{{Short description|Personality disorder}}{{Distinguish|Bipolar disorder|ADHD|Social anxiety disorder|Avoidant personality disorder|text=}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Use dmy dates|date=November 2022}} {{Use American English|date=March 2024}} {{Infobox medical condition | name = Borderline Personality Disorder | image = File:Edvard Munch - The Brooch. Eva Mudocci - Google Art Project.jpg | image_size = 280px | caption = ''The Brooch'' by Edvard Munch (1903), who is exemplified of a person with borderline personality disorder<ref>{{cite book|title=Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art|trans-title=Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder|isbn=978-87-983524-1-9|vauthors=Aarkrog T|year=1990|publisher=Lundbeck Pharma A/S|location=Denmark}}</ref><ref name="auto">{{cite book|author-link=James F. Masterson|vauthors=Masterson JF|title=Search for the Real Self. Unmasking The Personality Disorders of Our Age|chapter=Chapter 12: The Creative Solution: Sartre, Munch, and Wolfe|pages=208–230, especially 212–213|publisher=Simon and Schuster|location=New York|date=1988|isbn=978-1-4516-6891-9}}</ref> | field = Psychiatry, clinical psychology | synonyms = {{collapsible list|title={{pad}}|{{plainlist| * Emotionally unstable personality disorder (EUPD, in ICD-10) * Emotional intensity disorder<ref>{{cite book|vauthors=Blom JD|title=A Dictionary of Hallucinations|date=2010|publisher=Springer|location=New York|isbn=978-1-4419-1223-7|page=74|edition=1st|url=https://books.google.com/books?id=KJtQptBcZloC&pg=PA74|access-date=5 June 2020|archive-date=4 December 2020|archive-url=https://web.archive.org/web/20201204232039/https://books.google.com/books?id=KJtQptBcZloC&pg=PA74|url-status=live|quote=Borderline personality disorder (BPD) is also known as emotional regulation disorder (ERD), emotional intensity disorder (EID), and unstable personality disorder (UPD).}}</ref> * Hysteria (formerly)<ref>{{cite book |vauthors=Bollas C|title=Hysteria|publisher=Taylor & Francis|edition=1st|date=2000|doi=10.4324/9780203361085 |isbn=978-1-136-88680-5}}</ref> * Hysteric personality – Hysteroid (formerly)<ref name=NLM>{{cite journal|vauthors=Novais F, Araújo A, Godinho P|title=Historical roots of histrionic personality disorder|journal=Frontiers in Psychology|volume=6|issue=1463|page=1463|date=25 September 2015|pmid=26441812|pmc=4585318|doi=10.3389/fpsyg.2015.01463|doi-access=free}}</ref> }} }} | symptoms = Unstable relationships, distorted sense of self, and intense emotions; impulsivity; recurrent suicidal and self-harming behavior; fear of abandonment; chronic feelings of emptiness; inappropriate anger; dissociation<ref name=NIH2016/><ref name="DSM53"/> | complications = Suicide, self-harm<ref name=NIH2016/> | onset = Early adulthood<ref name="DSM53"/> | duration = Long term<ref name=NIH2016/> | causes = Genetic, neurobiologic, and psychosocial theories proposed | risks = | diagnosis = Based on reported symptoms<ref name=NIH2016/> | differential = See § Differential diagnosis<!--Bipolar disorder, attachment disorder, dissociative identity disorder, identity disorder, mood disorders, post-traumatic stress disorder, CPTSD, substance use disorders, ADHD, histrionic, narcissistic, or antisocial personality disorder<ref name="DSM53"/><ref>{{EMedicine|article|913575|Borderline Personality Disorder|differential}}</ref>--> | prevention = | treatment = Behavior therapy<ref name=NIH2016/> | medication = | prognosis = Improves over time,<ref name="DSM53"/> remission occurs in 45% of patients over a wide range of follow-up periods<ref name="Skodol Siever Livesley Gunderson 2002 pp. 951–963">{{cite journal|last1=Skodol|first1=Andrew E|last2=Siever|first2=Larry J|last3=Livesley|first3=W.John|last4=Gunderson|first4=John G|last5=Pfohl|first5=Bruce|last6=Widiger|first6=Thomas A|title=The borderline diagnosis II: biology, genetics, and clinical course|journal=Biological Psychiatry|volume=51|issue=12|year=2002|doi=10.1016/S0006-3223(02)01325-2|pages=951–963|pmid=12062878}}</ref><ref name="Skodol Bender Pagano Shea 2007 pp. 1102–1108">{{cite journal |last1=Skodol |first1=Andrew E. |last2=Bender |first2=Donna S. |last3=Pagano |first3=Maria E. |last4=Shea |first4=M. Tracie |last5=Yen |first5=Shirley |last6=Sanislow |first6=Charles A. |last7=Grilo |first7=Carlos M. |last8=Daversa |first8=Maria T. |last9=Stout |first9=Robert L. |last10=Zanarini |first10=Mary C. |last11=McGlashan |first11=Thomas H. |last12=Gunderson |first12=John G. |title=Positive Childhood Experiences: Resilience and Recovery From Personality Disorder in Early Adulthood |journal=The Journal of Clinical Psychiatry |date=15 July 2007 |volume=68 |issue=07 |pages=1102–1108 |doi=10.4088/jcp.v68n0719 |pmid=17685749 |pmc=2705622 }}</ref><ref name="Zanarini Frankenburg Hennen Reich 2006 pp. 827–832">{{cite journal |last1=Zanarini |first1=Mary C. |last2=Frankenburg |first2=Frances R. |last3=Hennen |first3=John |last4=Reich |first4=D. Bradford |last5=Silk |first5=Kenneth R. |title=Prediction of the 10-Year Course of Borderline Personality Disorder |journal=American Journal of Psychiatry |date=May 2006 |volume=163 |issue=5 |pages=827–832 |doi=10.1176/ajp.2006.163.5.827 |pmid=16648323 }}</ref><ref name="Zanarini Frankenburg Reich Fitzmaurice 2010 pp. 663–667">{{cite journal |last1=Zanarini |first1=Mary C. |last2=Frankenburg |first2=Frances R. |last3=Reich |first3=D. Bradford |last4=Fitzmaurice |first4=Garrett |title=Time to Attainment of Recovery From Borderline Personality Disorder and Stability of Recovery: A 10-year Prospective Follow-Up Study |journal=American Journal of Psychiatry |date=June 2010 |volume=167 |issue=6 |pages=663–667 |doi=10.1176/appi.ajp.2009.09081130 |pmid=20395399 |pmc=3203735 }}</ref><ref name="Zanarini Frankenburg Reich Fitzmaurice 2012 pp. 476–483">{{cite journal |last1=Zanarini |first1=Mary C. |last2=Frankenburg |first2=Frances R. |last3=Reich |first3=D. Bradford |last4=Fitzmaurice |first4=Garrett |title=Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study |journal=American Journal of Psychiatry |date=May 2012 |volume=169 |issue=5 |pages=476–483 |doi=10.1176/appi.ajp.2011.11101550 |pmid=22737693 |pmc=3509999 }}</ref> | frequency = 5.9% (lifetime prevalence)<ref name=NIH2016/> | deaths = }} {{Personality disorders sidebar}} <!-- Definition and symptoms --> <!-- The content of this section is transcluded to Classification of personality disorders#Cluster B. Please be aware that changes made to the original source here will affect the transcluded version on the target page mentioned. --> '''Borderline Personality Disorder''' ('''BPD''') is <noinclude>a personality disorder </noinclude>characterized by a pervasive, long-term pattern across several contexts of significant interpersonal relationship instability, extreme fear of abandonment, and intense emotional outbursts.<ref name="DSM53">{{harvnb|American Psychiatric Association|2013|pages=[https://archive.org/details/diagnosticstatis0005unse/page/645 645, 663–6]}}</ref><ref name="NIH20163">{{cite web|title=Borderline Personality Disorder|url=https://www.nimh.nih.gov/health/topics/borderline-personality-disorder|url-status=live|archive-url=https://web.archive.org/web/20160322130612/http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml|archive-date=22 March 2016|access-date=16 March 2016|website=NIMH}}</ref><ref name=":15">{{cite journal |last1=Chapman |first1=Alexander L. |title=Borderline personality disorder and emotion dysregulation |journal=Development and Psychopathology |date=August 2019 |volume=31 |issue=3 |pages=1143–1156 |doi=10.1017/S0954579419000658 |pmid=31169118 }}</ref> People with BPD frequently exhibit self-harming behaviors and engage in risky activities, primarily caused by difficulties in regulating emotions.<ref>{{cite journal|vauthors=Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S|title=The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective|journal=Frontiers in Psychiatry|volume=12|article-number=721361|date=23 September 2021|pmid=34630181|pmc=8495240|doi=10.3389/fpsyt.2021.721361|doi-access=free}}</ref><ref>{{cite journal |vauthors=Cattane N, Rossi R, Lanfredi M, Cattaneo A |date=June 2017 |title=Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms |journal=BMC Psychiatry |volume=17 |issue=1 |doi=10.1186/s12888-017-1383-2 |pmc=5472954 |pmid=28619017 |quote=[BPD] is a pervasive pattern of emotional dysregulation, impulsiveness, unstable sense of identity and difficult interpersonal relationships. [Prevalence is 0.2–1.8% for general community, 15–25% among] psychiatric inpatients and 10% of all psychiatric outpatients. [Linehan (1993) proposed BPD to] be the result of [...] biologically based temperamental vulnerabilities and [adverse/traumatic childhood experiences]. Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders, with a range between 30 and 90% in BPD patients. |doi-access=free |article-number=221}}</ref><ref>{{cite web|date=December 2017|title=Borderline Personality Disorder|url=https://www.nimh.nih.gov/health/topics/borderline-personality-disorder|access-date=25 February 2021|publisher=The National Institute of Mental Health|quote=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.|archive-date=29 March 2023|archive-url=https://web.archive.org/web/20230329213453/http://nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml|url-status=live}}</ref> Symptoms such as dissociation, a pervasive sense of emptiness, and distorted sense of self are prevalent.<ref name="NIH20163" />
Onset of symptoms can be triggered by events others perceive as normal,<ref name="NIH20163" /> with the disorder manifesting in early adolescence, but is typically diagnosed in early adulthood; <ref>{{https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=borderline+pd+12+years+&btnG=#d=gs_qabs&t=1779127093751&u=%23p%3DlKBowkOjulsJ}}</ref> and persisting across diverse contexts.<ref name="DSM53" /> BPD is often comorbid with substance use disorders,<ref>{{cite journal|vauthors=Helle AC, Watts AL, Trull TJ, Sher KJ|title=Alcohol Use Disorder and Antisocial and Borderline Personality Disorders|journal=Alcohol Research: Current Reviews|volume=40|issue=1|article-number=arcr.v40.1.05|year=2019|pmid=31886107|pmc=6927749|doi=10.35946/arcr.v40.1.05}}</ref><ref>{{cite journal |last1=Trull |first1=Timothy J. |last2=Freeman |first2=Lindsey K. |last3=Vebares |first3=Tayler J. |last4=Choate |first4=Alexandria M. |last5=Helle |first5=Ashley C. |last6=Wycoff |first6=Andrea M. |title=Borderline personality disorder and substance use disorders: an updated review |journal=Borderline Personality Disorder and Emotion Dysregulation |date=December 2018 |volume=5 |issue=1 |doi=10.1186/s40479-018-0093-9 |pmid=30250740 |doi-access=free |pmc=6145127 }}</ref> depressive disorders, and eating disorders.<ref name="NIH20163" /> Studies estimate up to 10 percent of people with BPD die by suicide.<ref name="Kreisman J, Strauss H 2004">{{cite book|url=https://archive.org/details/sometimesiactcra00jero|title=Sometimes I Act Crazy. Living With Borderline Personality Disorder|vauthors=Kreisman J, Strauss H|publisher=Wiley & Sons|year=2004|isbn=978-0-471-22286-6|url-access=registration|page=206}}</ref><ref>{{Cite journal|last1=Kaurin|first1=Aleksandra|last2=Dombrovski|first2=Alexandre|last3=Hallquist|first3=Michael|last4=Wright|first4=Aidan|date=2020-12-10|title=Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder|journal=Psychological Medicine|volume=52|issue=13|pages=2702–2712|doi=10.1017/S0033291720004791|pmid=33298227|quote=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).|pmc=8190164}}</ref> BPD faces significant stigmatization in media portrayals and the psychiatric field, leading to underdiagnosis and insufficient treatment.<ref name="Borderline personality disorder, st">{{cite journal |last1=Aviram |first1=Ron B. |last2=Brodsky |first2=Beth S. |last3=Stanley |first3=Barbara |title=Borderline Personality Disorder, Stigma, and Treatment Implications |journal=Harvard Review of Psychiatry |date=September 2006 |volume=14 |issue=5 |pages=249–256 |doi=10.1080/10673220600975121 |pmid=16990170 |quote=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. }}</ref><ref name="EP">{{Cite journal |vauthors=Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S |year=2017 |title=Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice |journal=Journal of Psychotherapy Integration |volume=27 |issue=4 |pages=425–438 |doi=10.1037/int0000044 |pmc=5842953 |pmid=29527105 |quote=[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 evidence include Dialectical behavior therapy, Mentalization-based treatment, Transference-focused psychotherapy, Schema-focused therapy, and General Psychiatric Management... 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].}}</ref>
<!--Cause, mechanism, diagnosis-->Causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development.<ref name="NIH2016">{{cite web |title=Borderline Personality Disorder |url=https://www.nimh.nih.gov/health/topics/borderline-personality-disorder |url-status=live |archive-url=https://web.archive.org/web/20160322130612/http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |archive-date=22 March 2016 |access-date=16 March 2016 |website=NIMH}}</ref><ref name=":12">{{Cite web |date=2021-02-12 |title=Causes - Borderline personality disorder |url=https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/causes/ |access-date=2025-12-21 |website=nhs.uk |language=en}}</ref> The current hypothesis suggests BPD is caused by an interaction between genetic factors and adverse childhood experiences.<ref>{{Citation |last1=Chapman |first1=Jennifer |title=Borderline Personality Disorder |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK430883/ |access-date=2025-06-10 |place=Treasure Island, Fla. |publisher=StatPearls Publishing |pmid=28613633 |quote=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. |last2=Jamil |first2=Radia T. |last3=Fleisher |first3=Carl |last4=Torrico |first4=Tyler J.}}</ref><ref name=":13">{{cite journal |last1=Leichsenring |first1=Falk |last2=Fonagy |first2=Peter |last3=Heim |first3=Nikolas |last4=Kernberg |first4=Otto F. |last5=Leweke |first5=Frank |last6=Luyten |first6=Patrick |last7=Salzer |first7=Simone |last8=Spitzer |first8=Carsten |last9=Steinert |first9=Christiane |title=Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies |journal=World Psychiatry |date=February 2024 |volume=23 |issue=1 |pages=4–25 |doi=10.1002/wps.21156 |pmc=10786009 |pmid=38214629 |quote=It is currently hypothesized that, in BPD, genetic factors and adverse childhood experiences interact to influence brain development via hormones and neuropeptides. Adverse childhood experiences are thought to modulate gene expression and lead to stable personality traits that may predispose to BPD. [...] There is familial aggregation of BPD, with recent data from a Swedish population-based study estimating heritability at 46%. The risk of receiving a BPD diagnosis was increased 4.7-fold for full siblings. The hazard ratio in identical twins was 11.5.}}</ref> BPD is significantly more common in people with a family history of BPD, particularly immediate relatives, suggesting genetic predisposition.<ref name=":13" /> There is a risk of misdiagnosis, with BPD commonly confused with a mood disorder, substance use disorder, or other mental health disorders.<ref name="DSM53"/><!-- Treatment -->
