fnref:106" class="footnote-back-ref">↩</a></li>
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<li id="fn:222">Chapman & Gratz 2007, p. 87 - Chapman AL, Gratz KL (2007). The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD. Oakland, CA: New Harbinger Publications. ISBN 978-1-57224-507-5. <a href="#fnref:222" class="footnote-back-ref">↩</a></li>
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<li id="fn:346">Kreisman J, Strauss H (2004). Sometimes I Act Crazy. Living With Borderline Personality Disorder. Wiley & Sons. p. 206. ISBN 978-0-471-22286-6. <a href="978-0-471-22286-6" target="_blank">978-0-471-22286-6</a> <a href="#fnref:346" class="footnote-back-ref">↩</a></li>
<li id="fn:347">Sansone RA, Sansone LA (May 2011). "Gender patterns in borderline personality disorder". Innovations in Clinical Neuroscience. 8 (5): 16–20. PMC 3115767. PMID 21686143. Men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking. [For Axis I comobidity, men are] more likely to evidence substance use disorders whereas [women with BPD] are more likely to evidence eating, mood, anxiety, and posttraumatic stress disorders. With regard to Axis II comobridity, [men] are more likely than women to evidence antisocial personality disorder. Finally, in terms of treatment utilization, [men] are more likely to have treatment histories relating to substance abuse whereas women are more likely to have treatment histories characterized by more pharmacotherapy and psychotherapy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767</a> <a href="#fnref:347" class="footnote-back-ref">↩</a></li>
<li id="fn:348">Sansone RA, Sansone LA (May 2011). "Gender patterns in borderline personality disorder". Innovations in Clinical Neuroscience. 8 (5): 16–20. PMC 3115767. PMID 21686143. Men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking. [For Axis I comobidity, men are] more likely to evidence substance use disorders whereas [women with BPD] are more likely to evidence eating, mood, anxiety, and posttraumatic stress disorders. With regard to Axis II comobridity, [men] are more likely than women to evidence antisocial personality disorder. Finally, in terms of treatment utilization, [men] are more likely to have treatment histories relating to substance abuse whereas women are more likely to have treatment histories characterized by more pharmacotherapy and psychotherapy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767</a> <a href="#fnref:348" class="footnote-back-ref">↩</a></li>
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<li id="fn:355">Aviram RB, Brodsky BS, Stanley B (2006). "Borderline personality disorder, stigma, and treatment implications" (PDF). Harvard Review of Psychiatry. 14 (5): 249–256. doi:10.1080/10673220600975121. PMID 16990170. S2CID 23923078. Retrieved 24 December 2024. The stigmatization of BPD is likely to be a result of several characteristics of the BPD syndrome. [... Pejorative] terms such as "difficult," "treatment resistant," "manipulative," "demanding," and "attention seeking" [are used to describe such individuals. This] can have an impact upon the treater's a priori expectations. [... Such] stigmatization is likely to be a result of several [behaviour characteristics of individuals with BPD, and the fact that] psychotherapy with [them] may involve disturbing and frightening behavior, including intense anger, chronic suicidal ideation, self-injury, and suicide attempts. [... Clinicians, under the stigma, may] see lower levels of [their patient's] functioning as deliberate and within [ones] control, or as manipulation, or as a rejection of help, [and may therefore respond] in unintentially damaging ways, [possibly by withdrawing] physically and emotionally. [...] It has been found that when one person has negative expectations of another, the former changes his or her behavior toward the latter. These interpersonal situations have been described as self-fulfilling prophecies. <a href="https://static1.squarespace.com/static/5e7bbc0adb05de74ea06f6a0/t/5ea1c293f38c3a5c41f7ed9e/1587659411794/Aviram+BPD+and+Stigma+Har+Rev+Psychiatry.pdf" target="_blank">https://static1.squarespace.com/static/5e7bbc0adb05de74ea06f6a0/t/5ea1c293f38c3a5c41f7ed9e/1587659411794/Aviram+BPD+and+Stigma+Har+Rev+Psychiatry.pdf</a> <a href="#fnref:355" class="footnote-back-ref">↩</a></li>
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</ol>

Borderline personality disorder open-in-new

Borderline personality disorder