Therapeutic interventions predominantly involve psychotherapy, with dialectical behavior therapy (DBT) and schema therapy being the most effective.<ref name="NIH2016" /><ref name="EP" /> Although pharmacotherapy cannot cure BPD, it may be employed to mitigate symptoms,<ref name="NIH2016" /> with atypical antipsychotics and selective serotonin reuptake inhibitor (SSRI) antidepressants commonly prescribed. Medications are used cautiously and may have minimal impact on neural function.<ref name=":4" /><ref name="pmid37256484" /><ref>{{Cite journal |last=Gerolymos |first=Cyril |last2=Garosi |first2=Alexandra |last3=Boyer |first3=Laurent |last4=Yon |first4=Dong Keon |last5=Rahmati |first5=Masoud |last6=Gavaudan |first6=Mika |last7=Fond |first7=Guillaume |date=2026-02-10 |title=Efficacy and safety of pharmacological treatments in borderline personality disorder: A systematic review and network meta-analysis |url=https://www.nature.com/articles/s41380-026-03451-4 |journal=Molecular Psychiatry |language=en |pages=1–13 |doi=10.1038/s41380-026-03451-4 |issn=1476-5578|url-access=subscription }}</ref> Due to the high utilization of healthcare resources by people with BPD,<ref name="Bourke_2018">{{cite journal|vauthors=Bourke J, Murphy A, Flynn D, Kells M, Joyce M, Hurley J|title=Borderline personality disorder: resource utilisation costs in Ireland|journal=Irish Journal of Psychological Medicine|volume=38|issue=3|pages=169–176|date=September 2021|pmid=34465404|doi=10.1017/ipm.2018.30|hdl-access=free|hdl=10468/7005}}</ref> up to half may show significant improvement over ten years with appropriate treatment.<ref name="DSM53" />
Estimation of BPD's prevalence varies. In the US, around 1% of the population are diagnosed with it.<ref name=":5">{{cite journal |last1=Ellison |first1=William D. |last2=Rosenstein |first2=Lia K. |last3=Morgan |first3=Theresa A. |last4=Zimmerman |first4=Mark |title=Community and Clinical Epidemiology of Borderline Personality Disorder |journal=Psychiatric Clinics of North America |date=December 2018 |volume=41 |issue=4 |pages=561–573 |doi=10.1016/j.psc.2018.07.008 |pmid=30447724 |quote=BPD tends to be more prevalent in adult women than adult men, [but] this gender split is not apparent among adolescents. [...] BPD has been found to decrease and even remit as individuals age. [...] BPD [has] a point prevalence around 1%. [Prevalence differ between subpopulations, being] substantially higher [for psychiatric population, around 12% for outpatient and 22% for inpatient.] Research also suggests [potential] differences [between] ethnic groups[. Deliberate] self-harm [...] differs among ethnic groups, [with] African-American individuals [reporting] more affective instability and emotion dysregulation, but less suicidal behavior and deliberate self-harm, than White American individuals with the disorder.}}</ref> BPD is more prevalent among adolescents and young adults than elderly, and symptoms may remit with age.<ref name=":5" /> The term 'borderline' is debated, as it referred to concepts of borderline insanity and patients on the border between neurosis and psychosis, which are now considered clinically imprecise.<ref name="NIH2016" /><ref>{{cite journal|vauthors=Gunderson JG|title=Borderline personality disorder: ontogeny of a diagnosis|journal=The American Journal of Psychiatry|volume=166|issue=5|pages=530–539|date=May 2009|pmid=19411380|pmc=3145201|doi=10.1176/appi.ajp.2009.08121825}}</ref> {{TOC limit}}
== Signs and symptoms == [[File:BPD 1.png|thumb|alt=On the right, a girl reaches out her arm for a male who is looking the other way, they are both black silhouettes. The girl has short hair and white squiggly lines in her body that condense near her heart and resemble lines seen on a black marble floor, and the male has a crew cut|One of the symptoms of BPD is an intense fear of emotional abandonment.]]
The distinguishing characteristics of borderline personality disorder (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 and self, alongside fluctuating moods and difficulty regulating intense emotional reactions. Dangerous or impulsive behaviors are commonly associated with BPD.<ref>{{cite web |last1=Smith |first1=Melinda |first2=Jeanne |last2=Segal|title=Borderline Personality Disorder |url=https://www.helpguide.org/mental-health/personality-disorders/borderline-personality-disorder |website=HelpGuide |date=2 November 2018 |access-date=12 August 2025}}</ref>
Additional symptoms may encompass uncertainty about one's identity, values, morals, and beliefs; experiencing paranoid thoughts under stress; episodes of depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or episodes of psychosis. It is also common for individuals with BPD to have comorbid conditions such as depressive or bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).<ref name="DSM-5 Task Force_2013">{{cite book|author=((DSM-5 Task Force))|title=Diagnostic and Statistical Manual of Mental Disorders: DSM-5|publisher=American Psychiatric Association|year=2013|isbn=978-0-89042-554-1|oclc=863153409}}</ref>
===Emotional dysregulation=== {{Further|Emotional dysregulation}}
Emotional dysregulation is a core feature of BPD and it is characterized by a difficulty in effectively managing emotional states.<ref>{{cite journal |last1=Carpenter |first1=Ryan W. |last2=Trull |first2=Timothy J. |title=Components of Emotion Dysregulation in Borderline Personality Disorder: A Review |journal=Current Psychiatry Reports |date=January 2013 |volume=15 |issue=1 |article-number=335 |doi=10.1007/s11920-012-0335-2 |pmc=3973423 |pmid=23250816 }}</ref>{{rp|1}}It may involve high sensitivity to emotional stimuli, heightened emotional intensity, large and rapid mood shifts, tendency for negative emotions, high affective empathy but low cognitive empathy, and a slow return to baseline after emotional arousal.<ref name=":emo">Multiple sources:
* {{cite journal |last1=Carpenter |first1=Ryan W. |last2=Trull |first2=Timothy J. |title=Components of Emotion Dysregulation in Borderline Personality Disorder: A Review |journal=Current Psychiatry Reports |date=January 2013 |volume=15 |issue=1 |article-number=335 |doi=10.1007/s11920-012-0335-2 |pmc=3973423 |pmid=23250816 }} * {{cite journal |last1=Glenn |first1=Catherine R. |last2=Klonsky |first2=E. David |title=Emotion Dysregulation as a Core Feature of Borderline Personality Disorder |journal=Journal of Personality Disorders |date=February 2009 |volume=23 |issue=1 |pages=20–28 |doi=10.1521/pedi.2009.23.1.20 |pmid=19267659 }} * {{cite journal |last1=Ebner-Priemer |first1=Ulrich W. |last2=Houben |first2=Marlies |last3=Santangelo |first3=Philip |last4=Kleindienst |first4=Nikolaus |last5=Tuerlinckx |first5=Francis |last6=Oravecz |first6=Zita |last7=Verleysen |first7=Gregory |last8=Van Deun |first8=Katrijn |last9=Bohus |first9=Martin |last10=Kuppens |first10=Peter |title=Unraveling affective dysregulation in borderline personality disorder: A theoretical model and empirical evidence. |journal=Journal of Abnormal Psychology |date=February 2015 |volume=124 |issue=1 |pages=186–198 |doi=10.1037/abn0000021 |pmid=25603359 }} * {{cite journal |last1=Bayes |first1=Adam |last2=Parker |first2=Gordon |last3=McClure |first3=Georgia |title=Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression |journal=Journal of Affective Disorders |date=November 2016 |volume=204 |pages=103–111 |doi=10.1016/j.jad.2016.06.027 |pmid=27344618 }} * {{cite journal |last1=Fitzpatrick |first1=Skye |last2=Dixon-Gordon |first2=Katherine L. |last3=Turner |first3=Cassandra J. |last4=Chen |first4=Spencer X. |last5=Chapman |first5=Alexander |title=Emotion Dysregulation in Personality Disorders |journal=Current Psychiatry Reports |date=May 2023 |volume=25 |issue=5 |pages=223–231 |doi=10.1007/s11920-023-01418-8 |pmid=37036627 }}</ref><ref name=":14">{{cite journal |last1=Blunden |first1=Anthea G. |last2=Henry |first2=Julie D. |last3=Pilkington |first3=Pamela D. |last4=Pizarro-Campagna |first4=Elizabeth |title=Early affective empathy, emotion contagion, and empathic concern in borderline personality disorder: A systematic review and meta-analysis |journal=Journal of Affective Disorders |date=December 2024 |volume=367 |pages=462–478 |doi=10.1016/j.jad.2024.08.215 |doi-access=free |pmid=39236884 }}</ref> Emotional dysregulation extends beyond emotions, affecting cognition, relationships, and behavior.<ref name=":2">{{cite journal |last1=Chapman |first1=Alexander L. |title=Borderline personality disorder and emotion dysregulation |journal=Development and Psychopathology |date=August 2019 |volume=31 |issue=3 |pages=1143–1156 |doi=10.1017/S0954579419000658 |pmid=31169118 }}</ref>{{rp|899}}
Deficits in emotion regulation strategies are observed in BPD. These include resistance to accepting emotional responses, low flexibility to changing strategies, difficulty in identifying emotions, as well as a deficit in goal-directed behavior, and in using healthy coping strategies.<ref>{{cite journal |last1=Bayes |first1=Adam |last2=Parker |first2=Gordon |last3=McClure |first3=Georgia |title=Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression |journal=Journal of Affective Disorders |date=November 2016 |volume=204 |pages=103–111 |doi=10.1016/j.jad.2016.06.027 |pmid=27344618 }}</ref>{{rp|108}}<ref name=":3" />{{rp|226}} Maladaptive strategies commonly used to regulate their emotions include self-harm, rumination, avoidance, and thought suppression.<ref name=":2" />{{rp|905}}<ref>{{cite journal |last1=Glenn |first1=Catherine R. |last2=Klonsky |first2=E. David |title=Emotion Dysregulation as a Core Feature of Borderline Personality Disorder |journal=Journal of Personality Disorders |date=February 2009 |volume=23 |issue=1 |pages=20–28 |doi=10.1521/pedi.2009.23.1.20 |pmid=19267659 }}</ref>{{rp|21}}<ref name=":3">{{Cite journal |last1=Fitzpatrick |first1=Skye |last2=Dixon-Gordon |first2=Katherine L. |last3=Turner |first3=Cassandra J. |last4=Chen |first4=Spencer X. |last5=Chapman |first5=Alexander |date=2023-05-01 |title=Emotion Dysregulation in Personality Disorders |journal=Current Psychiatry Reports |language=en |volume=25 |issue=5 |pages=223–231 |doi=10.1007/s11920-023-01418-8 |pmid=37036627 }}</ref>{{rp|225}}
Emotional dysregulation is thought to be caused by an imbalance in the limbic system and the prefrontal cortex, particularly in the amygdala.<ref>{{cite journal |last1=Sicorello |first1=Maurizio |last2=Schmahl |first2=Christian |title=Emotion dysregulation in borderline personality disorder: A fronto–limbic imbalance? |journal=Current Opinion in Psychology |date=February 2021 |volume=37 |pages=114–120 |doi=10.1016/j.copsyc.2020.12.002 |pmid=33422855 }}</ref>{{rp|114–115}} Dialectical behavior therapy can be employed to help with emotional dysregulation.<ref name=":3" />{{rp|224}}
===Interpersonal relationships=== 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<ref>{{Cite journal|vauthors=Hepp J, Lane SP, Carpenter RW, Niedtfeld I, Brown WC, Trull TJ|year=2017|title=Interpersonal Problems and Negative Affect in Borderline Personality and Depressive Disorders in Daily Life|journal=Clinical Psychological Science|publisher=Sage Publishing|volume=5|issue=3|pages=470–484|doi=10.1177/2167702616677312|pmid=28529826|pmc=5436804|quote=[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.}}</ref> towards perceived criticism or harm.<ref name="cogemo">{{cite journal|vauthors=Arntz A|date=September 2005|title=Introduction to special issue: cognition and emotion in borderline personality disorder|journal=Journal of Behavior Therapy and Experimental Psychiatry|volume=36|issue=3|pages=167–72|doi=10.1016/j.jbtep.2005.06.001|pmid=16018875}}</ref> A notable feature of BPD is the tendency to engage in idealization and devaluation of others—that is to idealize and subsequently devalue others—oscillating between extreme admiration and profound mistrust or dislike.<ref>{{harvnb|Linehan|1993|page=146}}</ref> This pattern, referred to as "splitting", can significantly influence the dynamics of interpersonal relationships.<ref>{{cite web|title=What Is BPD: Symptoms|url=http://www.borderlinepersonalitydisorder.com/understading-bpd/|archive-url=https://web.archive.org/web/20130210110927/http://www.borderlinepersonalitydisorder.com/understading-bpd/|archive-date=10 February 2013|access-date=31 January 2013|website=National Education Alliance for Borderline Personality Disorder}}</ref><ref name="Robinson">{{cite book|vauthors=Robinson DJ|title=Disordered Personalities|publisher=Rapid Psychler Press|year=2005|pages=255–310|isbn=978-1-894328-09-8}}</ref> 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.<ref name="Gund2011" />
Despite a strong desire for intimacy, individuals with BPD may exhibit insecure, avoidant, ambivalent, or fearfully preoccupied attachment styles in relationships, complicating their interactions and connections with others.<ref>{{cite journal|vauthors=Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF|title=Attachment and borderline personality disorder: implications for psychotherapy|journal=Psychopathology|volume=38|issue=2|pages=64–74|year=2005|pmid=15802944|doi=10.1159/000084813 }}</ref> 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,<ref name="parents">{{cite journal|vauthors=Allen DM, Farmer RG|title=Family relationships of adults with borderline personality disorder|journal=Comprehensive Psychiatry|volume=37|issue=1|pages=43–51|year=1996|pmid=8770526|doi=10.1016/S0010-440X(96)90050-4}}</ref> contributing to a sense of alienation within the family unit.<ref name="Gund2011">{{cite journal|vauthors=Gunderson JG|title=Clinical practice. Borderline personality disorder|journal=The New England Journal of Medicine|volume=364|issue=21|pages=2037–2042|date=May 2011|pmid=21612472|doi=10.1056/NEJMcp1007358|hdl=10150/631040|hdl-access=free}}</ref> 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.<ref name="Lester 70–77">{{cite journal |last1=Lester |first1=Rebecca J |title=Lessons from the borderline: Anthropology, psychiatry, and the risks of being human |journal=Feminism & Psychology |date=February 2013 |volume=23 |issue=1 |pages=70–77 |doi=10.1177/0959353512467969 }}</ref>
Personality disorders, including BPD, are associated with an increased incidence of chronic stress and conflict, reduced satisfaction in romantic partnerships, domestic abuse, and unintended pregnancies.<ref name="Daley SE, Burge D, Hammen C 2000 451–60">{{cite journal|vauthors=Daley SE, Burge D, Hammen C|title=Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity|journal=Journal of Abnormal Psychology|volume=109|issue=3|pages=451–460|date=August 2000|pmid=11016115|doi=10.1037/0021-843X.109.3.451 }}</ref> 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.<ref name="Ryan_2007">{{cite journal |last1=Ryan |first1=Kimberly |last2=Shean |first2=Glenn |title=Patterns of interpersonal behaviors and borderline personality characteristics |journal=Personality and Individual Differences |date=January 2007 |volume=42 |issue=2 |pages=193–200 |doi=10.1016/j.paid.2006.06.010 }}</ref> 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.<ref name="Ryan_2007" /> In certain cases, BPD may be recognized as a disability 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.<ref>{{cite journal|vauthors=Arvig TJ|title=Borderline personality disorder and disability|journal=AAOHN Journal|volume=59|issue=4|pages=158–60|date=April 2011|pmid=21462898|doi=10.1177/216507991105900401|doi-access=free}}</ref> Individuals with BPD express higher levels of jealousy towards their partners in romantic relations.<ref>{{cite journal|doi=10.1016/j.avb.2016.03.005|title=Battering typologies, attachment insecurity, and personality disorders: A comprehensive literature review|year=2016|last1=Cameranesi|first1=Margherita|journal=Aggression and Violent Behavior|volume=28|pages=29–46}}</ref><ref name="pmid16757985">{{cite journal|vauthors=Stone MH|title=Management of borderline personality disorder: a review of psychotherapeutic approaches|journal=World Psychiatry|volume=5|issue=1|pages=15–20|date=February 2006|pmid=16757985|pmc=1472266}}</ref>
Manipulative behavior to obtain nurturance is considered by the DSM-IV-TR<ref name=":6" /> and many mental health professionals<ref>{{Cite journal |last=Potter |first=Nancy Nyquist |date=April 2006 |title=What is Manipulative Behavior, Anyway? |url=https://guilfordjournals.com/doi/10.1521/pedi.2006.20.2.139 |journal=Journal of Personality Disorders |volume=20 |issue=2 |pages=139–156 |doi=10.1521/pedi.2006.20.2.139 |issn=0885-579X}}</ref><ref>{{Cite journal |last=Schmidt |first=Philipp |date=2021 |title=Crossing the Lines: Manipulation, Social Impairment, and a Challenging Emotional Life |url=https://journals.openedition.org/phenomenology/312 |journal=Phenomenology & Mind |pages=62 |doi=10.17454/pam-2105 |issn=2239-4028}}</ref> to be a characteristic of borderline personality disorder.<ref name=":6">{{harvnb|American Psychiatric Association|2000|page=705}}</ref> In one research study, 88% of therapists reported that they have experienced manipulation attempts from patient(s).<ref>{{cite journal |vauthors=Mandal E, Kocur D |year=2013 |title=Psychological masculinity, femininity, and tactics of manipulation in patients with borderline personality disorder |journal=Archives of Psychiatry and Psychotherapy |issue=1 |pages=45–53 |url=https://www.archivespp.pl/pdf-153362-78027?filename=Psychological.pdf }}</ref> Marsha Linehan 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 to influence the behavior of others.<ref name="Linehanp14">{{harvnb|Linehan|1993|page=14}}</ref> 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.<ref name="Linehanp14" /> 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.<ref>{{harvnb|Linehan|1993|page=15}}</ref>
===Behavior=== 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.<ref name=Manning_18/> These behaviors are a response to the intense emotional distress experienced by individuals with BPD, serving as an immediate but temporary alleviation of their emotional pain.<ref name=Manning_18/> However, such actions typically result in feelings of shame and guilt, contributing to a recurrent cycle.<ref name=Manning_18>{{harvnb|Manning|2011|page=18}}</ref> 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.<ref name=Manning_18/> This escalation of emotional pain then intensifies the compulsion 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.<ref name=Manning_18/> Interventions such as dialectical behavior therapy (DBT) and schema therapy aim to disrupt this cycle by improving emotional regulation, distress tolerance, and adaptive coping strategies.<ref>{{cite journal | last1=Giesen-Bloo | first1=Josephine | last2=Van Dyck | first2=Richard | last3=Spinhoven | first3=Philip | last4=Van Tilburg | first4=Willem | last5=Dirksen | first5=Carmen | last6=Van Asselt | first6=Thea | last7=Kremers | first7=Ismay | last8=Nadort | first8=Marjon | last9=Arntz | first9=Arnoud | title=Outpatient Psychotherapy for Borderline Personality Disorder | journal=Archives of General Psychiatry | date=2006 | volume=63 | issue=6 | pages=649–658 | doi=10.1001/archpsyc.63.6.649 | pmid=16754838 | hdl=11370/b6541436-3ed9-4308-942d-9870a069730e | hdl-access=free }}</ref>
===Self-harm and suicidality===<!-- Self harm -->
Self-harm and suicidal behaviors are core diagnostic criteria for BPD as outlined in the DSM-5.<ref name="DSM53" /> Between 50% and 80% of individuals diagnosed with BPD<!--<ref name=Ou2008/> --> engage in self-harm, with cutting being the most common method.<ref name="Ou2008">{{cite journal|vauthors=Oumaya M, Friedman S, Pham A, Abou Abdallah T, Guelfi JD, Rouillon F|title=[Borderline personality disorder, self-mutilation and suicide: literature review]|language=fr|journal=L'Encéphale|volume=34|issue=5|pages=452–8|date=October 2008|pmid=19068333|doi=10.1016/j.encep.2007.10.007}}</ref> Other methods, such as bruising, burning, head banging, or biting, are also prevalent.<ref name="Ou2008" /> It is hypothesized that individuals with BPD might experience a sense of emotional relief following acts of self-harm.<ref name="DucasseCourtet2014">{{cite journal|vauthors=Ducasse D, Courtet P, Olié E|title=Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review|journal=Current Psychiatry Reports|volume=16|issue=5|article-number=443|date=May 2014|pmid=24633938|doi=10.1007/s11920-014-0443-2 }}</ref><!-- Reasons -->
The motivations behind self-harm and suicide attempts among individuals with BPD are reported to differ.<ref name="reasons_NSSI">{{cite journal|vauthors=Brown MZ, Comtois KA, Linehan MM |title=Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder|journal=Journal of Abnormal Psychology|volume=111|issue=1|pages=198–202|date=February 2002|pmid=11866174|doi=10.1037/0021-843X.111.1.198}}</ref> 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.<ref name="reasons_NSSI" />{{Primary source inline|date=April 2025}} Conversely, true suicide attempts by individuals with BPD are frequently motivated by the notion that others will be better off in their absence.<ref name="reasons_NSSI" />{{Primary source inline|date=April 2025}}
===Sense of self and self-concept=== Individuals diagnosed with BPD frequently experience significant difficulties in maintaining a stable self-concept.<ref>{{cite journal |last1=Vater |first1=Aline |last2=Schröder-Abé |first2=Michela |last3=Weißgerber |first3=Susan |last4=Roepke |first4=Stefan |last5=Schütz |first5=Astrid |title=Self-concept structure and borderline personality disorder: Evidence for negative compartmentalization |journal=Journal of Behavior Therapy and Experimental Psychiatry |date=March 2015 |volume=46 |pages=50–58 |doi=10.1016/j.jbtep.2014.08.003 |pmid=25222626 |quote=Borderline personality disorder (BPD) is characterized by an unstable and incongruent self-concept. [...] The results of our study show that patients with BPD exhibit more compartmentalized self-concepts than non-clinical and depressed individuals, i.e., they have difficulties incorporating both positive and negative traits within separate self-aspects. }}</ref> This identity disturbance manifests as uncertainty in personal values, beliefs, preferences, and interests.<ref name="Manning_23" /> 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 identity.<ref name=Manning_23/> Moreover, their self-perception 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, known as mirroring.<ref>{{cite journal|vauthors=Biskin RS, Paris J|title=Diagnosing borderline personality disorder|journal=CMAJ|volume=184|issue=16|pages=1789–1794|date=November 2012|pmid=22988153|pmc=3494330|doi=10.1503/cmaj.090618}}</ref> This can also often lead to pervasive emotional contagion.<ref name=":14" />
===Dissociation and cognitive challenges=== The heightened emotional states experienced by individuals with BPD can impede their ability to concentrate and cognitively function.<ref name=Manning_23>{{harvnb|Manning|2011|page=23}}</ref> Additionally, individuals with BPD may frequently dissociate, which can be regarded as a mild to severe disconnection from physical and emotional experiences.<ref name=Manning_24>{{harvnb|Manning|2011|page=24}}</ref> 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.<ref name=Manning_24/>
Researchers disagree about whether dissociation or a sense of emotional detachment 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 autobiographical memory was decreased in BPD patients.<ref name="Startup">{{cite journal |vauthors=Jones B, Heard H, Startup M, Swales M, Williams JM, Jones RS |date=November 1999 |title=Autobiographical memory and dissociation in borderline personality disorder |journal=Psychological Medicine |volume=29 |issue=6 |pages=1397–1404 |doi=10.1017/S0033291799001208 |pmid=10616945 }}</ref> The researchers found that decreased ability to recall specifics was correlated with patients' levels of dissociation, which "may help them to avoid episodic information that would evoke acutely negative affect".<ref name="Startup" /><ref>{{Cite journal |vauthors=Al-Shamali HF, Winkler O, Talarico F, Greenshaw AJ, Forner C, Zhang Y, Vermetten E, Burback L |date=2022-02-13 |title=A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog |journal=Australian and New Zealand Journal of Psychiatry |volume=56 |issue=10 |pages=1252–1264 |doi=10.1177/00048674221077029 |pmc=9511244 |pmid=35152771}}</ref>
=== Psychotic symptoms === 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.<ref name="Schroeder_2013">{{cite journal|vauthors=Schroeder K, Fisher HL, Schäfer I|date=January 2013|editor-last=Pull|editor-first=Charles B.|editor2-last=Janca|editor2-first=Aleksandar|title=Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management|journal=Current Opinion in Psychiatry|volume=26|issue=1|pages=113–9|doi=10.1097/YCO.0b013e32835a2ae7|pmid=23168909 |quote=Of patients with BPD about 20–50% report psychotic symptoms. Hallucinations can be similar to those in patients with psychotic disorders in terms of phenomenology, emotional impact, and their persistence over time [...] terms like pseudo-psychotic or quasi-psychotic are misleading and should be avoided [...] and current diagnostic systems might require revision to emphasise psychotic symptoms.|doi-access=}}</ref> These manifestations have historically been labeled as "pseudo-psychotic" or "psychotic-like", implying a differentiation from symptoms observed in primary psychotic disorders. Studies conducted in the 2010s suggest a closer similarity between psychotic symptoms in BPD and those in recognized psychotic disorders than previously understood.<ref name="Schroeder_2013" /><ref name="Niemantsverdriet_2017">{{cite journal|vauthors=Niemantsverdriet MB, Slotema CW, Blom JD, Franken IH, Hoek HW, Sommer IE, van der Gaag M|title=Hallucinations in borderline personality disorder: Prevalence, characteristics and associations with comorbid symptoms and disorders|journal=Scientific Reports|volume=7|issue=1|article-number=13920|date=October 2017|pmid=29066713|pmc=5654997|doi=10.1038/s41598-017-13108-6|bibcode=2017NatSR...713920N}}</ref> The distinction of pseudo-psychosis has faced criticism for its weak construct validity 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.<ref name="Schroeder_2013" /><ref name="Slotema_2018">{{cite journal|vauthors=Slotema CW, Blom JD, Niemantsverdriet MB, Sommer IE|title=Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review|journal=Frontiers in Psychiatry|volume=9|article-number=347|date=31 July 2018|pmid=30108529|pmc=6079212|doi=10.3389/fpsyt.2018.00347|doi-access=free}}</ref> The DSM-5 identifies transient paranoia, exacerbated by stress, as a symptom of BPD.<ref name="DSM53" /> Research has identified the presence of both hallucinations and delusions in individuals with BPD who do not possess an alternate diagnosis that would better explain these symptoms.<ref name="Niemantsverdriet_2017" /> Further, phenomenological analysis indicates that auditory verbal hallucinations in BPD patients are indistinguishable from those observed in schizophrenia.<ref name="Niemantsverdriet_2017" /><ref name="Slotema_2018" /> This has led to suggestions of a potential shared etiological basis for hallucinations across BPD and other disorders, including psychotic and affective disorders.<ref name="Niemantsverdriet_2017" />
==Causes==<!-- This section needs its sub-headers redone and re-imagined. -->
The etiology, or causes, of BPD is multifaceted, with no consensus on a singular cause.<ref name="mayo">{{cite web|url=http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=3|title=Borderline personality disorder|publisher=Mayo Clinic|access-date=15 May 2008|url-status=live|archive-url=https://web.archive.org/web/20080430112844/http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION%3D3|archive-date=30 April 2008}}</ref> BPD may share a connection with post-traumatic stress disorder (PTSD), with both having a traumatic substrate.<ref name="BPD & PTSD">{{cite journal|vauthors=Gunderson JG, Sabo AN|title=The phenomenological and conceptual interface between borderline personality disorder and PTSD|journal=The American Journal of Psychiatry|volume=150|issue=1|pages=19–27|date=January 1993|pmid=8417576|doi=10.1176/ajp.150.1.19}}</ref> While childhood trauma is a recognized contributing factor, the roles of congenital brain abnormalities, genetics, neurobiology, and non-traumatic environmental factors remain subjects of ongoing investigation.<ref name=":12" /><ref name="mayo" />
===Genetics and heritability=== Compared to other major psychiatric conditions, the exploration of genetic underpinnings in BPD remains novel.<ref name="pmid29032046">{{cite journal|vauthors=Bassir Nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM|title=Past, present, and future of genetic research in borderline personality disorder|journal=Current Opinion in Psychology|volume=21|pages=60–68|date=June 2018|pmid=29032046|pmc=5847441|doi=10.1016/j.copsyc.2017.09.002}}</ref> Estimates suggest the heritability of BPD ranges from 37% to 69%,<ref name="Her2014">{{cite journal|vauthors=Gunderson JG, Zanarini MC, Choi-Kain LW, Mitchell KS, Jang KL, Hudson JI|date=August 2011|title=Family Study of Borderline Personality Disorder and Its Sectors of Psychopathology|journal=JAMA: The Journal of the American Medical Association|volume=68|issue=7|pages=753–762|doi=10.1001/archgenpsychiatry.2011.65|pmid=3150490|pmc=3150490}}</ref> indicating that human genetic variations account for a substantial portion of the risk for BPD within the population. Twin studies, 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.<ref>{{cite journal|vauthors=Torgersen S|title=Genetics of patients with borderline personality disorder|journal=The Psychiatric Clinics of North America|volume=23|issue=1|pages=1–9|date=March 2000|pmid=10729927|doi=10.1016/S0193-953X(05)70139-8}}</ref>
Certain studies propose that personality disorders are significantly shaped by genetics, more so than many Axis I disorders, such as depression and eating disorders, and even surpassing the genetic impact on broad personality traits.<ref name="TS" >{{cite journal|vauthors=Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, Tambs K, Kringlen E|title=A twin study of personality disorders|journal=Comprehensive Psychiatry|volume=41|issue=6|pages=416–425|year=2000|pmid=11086146|doi=10.1053/comp.2000.16560}}</ref> A twin study found that BPD ranks as the third most heritable among ten surveyed personality disorders.<ref name="TS" />
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 serotonin-related genes appearing to be modest.<ref name="neurotrauma">{{cite journal|vauthors=Goodman M, New A, Siever L|title=Trauma, genes, and the neurobiology of personality disorders|journal=Annals of the New York Academy of Sciences|volume=1032|issue=1|pages=104–116|date=December 2004|pmid=15677398|doi=10.1196/annals.1314.008|bibcode=2004NYASA1032..104G }}</ref>
A study conducted by Trull et al. in the Netherlands, which included 711 sibling pairs and 561 parents, aimed to identify genetic markers associated with BPD.<ref name="Possible Genetic Causes">{{cite press release |title=Possible Genetic Causes Of Borderline Personality Disorder Identified |url=https://www.sciencedaily.com/releases/2008/12/081216114100.htm |work=ScienceDaily |publisher=University of Missouri-Columbia |date=20 December 2008 }}</ref> This research identified a linkage to genetic markers on chromosome 9 as relevant to BPD characteristics,<ref name="Possible Genetic Causes" /> underscoring a significant genetic contribution to the variability observed in BPD features.<ref name="Possible Genetic Causes" /> 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.<ref name="Possible Genetic Causes" />
Among specific genetic variants under scrutiny {{as of|2012|lc=y}}, the DRD4 7-repeat polymorphism (of the dopamine receptor D<sub>4</sub>) located on chromosome 11 has been linked to disorganized attachment, and in conjunction with the 10/10-repeat genotype of the dopamine transporter (DAT), it has been associated with issues with inhibitory control, both of which are characteristic of BPD.<ref name="Brain Structure and Function">{{cite journal|vauthors=O'Neill A, Frodl T|title=Brain structure and function in borderline personality disorder|journal=Brain Structure & Function|volume=217|issue=4|pages=767–782|date=October 2012|pmid=22252376|doi=10.1007/s00429-012-0379-4 }}</ref>
===Psychosocial factors=== Empirical studies have established a strong correlation between adverse childhood experiences such as child abuse, particularly child sexual abuse, and the onset of BPD later in life.<ref>{{cite journal |last1=Cohen |first1=Patricia |title=Child Development and Personality Disorder |journal=Psychiatric Clinics of North America |date=September 2008 |volume=31 |issue=3 |pages=477–493 |doi=10.1016/j.psc.2008.03.005 |pmid=18638647 }}</ref><ref name="Herman91">{{cite book|url=https://archive.org/details/traumarecovery00herm_0|title=Trauma and recovery|vauthors=Herman JL|publisher=Basic Books|year=1992|isbn=978-0-465-08730-3|location=New York}}</ref><ref name="AxisOne/AxisTwo">{{cite web |vauthors=Quadrio C |title=Axis One/Axis Two: A disordered borderline |page=A107 |url=https://www.researchgate.net/publication/295309096 }} in: {{cite journal |title=Abstracts for The Royal Australian and New Zealand College of Psychiatrists 40th Congress Psychiatry in a Changing World Sydney, Australia Sunday 22 - Thursday 26 May, 2005 |journal=Australian and New Zealand Journal of Psychiatry |date=28 July 2005 |volume=39 |issue=S1 |pages=A97–A153 |doi=10.1111/j.1440-1614.2005.01674_39_s1.x }}</ref> Reports from individuals diagnosed with BPD frequently include narratives of extensive abuse and neglect during early childhood, though causality remains a subject of ongoing investigation.<ref>{{cite journal |last1=Ball |first1=Jeffrey S. |last2=Links |first2=Paul S. |title=Borderline personality disorder and childhood trauma: Evidence for a causal relationship |journal=Current Psychiatry Reports |date=February 2009 |volume=11 |issue=1 |pages=63–68 |doi=10.1007/s11920-009-0010-4 |pmid=19187711 |quote=[An] association [between childhood trauma and BPD] is consistently shown across studies. [While we] do not dispute that the etiology of BPD is likely [multifactorial, we] argue that [...] childhood trauma plays a role in this model as an etiologic factor. }}</ref> These individuals are significantly more prone to recount experiences of verbal, emotional, physical, or sexual abuse by caregivers,<ref>{{cite news|url=http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/risk-factors/con-20023204|title=Borderline personality disorder: Understanding this challenging mental illness|work=Mayo Clinic|access-date=5 September 2017|url-status=live|archive-url=https://web.archive.org/web/20170830054834/http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/risk-factors/con-20023204|archive-date=30 August 2017}}</ref> alongside a notable frequency of incest and loss of caregivers in early childhood.<ref name="failchild">{{cite journal |last1=Zanarini |first1=Mary C. |last2=Frankenburg |first2=Frances R. |last3=Reich |first3=D. Bradford |last4=Marino |first4=Margaret F. |last5=Lewis |first5=Ruth E. |last6=Williams |first6=Amy A. |last7=Khera |first7=Gagan S. |title=Biparental Failure in the Childhood Experiences of Borderline Patients |journal=Journal of Personality Disorders |date=September 2000 |volume=14 |issue=3 |pages=264–273 |doi=10.1521/pedi.2000.14.3.264 |pmid=11019749 }}</ref>
Moreover, there have been consistent accounts of caregivers invalidating the individuals' emotions and thoughts, neglecting physical care, failing to provide the necessary protection, and exhibiting emotional withdrawal and inconsistency.<ref name="failchild" /> 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.<ref name="failchild" /> Research also indicates that neurodevelopment variations such as autism spectrum traits, ADHD, or highly sensitive people (HSP) may increase vulnerability to trauma and subsequent borderline personality organization.<ref>{{cite journal |last1=Matthies |first1=Swantje D |last2=Philipsen |first2=Alexandra |title=Common ground in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD)–review of recent findings |journal=Borderline Personality Disorder and Emotion Dysregulation |date=2014 |volume=1 |issue=1 |pages=3 |doi=10.1186/2051-6673-1-3 |pmid=26843958 |pmc=4739390 |doi-access=free }}</ref>
The enduring impact of chronic maltreatment and difficulties in forming secure attachments during childhood has been hypothesized to potentially contribute to the development of BPD.<ref name="Dozier-1999">{{cite book|title=Handbook of attachment|vauthors=Dozier M, Stovall-McClough KC, Albus KE|publisher=Guilford Press|year=1999|veditors=Cassidy J, Shaver PR|location=New York|pages=497–519|chapter=Attachment and psychopathology in adulthood}}</ref> Marsha Linehan'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.<ref>{{Cite journal|vauthors=Crowell SE, Beauchaine TP, Linehan MM|date=May 2009|title=A Biosocial Developmental Model of Borderline Personality: Elaborating and Extending Linehan's Theory|journal=Psychological Bulletin|volume=135|issue=3|pages=495–510|doi=10.1037/a0015616|pmc=2696274|pmid=19379027}}</ref> Due to it drawing on attachment theory, which centers Western nuclear family norms, the diagnosis of BPD has been critiqued by Indigenous and decolonial scholars for possibly pathologizing Indigenous and collectivist cultural forms of caregiving.<ref name=":9">{{cite journal |last1=Cobbaert |first1=Laurence |last2=Maloney |first2=Ellen |last3=Harding |first3=Keir |last4=James |first4=Sandi |title=Dismantling the Diagnostic Construct of Borderline Personality Disorder: A Critical Discourse Analysis |journal=International Journal of Mental Health Nursing |date=April 2026 |volume=35 |issue=2 |article-number=e70241 |doi=10.1111/inm.70241 |pmid=41742442 |pmc=12936405 }}</ref><ref>{{cite journal |last1=Choate |first1=Peter W. |last2=Kohler |first2=Taylor |last3=Cloete |first3=Felicia |last4=CrazyBull |first4=Brandy |last5=Lindstrom |first5=Desi |last6=Tatoulis |first6=Parker |title=Rethinking Racine v Woods from a Decolonizing Perspective: Challenging the Applicability of Attachment Theory to Indigenous Families Involved with Child Protection |journal=Canadian Journal of Law and Society / Revue Canadienne Droit et Société |date=April 2019 |volume=34 |issue=1 |pages=55–78 |doi=10.1017/cls.2019.8 }}</ref>
===Brain and neurobiologic factors===<!-- Structural brain changes -->
Research employing structural neuroimaging techniques, such as voxel-based morphometry, has reported variations in individuals diagnosed with BPD in specific brain regions that have been associated with the psychopathology of BPD. Reductions in volume enclosed have been observed in the hippocampus, orbitofrontal cortex, anterior cingulate cortex, and amygdala, among others, which are crucial for emotional self-regulation and stress management.<ref name="Brain Structure and Function" /><!-- Biochemical alterations --><!-- Alterations in glucose metabolism and brain oxygenation --><!-- Neurometabolites -->
In addition to structural imaging, a subset of studies utilizing magnetic resonance spectroscopy has investigated the neurometabolic profile within these affected regions. These investigations have focused on the concentrations of various neurometabolites, including ''N''-acetylaspartate, creatine, compounds related to glutamate, and compounds containing choline. These studies aim to show the biochemical alterations that may underlie the symptomatology observed in BPD.<ref name="Brain Structure and Function" />
==== Neurological patterns ==== Research has shown changes in two brain circuits 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 limbic system, though individual variances necessitate further neuroimaging research to explore these patterns in detail.<ref name="Ruocco, Anthony C.; Amirthavasagam, Sathya, Choi-Kain, Lois W.; McMain, Shelley F. 2013 153–160">{{cite journal|vauthors=Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF|title=Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis|journal=Biological Psychiatry|volume=73|issue=2|pages=153–160|date=January 2013|pmid=22906520|doi=10.1016/j.biopsych.2012.07.014 }}</ref><!-- Seems this was inserted by someone related to study possibly for self-gain? -->
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 ''Biological Psychiatry'', 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.<ref name="Ruocco, Anthony C.; Amirthavasagam, Sathya, Choi-Kain, Lois W.; McMain, Shelley F. 2013 153–160" /> This emotional volatility is consistently linked to disparities in several brain regions, emphasizing the neurobiological underpinnings of BPD.<ref name="Koenigsberg">{{cite journal|vauthors=Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, Cheng H, Flory J, Prohovnik I|title=Neural correlates of emotion processing in borderline personality disorder|journal=Psychiatry Research|volume=172|issue=3|pages=192–199|date=June 2009|pmid=19394205|pmc=4153735|doi=10.1016/j.pscychresns.2008.07.010|quote=BPD patients demonstrated greater differences in activation than controls, when viewing negative pictures compared with rest, in the amygdala, fusiform gyrus, primary visual areas, superior temporal gyrus (STG), and premotor areas, while healthy controls showed greater differences than BPD patients in the insula, middle temporal gyrus and dorsolateral prefrontal cortex.}}</ref>
===Mediating and moderating factors<!-- These 'factors' are all causes anyway? Why not be part of causes, why their own 'mediating and moderating factors'? -->===
====Executive function and social rejection sensitivity<!-- Should likely be under Brain function -->==== High sensitivity to social rejection is linked to more severe symptoms of BPD, with executive function playing a mediating role.<ref name="Executive_function">{{cite journal|vauthors=Ayduk O, Zayas V, Downey G, Cole AB, Shoda Y, Mischel W|author-link6=Walter Mischel|title=Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features|journal=Journal of Research in Personality|volume=42|issue=1|pages=151–168|date=February 2008|pmid=18496604|pmc=2390893|doi=10.1016/j.jrp.2007.04.002}}</ref> Executive function—encompassing planning, working memory, attentional control, and problem-solving—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.<ref name="Executive_function"/> Conversely, higher executive function may mitigate the impact of rejection sensitivity, potentially offering protection against BPD symptoms.<ref name="Executive_function"/>
==Diagnosis== The clinical diagnosis of BPD can be made through a psychiatric assessment conducted by a mental health professional, ideally a psychiatrist or psychologist. This comprehensive assessment integrates various sources of information to confirm the diagnosis, encompassing the patient's self-reported clinical history, 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.<ref>{{cite web |first1=Andrew |last1=Skodol |website=UpToDate |title=Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis |url=https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis }}</ref>
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.<ref name="Gund2011" />
The psychological evaluation for BPD typically explores the onset and intensity of symptoms and their impact on the individual's quality of life. Critical areas of focus include suicidal thoughts, self-harm behaviors, and any thoughts of harming others.<ref name="Mayo_Clinic_Diagnosis">{{cite web|title=Personality Disorders: Tests and Diagnosis|url=http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=tests-and-diagnosis|publisher=Mayo Clinic|access-date=13 June 2013|url-status=live|archive-url=https://web.archive.org/web/20130606185940/http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION%3Dtests-and-diagnosis|archive-date=6 June 2013}}</ref> The diagnosis relies on both the individual's self-reported symptoms and the clinician's observations.<ref name="Mayo_Clinic_Diagnosis" /> To exclude other potential causes of the symptoms, additional assessments may include a physical examination and blood tests, to exclude thyroid disorders or substance use disorders.<ref name="Mayo_Clinic_Diagnosis" />
=== Classification === Classification of personality disorders differs significantly between the two most prominent frameworks for classification of mental disorders, namely: the ''Diagnostic and Statistical Manual of Mental Disorders'' and the International Classification of Diseases, the most recent editions of which are the DSM-5-TR and ICD-11, respectively. While personality disorders, including BPD, are diagnosed as separate entities in the DSM-5; in the ICD-11 classification of personality disorders, they are assessed in terms of severity levels, with trait and pattern specifiers serving to characterize the particular style of pathology.<ref name=":7" /> There is also a hybrid model,<ref>{{cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Ruggero |first2=Camilo |last3=Eaton |first3=Nicholas R. |last4=Krueger |first4=Robert F. |title=The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review |journal=Current Treatment Options in Psychiatry |date=December 2019 |volume=6 |issue=4 |pages=284–298 |doi=10.1007/s40501-019-00187-7 }}</ref> called the ''Alternative DSM-5 model for personality disorders'', which defines BPD and five other PDs through disorder-specific combinations of pathological traits and areas of overall impairment.<ref name=":7">{{cite journal |last1=Clark |first1=Lee Anna |title=Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis |journal=Current Psychiatry Reports |date=May 2025 |volume=27 |issue=5 |pages=267–277 |doi=10.1007/s11920-025-01602-y |pmc=12003573 |pmid=40108080 }}</ref>
==== {{anchor|AMPD}}''DSM-5'' ==== {{Further|Classification of personality disorders#DSM-5|Alternative DSM-5 model for personality disorders}}<!-- Please do not add diagnosis criteria as this constitutes a copyright violation. APA has forbidden us.-->
The multiaxial diagnostic system of previous editions has been eliminated with the introduction of the DSM-5,<ref>{{cite journal |last1=Krueger |first1=Robert F. |last2=Hobbs |first2=Kelsey A. |title=An Overview of the DSM-5 Alternative Model of Personality Disorders |journal=Psychopathology |date=2020 |volume=53 |issue=3–4 |pages=126–132 |doi=10.1159/000508538 |pmc=7529724 |pmid=32645701 }}</ref> with all disorders, including personality disorders, being integrated into Section II of the manual.<ref>{{cite journal |last1=Gintner |first1=Gary G. |title=DSM-5 Conceptual Changes: Innovations, Limitations and Clinical Implications |journal=The Professional Counselor |date=July 2014 |volume=4 |issue=3 |pages=179–190 |doi=10.15241/ggg.4.3.179 |doi-access=free }}</ref> For a diagnosis of BPD, an individual must meet five out of nine specified diagnostic criteria.<ref name=":1">{{Cite journal |last1=Leichsenring |first1=Falk |last2=Fonagy |first2=Peter |author-link2=Peter Fonagy |last3=Heim |first3=Nikolas |last4=Kernberg |first4=Otto F. |author-link4=Otto F. Kernberg |last5=Leweke |first5=Frank |last6=Luyten |first6=Patrick |last7=Salzer |first7=Simone |last8=Spitzer |first8=Carsten |last9=Steinert |first9=Christiane |date=2024 |title=Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies |journal=World Psychiatry |language=en |volume=23 |issue=1 |pages=4–25 |doi=10.1002/wps.21156 |pmid=38214629 |pmc=10786009 |quote=The DSM‐5 characterizes BPD as a pervasive pattern of instability of interpersonal relationships, self‐image and affects, and marked impulsivity, emerging by early adulthood and present in a variety of contexts, as indicated by five or more of a set of nine criteria 27 (see Table 1).}}</ref><ref name="DSM-5-borderine personality disorders" /> The DSM-5 characterizes BPD as a pervasive pattern of instability in interpersonal relationships, self-image, affect, and a significant propensity towards impulsive behavior.<ref name=":1" /><ref name="DSM-5-borderine personality disorders">{{harvnb|American Psychiatric Association|2013|pages=663–8}}</ref> 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.<ref name="Manning_13">{{harvnb|Manning|2011|page=13}}</ref> To mitigate these challenges, Linehan categorizes BPD symptoms into five principal areas of dysregulation: emotions, behavior, interpersonal relationships, sense of self, and cognition.<ref name="Manning_13" />
Moreover, the ''Alternative DSM-5 Model for Personality Disorders'' (AMPD), located in Section III of the DSM-5,<ref>{{cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Ruggero |first2=Camilo |last3=Eaton |first3=Nicholas R. |last4=Krueger |first4=Robert F. |title=The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review |journal=Current Treatment Options in Psychiatry |date=December 2019 |volume=6 |issue=4 |pages=284–298 |doi=10.1007/s40501-019-00187-7 }}</ref> defines six specific personality disorders—one of them being BPD<ref>{{cite journal |last1=Christopher Fowler |first1=J. |last2=Sharp |first2=Carla |last3=Kalpakci |first3=Allison |last4=Madan |first4=Alok |last5=Clapp |first5=Joshua |last6=Allen |first6=Jon G. |last7=Christopher Frueh |first7=B. |last8=Oldham |first8=John M. |title=A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria |journal=Comprehensive Psychiatry |date=January 2015 |volume=56 |pages=75–84 |doi=10.1016/j.comppsych.2014.09.001 |pmid=25261890 |quote=The number of specific PDs was reduced from 10 to 6 (antisocial, avoidant, borderline, narcissistic, obsessive–compulsive, and schizotypal) as well as a diagnosis of "personality disorder—trait specified" that can be made when criteria for a specific disorder are not met, but a personality disorder is assessed as present [23]. }}</ref>—in terms of a description of the disorder; the characteristic manner in which the disorder impacts personality functioning, i.e. identity, self-direction, empathy and intimacy (criterion A); as well as a listing and description of the pathological personality traits associated with the disorder (criterion B).<ref>{{Cite journal |last1=Zimmermann |first1=Johannes |last2=Kerber |first2=André |last3=Rek |first3=Katharina |last4=Hopwood |first4=Christopher J. |last5=Krueger |first5=Robert F. |date=2019-08-13 |title=A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders |journal=Current Psychiatry Reports |language=en |volume=21 |issue=9 |page=92 |doi=10.1007/s11920-019-1079-z |pmid=31410586 |url=https://escholarship.org/uc/item/17v5n4jd |doi-access=free }}</ref> In the case of BPD, this necessitates the identification of at least four out of seven maladaptive traits, these being: emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk-taking, and hostility, of which at least one must be of the three last mentioned.<ref>{{Cite journal |last1=Hines |first1=Alexandra |last2=Kushner |first2=Madeline L. |last3=Stumpp |first3=Nicole |last4=Semcho |first4=Stephen |last5=Bridges |first5=Eric |last6=Croom |first6=Hannah |last7=Rahman |first7=Abrar |last8=Cecil |first8=Sarah |last9=Maynard |first9=Caden |last10=Southward |first10=Matthew W. |last11=Widiger |first11=Thomas A. |last12=Sauer-Zavala |first12=Shannon |date=2024 |title=Different routes to the same destination? Comparing Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II- and alternative model of personality disorder-defined borderline personality disorder. |journal=Personality Disorders: Theory, Research, and Treatment |language=en |volume=15 |issue=5 |pages=352–360 |doi=10.1037/per0000676 |pmid=39073371 |quote=In the Alternative Model of Personality Disorders (AMPD) presented in Section III (Emerging Measures and Models) of DSM-5, BPD is represented by at least moderate impairment in self (e.g., identity and self-direction) and/ or interpersonal (e.g., empathy and intimacy) functioning (i.e., Criterion A) and at least four of seven trait facets (i.e., Criterion B): emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk-taking, and hostility.|doi-access=free }}</ref> These traits have been found to correspond well to BPD as defined in the categorical model.<ref>{{cite book |last1=Salavati |first1=Mojgan |last2=Selby |first2=Edward A. |title=Theories of Borderline Personality Disorder |chapter=Diagnostic Perspectives of Borderline Personality Disorder |date=2024 |pages=13–35 |doi=10.1007/978-3-031-75503-3_2 |isbn=978-3-031-75502-6 }}</ref>
==== ICD-11 ==== {{Further|ICD-11 classification of personality disorders|Classification of personality disorders#ICD-10}} thumb|396x396px|Without the ''borderline pattern'' qualifier, an ICD-11 case profile could look like this for someone diagnosed with ''emotionally unstable'' PD in accordance with the ICD-10.<ref name=":8" /> The World Health Organization's ICD-11 has replaced the categorical classification of personality disorders in the ICD-10 with a dimensional model containing a unified ''personality disorder'' with severity specifiers, along with specifiers for ''prominent personality traits or patterns''.<ref name=":8">{{Cite journal |last1=Bach |first1=Bo |last2=First |first2=Michael B. |date=2018-10-29 |title=Application of the ICD-11 classification of personality disorders |journal=BMC Psychiatry |volume=18 |issue=1 |page=351 |doi=10.1186/s12888-018-1908-3 |doi-access=free |pmc=6206910 |pmid=30373564}}</ref> Among these is the ''borderline pattern'', which is similar to the diagnosis of BPD.<ref>{{Cite journal |last=Mulder |first=Roger T. |date=2021 |title=ICD-11 Personality Disorders: Utility and Implications of the New Model |journal=Frontiers in Psychiatry |volume=12 |article-number=655548 |doi=10.3389/fpsyt.2021.655548 |doi-access=free |pmc=8141634 |pmid=34040555}}</ref>
The borderline pattern specifier is described in the ICD-11 as applicable 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".<ref>{{cite journal |last1=Tyrer |first1=Peter |last2=Mulder |first2=Roger |last3=Kim |first3=Youl-Ri |last4=Crawford |first4=Mike J. |title=The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics |journal=Annual Review of Clinical Psychology |date=7 May 2019 |volume=15 |issue=1 |pages=481–502 |doi=10.1146/annurev-clinpsy-050718-095736 |pmid=30601688 |doi-access=free }}</ref> Borderline personality disorder has been found to be primarily associated with the ICD-11 trait domains of ''Negative Affectivity'' and ''Disinhibition'', reflecting core features such as emotional instability and impulsivity.<ref name=":0">{{Cite journal |last1=Simon |first1=Jonatan |last2=Lambrecht |first2=Bastian |last3=Bach |first3=Bo |date=2023-04-06 |title=Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings |journal=Frontiers in Psychiatry |volume=14 |article-number=1175425 |doi=10.3389/fpsyt.2023.1175425 |doi-access=free |pmc=10116048 |pmid=37091704}}</ref> Previously, the ICD-10 had identified a condition akin to BPD, termed ''Emotionally unstable personality disorder'' (EUPD).<ref>{{cite journal |last1=Lai |first1=Ching Man |last2=Leung |first2=Freedom |last3=You |first3=Jianing |last4=Cheung |first4=Fanny |title=Are DSM-IV-TR Borderline Personality Disorder, ICD-10 Emotionally Unstable Personality Disorder, and CCMD-III Impulsive Personality Disorder Analogous Diagnostic Categories Across Psychiatric Nomenclatures? |journal=Journal of Personality Disorders |date=August 2012 |volume=26 |issue=4 |pages=551–567 |doi=10.1521/pedi.2012.26.4.551 |pmid=22867506 |quote=There is no exact diagnostic label termed as BPD in the tenth edition of International Classification of Diseases (ICD-10; World Health Organization, 1992). After burgeoning evidence regarding the validity of BPD, the ICD has grudgingly introduced a derivative category coined as emotionally unstable personality disorder (EUPD) with the impulsive (EUPD-I) and borderline subtypes (EUPD-B). }}</ref>
The ICD-11 ''borderline pattern'' diagnosis has been criticized for being "indissociable" from ''negative affectivity'' upon undergoing regression and factor analyses.<ref name="FG" /> A study has found that the diagnosis of ''borderline pattern'' does not provide additional insight beyond what is captured by other specifiers, positing that it may be redundant.<ref name="FG">{{cite journal |vauthors=Gutiérrez F, Aluja A, Ruiz Rodríguez J, Peri JM, Gárriz M, Garcia LF, Sorrel MA, Sureda B, Vall G, Ferrer M, Calvo N |date=June 2022 |title=Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11) |journal=Personality Disorders |volume=14 |issue=3 |pages=355–359 |doi=10.1037/per0000592 |hdl=2445/206520 |pmid=35737563 |quote=The borderline pattern was a last-minute addendum to the ICD-11 whose accommodation within the diagnostic system of PDs has not yet been studied in depth. In this study, we found that the borderline construct is internally consistent and is a good predictor of severity. However, it shares most of its variance with the five initial ICD-11 domains and cannot be factorially uncoupled from negative affectivity. Furthermore, it adds nothing to the prediction of severity when the other domains are considered. Some of these findings warrant further comment. |hdl-access=free}}</ref> Apart from ''negative affectivity'' and ''disinhibition'', research has found "substantial but mixed" associations with the other trait domains, underscoring the heterogeneity of the diagnosis, which aligns with the view of BPD as an "index of global personality pathology and severity, which aligns with the original metaphorical use of the term 'borderline' or 'borderland{{' "}}.<ref name=":0" /> It is suggested that it "therefore seems reasonable if the borderline pattern serves as a transitional specifier that eventually is phased out in the coming era".<ref name=":0" />
===Millon's subtypes=== Psychologist Theodore Millon proposed four subtypes of BPD, where individuals with BPD would exhibit none, one, or multiple subtypes.<ref name="Millon">{{cite book|title=Personality Disorders in Modern Life|vauthors=Millon T|publisher=John Wiley & Sons|year=2004|isbn=978-0-471-23734-1|location=Hoboken, New Jersey|pages=482–88}}</ref> {| class="wikitable" !Subtype !Features !Traits |- |'''Discouraged borderline''' |Including avoidant, depressive, and dependant features |Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless. |- |'''Impulsive borderline''' |Including histrionic and antisocial features |Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal. |- |'''Petulant borderline''' |Including negativistic features |Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned. |- |'''Self-destructive borderline''' |Including depressive and masochistic features |Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possibly suicidal. |}
===Misdiagnosis=== {{Main|Misdiagnosis of borderline personality disorder}}
Individuals with BPD are subject to misdiagnosis due to various factors, such as the overlap (comorbidity) of BPD symptoms with those of other disorders such as depression, psychotic disorders, PTSD, and bipolar disorder.<ref name="Chanen">{{cite journal|vauthors=Chanen AM, Thompson KN|title=Prescribing and borderline personality disorder|journal=Australian Prescriber|volume=39|issue=2|pages=49–53|date=April 2016|pmid=27340322|pmc=4917638|doi=10.18773/austprescr.2016.019}}</ref><ref>{{cite journal|vauthors=Meaney R, Hasking P, Reupert A|title=Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination|journal=PLOS ONE|volume=11|issue=6|article-number=e0157294|year=2016|pmid=27348858|pmc=4922551|doi=10.1371/journal.pone.0157294|bibcode=2016PLoSO..1157294M|doi-access=free}}</ref>{{Failed verification|date=July 2025|reason=Neither one of the cited sources successfully verifies the content.}} 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.<ref>{{Cite journal|last=Sartorius|first=Norman|year=2015|title=Why do we need a diagnosis? Maybe a syndrome is enough?|journal=Dialogues in Clinical Neuroscience|volume=17|issue=1|pages=6–7|doi=10.31887/DCNS.2015.17.1/nsartorius|pmc=4421902|pmid=25987858}}</ref> Consequently, misdiagnosis may deprive individuals of access to suitable psychiatric medications or evidence-based psychological interventions tailored to their specific disorders.<ref>{{Cite journal|last1=Paris|first1=Joel|last2=Black|first2=Donald W.|year=2015|title=Borderline Personality Disorder and Bipolar Disorder|journal=The Journal of Nervous and Mental Disease|volume=203|issue=1|pages=3–7|doi=10.1097/nmd.0000000000000225 |pmid=25536097 }}</ref>
===Adolescence and prodrome=== The onset of BPD symptoms typically occurs during adolescence or early adulthood, with possible early signs in childhood.<ref>{{harvnb|Linehan|1993|page=49}}</ref> Predictive symptoms in adolescents include body image issues, extreme sensitivity to rejection, behavioral challenges, non-suicidal self-injury, seeking exclusive relationships, and profound shame.<ref name="Gund2011" /> 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.<ref name="Gund2011" />
BPD is recognized as a stable and valid diagnosis during adolescence, supported by the DSM-5 and ICD-11.<ref name="Miller_2008">{{cite journal|vauthors=Miller AL, Muehlenkamp JJ, Jacobson CM|date=July 2008|title=Fact or fiction: diagnosing borderline personality disorder in adolescents|journal=Clinical Psychology Review|volume=28|issue=6|pages=969–81|doi=10.1016/j.cpr.2008.02.004|pmid=18358579}}</ref><ref name="National Collaborating Centre for Mental Health (UK)_2009">{{cite book|author=National Collaborating Centre for Mental Health (UK)|url=https://www.ncbi.nlm.nih.gov/books/NBK55399/|title=Young People With Borderline Personality Disorder|date=2009|publisher=British Psychological Society|access-date=23 September 2020|archive-url=https://web.archive.org/web/20201204232017/https://www.ncbi.nlm.nih.gov/books/NBK55399/|archive-date=4 December 2020|url-status=live}}</ref><ref name="Kaess_2014">{{cite journal |last1=Kaess |first1=Michael |last2=Brunner |first2=Romuald |last3=Chanen |first3=Andrew |title=Borderline Personality Disorder in Adolescence |journal=Pediatrics |date=October 2014 |volume=134 |issue=4 |pages=782–793 |doi=10.1542/peds.2013-3677 |pmid=25246626 }}</ref><ref name="Biskin_2015">{{cite journal|vauthors=Biskin RS|date=July 2015|title=The Lifetime Course of Borderline Personality Disorder|journal=Canadian Journal of Psychiatry|volume=60|issue=7|pages=303–8|doi=10.1177/070674371506000702|pmc=4500179|pmid=26175388}}</ref> 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.<ref name="Kaess_2014" /><ref>{{cite book|last=National Health and Medical Research Council (Australia)|title=Clinical practice guideline for the management of borderline personality disorder|date=2013|publisher=National Health and Medical Research Council|isbn=978-1-86496-564-3|oclc=948783298}}</ref><ref>{{cite web|date=28 January 2009|title=Overview {{!}} Borderline personality disorder: recognition and management {{!}} Guidance {{!}} NICE|url=https://www.nice.org.uk/guidance/cg78|url-status=live|archive-url=https://web.archive.org/web/20191011171334/https://www.nice.org.uk/guidance/CG78|archive-date=11 October 2019|access-date=23 September 2020|website=nice.org.uk}}</ref>
Historically, diagnosing BPD during adolescence was met with caution,<ref name="Kaess_2014" /><ref>{{cite book |last1=De Vito |first1=Enrico |last2=Ladame |first2=François |last3=Orlandini |first3=Alvise |title=Treatment of Personality Disorders |chapter=Adolescence and Personality Disorders |date=1999 |pages=77–95 |doi=10.1007/978-1-4757-6876-3_7 |isbn=978-1-4419-3326-3 }}</ref><ref>{{cite journal|vauthors=Guilé JM, Boissel L, Alaux-Cantin S, de La Rivière SG|date=23 November 2018|title=Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies|journal=Adolescent Health, Medicine and Therapeutics|volume=9|pages=199–210|doi=10.2147/ahmt.s156565|pmc=6257363|pmid=30538595|doi-access=free}}</ref> due to concerns about the accuracy of diagnosing young individuals,<ref>{{cite book|last=American Psychiatric Association. Work Group on Borderline Personality Disorder.|title=Practice guideline for the treatment of patients with borderline personality disorder|date=2001|publisher=American Psychiatric Association|oclc=606593046}}</ref><ref>{{cite book|author=World Health Organization|title=The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines.|date=1992|publisher=World Health Organization|isbn=978-92-4-068283-2|oclc=476159430}}</ref> the potential misinterpretation of normal adolescent behaviors, stigma, and the stability of personality during this developmental stage.<ref name="Kaess_2014" /> Despite these challenges, research has confirmed the validity and clinical utility of the BPD diagnosis in adolescents,<ref name="Miller_2008" /><ref name="National Collaborating Centre for Mental Health (UK)_2009" /><ref name="Kaess_2014" /><ref name="Biskin_2015" /> though misconceptions persist among mental health care professionals,<ref name="Baltzersen_2020">{{cite journal|vauthors=Baltzersen ÅL|date=August 2020|title=Moving forward: closing the gap between research and practice for young people with BPD|journal=Current Opinion in Psychology|volume=37|pages=77–81|doi=10.1016/j.copsyc.2020.08.008|pmid=32916475 |doi-access=free}}</ref><ref>{{cite journal|vauthors=Boylan K|date=August 2018|title=Diagnosing BPD in Adolescents: More good than harm|journal=Journal of the Canadian Academy of Child and Adolescent Psychiatry|volume=27|issue=3|pages=155–156|pmc=6054283|pmid=30038651}}</ref><ref>{{cite journal|vauthors=Laurenssen EM, Hutsebaut J, Feenstra DJ, Van Busschbach JJ, Luyten P|date=February 2013|title=Diagnosis of personality disorders in adolescents: a study among psychologists|journal=Child and Adolescent Psychiatry and Mental Health|volume=7|issue=1|page=3|doi=10.1186/1753-2000-7-3|pmc=3583803|pmid=23398887|doi-access=free}}</ref> contributing to clinical reluctance in diagnosing and a key barrier to the provision of effective treatment of BPD in this population.<ref name="Baltzersen_2020" /><ref>{{cite journal |last1=Chanen |first1=Andrew M. |title=Borderline Personality Disorder in Young People: Are We There Yet? |journal=Journal of Clinical Psychology |date=August 2015 |volume=71 |issue=8 |pages=778–791 |doi=10.1002/jclp.22205 |pmid=26192914 }}</ref><ref>{{cite journal|vauthors=Koehne K, Hamilton B, Sands N, Humphreys C|date=January 2013|title=Working around a contested diagnosis: borderline personality disorder in adolescence|journal=Health|volume=17|issue=1|pages=37–56|doi=10.1177/1363459312447253|pmid=22674745 }}</ref>
A diagnosis of BPD in adolescence can indicate the persistence of the disorder into adulthood,<ref name="DSM-IV-TR">{{harvnb|American Psychiatric Association|2000}}{{Page needed|date=July 2013}}</ref><ref name="Netherton">{{cite book|vauthors=Netherton SD, Holmes D, Walker CE|year=1999|title=Child and Adolescent Psychological Disorders: Comprehensive Textbook|location=New York|publisher=Oxford University Press}}{{Page needed|date=July 2013}}</ref> with outcomes varying among individuals. Some maintain a stable diagnosis over time, while others may not consistently meet the diagnostic criteria.<ref name="Fact_or_Fiction">{{cite journal|vauthors=Miller AL, Muehlenkamp JJ, Jacobson CM|title=Fact or fiction: diagnosing borderline personality disorder in adolescents|journal=Clinical Psychology Review|volume=28|issue=6|pages=969–981|date=July 2008|pmid=18358579|doi=10.1016/j.cpr.2008.02.004}}</ref> Early diagnosis facilitates the development of effective treatment plans,<ref name="DSM-IV-TR" /><ref name="Netherton" /> including family therapy, to support adolescents with BPD.<ref>{{harvnb|Linehan|1993|page=98}}</ref>
===Differential diagnosis and comorbidity=== Lifetime 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 mood disorders (such as major depressive disorder and bipolar disorder), anxiety disorders (including panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD)), other personality disorders (notably schizotypal, antisocial, and dependent personality disorder), substance use disorder, eating disorders (anorexia nervosa and bulimia nervosa), attention deficit hyperactivity disorder (ADHD),<ref name="PM">{{cite journal|vauthors=Ferrer M, Andión O, Matalí J, Valero S, Navarro JA, Ramos-Quiroga JA, Torrubia R, Casas M|title=Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder|journal=Journal of Personality Disorders|volume=24|issue=6|pages=812–822|date=December 2010|pmid=21158602|doi=10.1521/pedi.2010.24.6.812}}{{primary source inline|date=May 2013}}</ref> somatic symptom disorder, and the dissociative disorders.<ref name="comorbidity">{{cite journal|vauthors=Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V|title=Axis I comorbidity of borderline personality disorder|journal=The American Journal of Psychiatry|volume=155|issue=12|pages=1733–1739|date=December 1998|pmid=9842784|doi=10.1176/ajp.155.12.1733}}</ref> 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.<ref>{{cite journal|vauthors=Vieta E|title=Bipolar II Disorder: Frequent, Valid, and Reliable|journal=Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie|volume=64|issue=8|pages=541–543|date=August 2019|pmid=31340672|pmc=6681515|doi=10.1177/0706743719855040}}</ref>
====Mood disorders==== Seventy-five percent (75%) of individuals with BPD concurrently experience mood disorders, notably major depressive disorder (MDD) or bipolar disorder (BD),<ref name="Robinson"/> complicating diagnostic clarity due to overlapping symptoms.<ref>{{cite journal|vauthors=Bolton S, Gunderson JG|date=September 1996|title=Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications|journal=The American Journal of Psychiatry|volume=153|issue=9|pages=1202–1207|doi=10.1176/ajp.153.9.1202|pmid=8780426}}</ref><ref name="APAguide">{{cite journal|author=American Psychiatric Association Practice Guidelines|date=October 2001|title=Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association|journal=The American Journal of Psychiatry|volume=158|issue=10 Suppl|pages=1–52|doi=10.1176/appi.ajp.158.1.1|pmid=11665545 }}</ref><ref>{{cite web|title=Differential Diagnosis of Borderline Personality Disorder|url=http://www.borderlinepersonalitytoday.com/main/diffdx.htm|archive-url=https://web.archive.org/web/20040509181831/http://www.borderlinepersonalitytoday.com/main/diffdx.htm|archive-date=9 May 2004|work=BPD Today}}</ref> Distinguishing BPD from BD is particularly challenging, as behaviors which are part of diagnostic criteria for both BPD and BD may emerge during depressive or manic episodes in BD. However, these behaviors are likely to subside as mood normalises in BD to euthymia, but typically are pervasive in BPD.<ref name="Chapman_87">{{harvnb|Chapman|Gratz|2007|page=87}}</ref>
Differences between BPD and BD mood swings include their duration, with BD episodes typically lasting for at least two weeks at a time,{{efn| An exception is rapid-cycling BD, which can be challenging to differentiate from the affective lability found in BPD.<ref>{{cite journal|vauthors=Mackinnon DF, Pies R|title=Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders|journal=Bipolar Disorders|volume=8|issue=1|pages=1–14|date=February 2006|pmid=16411976|doi=10.1111/j.1399-5618.2006.00283.x|doi-access=free}}</ref><ref name="Chapman_88">{{harvnb|Chapman|Gratz|2007|page=88}}</ref><ref name="Chapman_87" />}} in contrast to the rapid and transient mood shifts seen in BPD.<ref name="Chapman_87" /><ref name="BPD_vs_BD">{{cite book |url=https://archive.org/details/manicdepressivei00good/page/108 |title=Manic-depressive illness |vauthors=Jamison KR, Goodwin FJ |publisher=Oxford University Press |year=1990 |isbn=978-0-19-503934-4 |location=Oxford |page=[https://archive.org/details/manicdepressivei00good/page/108 108]}}</ref><ref name="Chapman_88"/> 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.<ref name="BPD_vs_BD" /> Furthermore, the euphoria in BPD lacks the racing thoughts and reduced need for sleep characteristic of BD,<ref name="BPD_vs_BD" /> though sleep disturbances have been noted in BPD.<ref>{{cite journal|vauthors=Selby EA|title=Chronic sleep disturbances and borderline personality disorder symptoms|journal=Journal of Consulting and Clinical Psychology|volume=81|issue=5|pages=941–947|date=October 2013|pmid=23731205|pmc=4129646|doi=10.1037/a0033201}}</ref>
Historically, BPD was considered a milder form of BD,<ref>{{cite journal|vauthors=Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H|title=The nosologic status of borderline personality: clinical and polysomnographic study|journal=The American Journal of Psychiatry|volume=142|issue=2|pages=192–198|date=February 1985|pmid=3970243|doi=10.1176/ajp.142.2.192}}</ref><ref>{{cite journal|vauthors=Gunderson JG, Elliott GR|title=The interface between borderline personality disorder and affective disorder|journal=The American Journal of Psychiatry|volume=142|issue=3|pages=277–788|date=March 1985|pmid=2857532|doi=10.1176/ajp.142.3.277}}</ref> 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.<ref>{{cite journal|vauthors=Paris J|title=Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders|journal=Harvard Review of Psychiatry|volume=12|issue=3|pages=140–145|year=2004|pmid=15371068|doi=10.1080/10673220490472373 }}</ref> Research indicates only a modest association between BPD and BD, challenging the notion of a close spectrum relationship.<ref>{{cite book|vauthors=Jamison KR, Goodwin FJ|title=Manic-depressive illness|publisher=Oxford University Press|location=Oxford|year=1990|page=[https://archive.org/details/manicdepressivei00good/page/336 336]|isbn=978-0-19-503934-4|url=https://archive.org/details/manicdepressivei00good/page/336}}</ref><ref>{{cite journal|vauthors=Benazzi F|title=Borderline personality-bipolar spectrum relationship|journal=Progress in Neuro-Psychopharmacology & Biological Psychiatry|volume=30|issue=1|pages=68–74|date=January 2006|pmid=16019119|doi=10.1016/j.pnpbp.2005.06.010 }}</ref>
====Premenstrual dysphoric disorder==== BPD is a psychiatric condition distinguishable from premenstrual dysphoric disorder (PMDD), despite some symptom overlap. BPD affects individuals persistently across all stages of the menstrual cycle, unlike PMDD, which is confined to the luteal phase and ends with menstruation.<ref>{{cite journal|vauthors=Rapkin AJ, Berman SM, London ED|title=The Cerebellum and Premenstrual Dysphoric Disorder|journal=AIMS Neuroscience|volume=1|issue=2|pages=120–141|year=2014|pmid=28275721|pmc=5338637|doi=10.3934/Neuroscience.2014.2.120|bibcode=2014AIMES...1..120R}}</ref><ref name="Grady-Weliky">{{cite journal|vauthors=Grady-Weliky TA|date=January 2003|title=Clinical practice. Premenstrual dysphoric disorder|journal=The New England Journal of Medicine|volume=348|issue=5|pages=433–8|doi=10.1056/NEJMcp012067|pmid=12556546}}</ref> While PMDD, affecting 3–8% of women,<ref name="Rapkin">{{cite journal|vauthors=Rapkin AJ, Lewis EI|title=Treatment of premenstrual dysphoric disorder|journal=Women's Health|volume=9|issue=6|pages=537–56|date=November 2013|pmid=24161307|doi=10.2217/whe.13.62|doi-access=free}}</ref> includes mood swings, irritability, and anxiety tied to the menstrual cycle, BPD presents a broader, constant emotional and behavioral challenge irrespective of hormonal changes.
====Comorbid personality disorders==== Approximately 74% of individuals with BPD also fulfill criteria for another personality disorder during their lifetime, according to research conducted in 2008.<ref name="Grant_2008">{{cite journal |vauthors=Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ |date=April 2008 |title=Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions |journal=The Journal of Clinical Psychiatry |volume=69 |issue=4 |pages=533–545 |doi=10.4088/JCP.v69n0404 |pmc=2676679 |pmid=18426259}}</ref> 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.<ref name="Grant_2008" /> 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.<ref name="Grant_2008" />
==Management== {{Main|Management of borderline personality disorder}}
The main approach to managing BPD is through psychotherapy, with a few different interventions having demonstrated a reduction in symptoms and an increase in well-being.<ref>{{Cite web |title=Treating patients with borderline personality disorder |url=https://www.apa.org/monitor/2025/04-05/treating-borderline-personality |access-date=2025-12-21 |website=apa.org |publisher=American Psychological Association}}</ref> While medications do not directly treat BPD, they are beneficial in managing comorbid conditions like depression and anxiety.<ref>{{cite web|url=http://www.nice.org.uk/Guidance/CG78/NiceGuidance/pdf/English|title=CG78 Borderline personality disorder (BPD): NICE guideline|publisher=Nice.org.uk|date=28 January 2009|access-date=12 August 2009|url-status=live|archive-url=https://web.archive.org/web/20090411104754/http://www.nice.org.uk/Guidance/CG78/NiceGuidance/pdf/English|archive-date=11 April 2009}}</ref> 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.<ref>{{cite journal|vauthors=Paris J |title=Is hospitalization useful for suicidal patients with borderline personality disorder?|journal=Journal of Personality Disorders|volume=18|issue=3|pages=240–247|date=June 2004|pmid=15237044|doi=10.1521/pedi.18.3.240.35443}}</ref>
===Psychotherapy=== [[File:Dbt therapy cycle en.svg|thumb|right|The stages used in dialectical behavior therapy]]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.<ref name="BPD_therapies">{{cite journal|vauthors=Zanarini MC|title=Psychotherapy of borderline personality disorder|journal=Acta Psychiatrica Scandinavica|volume=120|issue=5|pages=373–377|date=November 2009|pmid=19807718|pmc=3876885|doi=10.1111/j.1600-0447.2009.01448.x}}</ref> Among the effective psychotherapeutic approaches, dialectical behavior therapy (DBT), schema therapy, and psychodynamic therapies have shown efficacy, although improvements may require extensive time, often years of dedicated effort.<ref>{{cite journal |last1=Cristea |first1=Ioana A. |last2=Gentili |first2=Claudio |last3=Cotet |first3=Carmen D. |last4=Palomba |first4=Daniela |last5=Barbui |first5=Corrado |last6=Cuijpers |first6=Pim |title=Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis |journal=JAMA Psychiatry |date=April 2017 |volume=74 |issue=4 |pages=319–328 |doi=10.1001/jamapsychiatry.2016.4287 |pmid=28249086 |hdl=1871.1/845f5460-273e-4150-b79d-159f37aa36a0 |hdl-access=free }}</ref>
Available treatments for BPD include dynamic deconstructive psychotherapy (DDP),<ref>{{cite book|vauthors=Gabbard GO|date=2014|title=Psychodynamic psychiatry in clinical practice|edition=5th|publisher=American Psychiatric Publishing|location=Washington, D.C.|pages=445–448}}</ref> mentalization-based treatment (MBT), schema therapy, transference-focused psychotherapy, dialectical behavior therapy (DBT), and general psychiatric management.<ref name="Gund2011" /><ref name="Choi-Kain_2017">{{cite journal|vauthors=Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT|title=What Works in the Treatment of Borderline Personality Disorder|journal=Current Behavioral Neuroscience Reports|volume=4|issue=1|pages=21–30|year=2017|pmid=28331780|pmc=5340835|doi=10.1007/s40473-017-0103-z}}</ref> The effectiveness of these therapies does not significantly vary between more intensive and less intensive approaches.<ref name="LinksShah2017">{{cite journal|vauthors=Links PS, Shah R, Eynan R|title=Psychotherapy for Borderline Personality Disorder: Progress and Remaining Challenges|journal=Current Psychiatry Reports|volume=19|issue=3|article-number=16|date=March 2017|pmid=28271272|doi=10.1007/s11920-017-0766-x }}</ref>
Transference-focused psychotherapy 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.<ref name="Bliss_2014">{{cite journal|vauthors=Bliss S, McCardle M|date=1 March 2014|title=An Exploration of Common Elements in Dialectical Behavior Therapy, Mentalization Based Treatment and Transference Focused Psychotherapy in the Treatment of Borderline Personality Disorder|journal=Clinical Social Work Journal|volume=42|issue=1|pages=61–69|doi=10.1007/s10615-013-0456-z }}</ref> Dialectical behavior therapy (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.<ref name="Bliss_2014" /><ref>{{cite book |title=Integrated Modular Treatment for Borderline Personality Disorder |chapter=Understanding Borderline Personality Disorder |date=2017 |pages=29–38 |doi=10.1017/9781107298613.004 |isbn=978-1-107-29861-3 }}</ref><ref name="Choi-Kain_2017" />
Cognitive behavioral therapy (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.<ref name="NIH2016" />
Mentalization-based therapy and transference-focused psychotherapy draw from psychodynamic principles, while DBT is rooted in cognitive-behavioral principles and mindfulness.<ref name="BPD_therapies" /> General psychiatric management integrates key aspects from these treatments and is seen as more accessible and less resource-intensive.<ref name="Gund2011" /> 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.<ref name="DBT_vs_therapyByExperts">{{cite journal|vauthors=Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N|title=Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder|journal=Archives of General Psychiatry|volume=63|issue=7|pages=757–766|date=July 2006|pmid=16818865|doi=10.1001/archpsyc.63.7.757|doi-access=free}}</ref><ref name="DBT_and_Mentalization">{{cite journal|vauthors=Paris J|title=Effectiveness of different psychotherapy approaches in the treatment of borderline personality disorder|journal=Current Psychiatry Reports|volume=12|issue=1|pages=56–60|date=February 2010|pmid=20425311|doi=10.1007/s11920-009-0083-0 }}</ref><ref name="BPD_therapies" />
Schema therapy considers early maladaptive schemas, conceptualized as organized patterns that recur throughout life in response to memories, emotions, bodily sensations, and cognitions associated with unmet childhood needs.<ref>{{Cite book|last1=Young|first1=Jeffrey E|title=Schema Therapy: A Practitioner's Guide|last2=Klosko|first2=Janet S|last3=Weishaar|first3=Marjorie E|publisher=Guilford Press|year=2003|isbn=978-1-59385-372-3|location=New York|pages=306–372|chapter=Schema Therapy for Borderline Personality Disorder}}</ref>
Additionally, mindfulness meditation 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.<ref name="Mindfulness_neuroscience">{{cite journal|vauthors=Tang YY, Posner MI|title=Special issue on mindfulness neuroscience|journal=Social Cognitive and Affective Neuroscience|volume=8|issue=1|pages=1–3|date=January 2013|pmid=22956677|pmc=3541496|doi=10.1093/scan/nss104}}</ref><ref name="Mindfulness_mechanisms">{{cite journal|vauthors=Posner MI, Tang YY, Lynch G|title=Mechanisms of white matter change induced by meditation training|journal=Frontiers in Psychology|volume=5|issue=1220|page=1220|year=2014|pmid=25386155|pmc=4209813|doi=10.3389/fpsyg.2014.01220|doi-access=free}}</ref><ref name="Mindfulness_therapies">{{cite journal|vauthors=Chafos VH, Economou P|date=October 2014|title=Beyond borderline personality disorder: the mindful brain|journal=Social Work|volume=59|issue=4|pages=297–302|doi=10.1093/sw/swu030|pmid=25365830 }}</ref><ref name="Mindfulness_BPD">{{cite journal|vauthors=Sachse S, Keville S, Feigenbaum J|date=June 2011|title=A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder|journal=Psychology and Psychotherapy|volume=84|issue=2|pages=184–200|doi=10.1348/147608310X516387|pmid=22903856}}</ref>
===Medications=== {{See also|List of investigational borderline personality disorder drugs}}
There are no clear pharmacological guidelines for borderline personality disorder; psychotherapy is considered the primary treatment, with medications used cautiously for common comorbidities.<ref name="pmid37256484" />
Topiramate (strong), lamotrigine (moderate), and aripiprazole (moderate) show evidence for reducing anger and hostility in BPD.<ref name=":15" />
Ketamine for unresponsive depression in BPD requires further research.<ref>{{Cite journal |last1=Kwan |first1=Angela T. H. |last2=Lakhani |first2=Moiz |last3=Singh |first3=Gurkaran |last4=Le |first4=Gia Han |last5=Wong |first5=Sabrina |last6=Teopiz |first6=Kayla M. |last7=Dev |first7=Donovan A. |last8=Manku |first8=Arshpreet Singh |last9=Sidhu |first9=Gurnoor |last10=McIntyre |first10=Roger S. |date=2024-11-20 |title=Ketamine for the Treatment of Psychiatric Disorders: A Systematic Review and Meta-Analysis |journal=CNS Spectrums |volume=29 |issue=5 |pages=354–361 |doi=10.1017/S1092852924000580 |pmid=39564613}}</ref>
Despite the lack of solid evidence, SSRIs and SNRIs are prescribed off-label for BPD<ref name="stofferswinterling20">{{cite journal |last1=Stoffers-Winterling |first1=Jutta |last2=Storebø |first2=Ole Jakob |last3=Lieb |first3=Klaus |title=Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies |journal=Current Psychiatry Reports |date=August 2020 |volume=22 |issue=8 |article-number=37 |doi=10.1007/s11920-020-01164-1 |pmc=7275094 |pmid=32504127 |quote=[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. |doi-access=free}}</ref><ref name="pmid37256484">{{cite journal |vauthors=Pascual JC, Arias L, Soler J |date=31 May 2023 |title=Pharmacological Management of Borderline Personality Disorder and Common Comorbidities |journal=CNS Drugs |volume=37 |issue=6 |pages=489–497 |doi=10.1007/s40263-023-01015-6 |pmc=10276775 |pmid=37256484 |quote=Comorbidity with other mental disorders is common in individuals with BPD [... Despite no drug has been approved specifically for the treatment of BPD,] various medications are routinely prescribed off label [, but] agreement among clinical guidelines [is lacking]. Comorbidity [of] other psychiatric disorders is considered [the] main [reason for the effectiveness of] pharmacological treatment and polypharmacy[. Patients receiving] BPD-specific psychotherapy usually require fewer medications[.] }}</ref> and are typically considered adjunctive to psychotherapy.<ref name="pmid37256484"/>
Pharmacological treatments appear to have minimal impact on brain activity and connectivity in borderline personality disorder patients during emotional processing, suggesting that observed neural alterations are largely independent of medication effects.<ref name=":4">{{cite journal|vauthors=Cattarinussi G, Delvecchio G, Prunas C, Moltrasio C, Brambilla P|title=Effects of pharmacological treatments on emotional tasks in borderline personality disorder: A review of functional magnetic resonance imaging studies|journal=Journal of Affective Disorders|volume=288|pages=50–57|date=June 2021|pmid=33839558|doi=10.1016/j.jad.2021.03.088 }}</ref>
===Health care services=== 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.<ref name="BPD Article">{{cite news|vauthors=Johnson RS|title=Treatment of Borderline Personality Disorder|url=http://bpdfamily.com/content/treatment-borderline-personality-disorder|publisher=BPDFamily.com|date=26 July 2014|access-date=5 August 2014|url-status=live|archive-url=https://web.archive.org/web/20140714183908/http://bpdfamily.com/content/treatment-borderline-personality-disorder|archive-date=14 July 2014}}</ref> 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.<ref>{{cite journal|vauthors=Friesen L, Gaine G, Klaver E, Burback L, Agyapong V|title=Key stakeholders' experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care|journal=PLOS ONE|volume=17|issue=9|article-number=e0274197|date=2022-09-22|pmid=36137103|pmc=9499299|doi=10.1371/journal.pone.0274197|bibcode=2022PLoSO..1774197F|doi-access=free}}</ref>
In the context of psychiatric hospitalizations, individuals with BPD constitute approximately 20% of admissions.<ref>{{cite journal|vauthors=Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J|title=Treatment histories of borderline inpatients|journal=Comprehensive Psychiatry|volume=42|issue=2|pages=144–150|year=2001|pmid=11244151|doi=10.1053/comp.2001.19749}}</ref> 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.<ref>{{cite journal|vauthors=Zanarini MC, Frankenburg FR, Hennen J, Silk KR|title=Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years|journal=The Journal of Clinical Psychiatry|volume=65|issue=1|pages=28–36|date=January 2004|pmid=14744165|doi=10.4088/JCP.v65n0105}}</ref>
Service experiences vary among individuals with BPD.<ref>{{cite journal|vauthors=Fallon P|title=Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services|journal=Journal of Psychiatric and Mental Health Nursing|volume=10|issue=4|pages=393–401|date=August 2003|pmid=12887630|doi=10.1046/j.1365-2850.2003.00617.x}}</ref> 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.<ref>{{cite journal|vauthors=Links PS, Bergmans Y, Warwar SH|date=1 July 2004|url=http://www.psychiatrictimes.com/articles/assessing-suicide-risk-patients-borderline-personality-disorder|title=Assessing Suicide Risk in Patients With Borderline Personality Disorder|journal=Psychiatric Times|series=Psychiatric Times Vol 21 No 8|volume=21|issue=8|url-status=live|archive-url=https://web.archive.org/web/20130821210809/http://www.psychiatrictimes.com/articles/assessing-suicide-risk-patients-borderline-personality-disorder|archive-date=21 August 2013}}</ref>
==== Problems in treatment ==== 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.<ref>{{cite journal |author-link=R. D. Hinshelwood |vauthors=Hinshelwood RD |date=March 1999 |title=The difficult patient. The role of 'scientific psychiatry' in understanding patients with chronic schizophrenia or severe personality disorder |journal=The British Journal of Psychiatry |volume=174 |issue=3 |pages=187–190 |doi=10.1192/bjp.174.3.187 |pmid=10448440 |doi-access=free}}</ref> A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with and more difficult than other client groups.<ref>{{cite journal |vauthors=Cleary M, Siegfried N, Walter G |date=September 2002 |title=Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder |journal=International Journal of Mental Health Nursing |volume=11 |issue=3 |pages=186–191 |doi=10.1046/j.1440-0979.2002.00246.x |pmid=12510596}}</ref> 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.<ref name="Campbell_2020">{{cite journal |vauthors=Campbell K, Clarke KA, Massey D, Lakeman R |date=19 May 2020 |title=Borderline Personality Disorder: To diagnose or not to diagnose? That is the question |journal=International Journal of Mental Health Nursing |volume=29 |issue=5 |pages=972–981 |doi=10.1111/inm.12737 |pmid=32426937 }}</ref> Mental health professionals frequently refuse to provide services to those who have received a BPD diagnosis.<ref name="Manning_ix">{{harvnb|Manning|2011|page=ix}}</ref>
With healthcare providers contributing to the stigma of a BPD diagnosis, seeking treatment can often result in the perpetuation of BPD features.<ref name="Campbell_2020" /> Efforts are ongoing to improve public and staff attitudes toward people with BPD.<ref>{{cite journal |last1=Deans |first1=Cecil |last2=Meocevic |first2=Elizabeth |title=Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder |journal=Contemporary Nurse |date=March 2006 |volume=21 |issue=1 |pages=43–49 |doi=10.5172/conu.2006.21.1.43 |hdl=1959.17/66356 |pmid=16594881 }}</ref><ref>{{cite journal |vauthors=Krawitz R |date=July 2004 |title=Borderline personality disorder: attitudinal change following training |journal=The Australian and New Zealand Journal of Psychiatry |volume=38 |issue=7 |pages=554–559 |doi=10.1111/j.1440-1614.2004.01409.x |pmid=15255829}}</ref>
==Prognosis== With treatment, the majority of people with BPD can find relief from distressing symptoms and achieve remission, defined as a consistent relief from symptoms for at least two years.<ref name="longitudinal_remission">{{cite journal|vauthors=Zanarini MC, Frankenburg FR, Hennen J, Silk KR|title=The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder|journal=The American Journal of Psychiatry|volume=160|issue=2|pages=274–283|date=February 2003|pmid=12562573|doi=10.1176/appi.ajp.160.2.274}}</ref><ref name=PToverview/> Remission rates are about 50–70% over five years.<ref name="Alvarez-Tomas 2019">{{cite journal |last1=Álvarez-Tomás |first1=Irene |last2=Ruiz |first2=José |last3=Guilera |first3=Georgina |last4=Bados |first4=Arturo |year=2019 |title=Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies |journal=European Psychiatry |volume=56 |issue=1 |pages=75–83 |doi=10.1016/j.eurpsy.2018.10.010 |pmid=30599336 |hdl-access=free |hdl=2445/175985}}</ref> 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.<ref name="Leichsenring 2023">{{cite journal |last1=Leichsenring |first1=Falk |last2=Heim |first2=Nikolas |last3=Leweke |first3=Frank |last4=Spitzer |first4=Carsten |last5=Steinert |first5=Christiane |last6=Kernberg |first6=Otto F. |date=28 February 2023 |title=Borderline Personality Disorder: A Review |journal=JAMA |volume=329 |issue=8 |pages=670–679 |doi=10.1001/jama.2023.0589 |pmid=36853245 |quote=An observational study of 290 patients with BPD reported that over a 10-year period, [...] 93% of BPD patients attained [symptomatic] remission from BPD lasting 2 years and 86% attained remission lasting 4 years. Excellent recovery, defined as remission of BPD or other personality disorders and good social and full-time vocational functioning, occurred in 39% of patients with BPD compared with 73% of patients with other personality disorders.}}</ref>
Patient personality can play an important role during the therapeutic process, leading to better clinical outcomes. Recent research has shown that BPD patients undergoing dialectical behavior therapy (DBT) exhibit better clinical outcomes correlated with higher levels of the trait of agreeableness 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 working alliance between patient and therapist; that is, more agreeable patients developed stronger working alliances with their therapists, which, in turn, led to better clinical outcomes.<ref>{{cite journal|vauthors=Hirsh JB, Quilty LC, Bagby RM, McMain SF |title=The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder|journal=Journal of Personality Disorders|volume=26|issue=4|pages=616–627|date=August 2012|pmid=22867511|doi=10.1521/pedi.2012.26.4.616}}</ref>
In addition to recovering from distressing symptoms, people with BPD can also achieve high levels of psychosocial 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.<ref>{{cite journal|vauthors=Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR|title=Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years|journal=Journal of Personality Disorders|volume=19|issue=1|pages=19–29|date=February 2005|pmid=15899718|doi=10.1521/pedi.19.1.19.62178}}</ref>
Estimates of the lifetime risk of death by suicide among individuals with BPD range between 3% and 10%, varying with the method of investigation.<ref name="pmid31142033">{{cite journal |vauthors=Paris J |year=2019 |title=Suicidality in Borderline Personality Disorder. |journal=Medicina (Kaunas) |volume=55 |issue=6 |page=223 |doi=10.3390/medicina55060223 |pmc=6632023 |pmid=31142033 |doi-access=free}}</ref><ref name="Gund2011" /><ref>{{cite book |title=Borderline Personality Disorder: A Clinical Guide |vauthors=Gunderson JG, Links PS |publisher=American Psychiatric Publishing, Inc |year=2008 |isbn=978-1-58562-335-8 |edition=2nd |page=9}}</ref> 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.<ref name="Paris J 2008 21–22">{{cite book |title=Treatment of Borderline Personality Disorder. A Guide to Evidence-Based Practice |vauthors=Paris J |publisher=The Guilford Press |year=2008 |pages=21–22}}{{isbn?}}</ref> 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.<ref name="Kreisman J, Strauss H 2004 206">{{cite book |url=https://archive.org/details/sometimesiactcra00jero |title=Sometimes I Act Crazy. Living With Borderline Personality Disorder |vauthors=Kreisman J, Strauss H |publisher=Wiley & Sons |year=2004 |isbn=978-0-471-22286-6 |page=[https://archive.org/details/sometimesiactcra00jero/page/206 206] |url-access=registration}}</ref> There is evidence that a significant proportion of males who die by suicide may have undiagnosed BPD.<ref name="Paris J 2008 21–22" /> About half of all individuals who commit suicide are diagnosed with a personality disorder, with BPD being the most common association.<ref>{{cite journal |vauthors=Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M |year=2004 |title=Borderline personality disorder |journal=Lancet |volume=364 |issue=9432 |pages=453–461 |doi=10.1016/S0140-6736(04)16770-6 |pmid=15288745 }}</ref>
==Epidemiology== BPD has a point prevalence of 1.6%<ref name="PToverview" /> and a lifetime prevalence of 5.9% of the global population.<ref name="Grant_2008" /><ref name="DSM53" /><ref name="NIH2016" /><ref name="Wolters Kluwer">{{Cite book |url=https://uptodate.com/ |title=UpToDate |publisher=Wolters Kluwer |chapter=Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis |access-date=13 March 2024 |chapter-url=https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis |url-access=subscription |archive-url=https://web.archive.org/web/20090106134307/http://uptodate.com/ |archive-date=6 January 2009 |url-status=live}}</ref><!-- Quote (in archived version): 'According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.' --><ref name="nimh.nih.gov">{{cite web |title=NIMH " Personality Disorders |url=https://www.nimh.nih.gov/health/statistics/personality-disorders |url-status=live |archive-url=https://web.archive.org/web/20220618193929/https://www.nimh.nih.gov/health/statistics/personality-disorders |archive-date=18 June 2022 |access-date=20 May 2021 |website=nimh.nih.gov}}</ref> Within clinical settings, the occurrence of BPD is 6.4% among urban primary care patients,<ref>{{cite journal|vauthors=Gross R, Olfson M, Gameroff M, Shea S, Feder A, Fuentes M, Lantigua R, Weissman MM|title=Borderline personality disorder in primary care|journal=Archives of Internal Medicine|volume=162|issue=1|pages=53–60|date=January 2002|pmid=11784220|doi=10.1001/archinte.162.1.53}}</ref> 9.3% among psychiatric outpatients,<ref>{{cite journal|vauthors=Zimmerman M, Rothschild L, Chelminski I|title=The prevalence of DSM-IV personality disorders in psychiatric outpatients|journal=The American Journal of Psychiatry|volume=162|issue=10|pages=1911–1918|date=October 2005|pmid=16199838|doi=10.1176/appi.ajp.162.10.1911}}</ref> and approximately 20% among psychiatric inpatients.<ref>{{Cite book|title=American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)}}</ref> Utilization of healthcare resources by individuals with BPD is high.<ref name="Bourke_2018" /> 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.<ref name="DSM53" />
Regarding gender distribution, women are diagnosed with BPD three times more frequently than men in clinical environments.<ref name="DSM53" /><ref name="Wolters Kluwer" /> Nonetheless, epidemiological research in the United States indicates no significant gender difference in the lifetime prevalence of BPD within the general population.<ref name="Lenzenweger_2007">{{cite journal|vauthors=Lenzenweger MF, Lane MC, Loranger AW, Kessler RC|date=September 2007|title=DSM-IV personality disorders in the National Comorbidity Survey Replication|journal=Biological Psychiatry|volume=62|issue=6|pages=553–564|doi=10.1016/j.biopsych.2006.09.019|pmc=2044500|pmid=17217923}}</ref><ref name="Grant_2008" /> Feminist scholars argue that the diagnosis is disproportionately applied to women, particularly survivors of childhood sexual abuse, and that it pathologizes the understandable emotional and relational responses to gendered violence.<ref>{{cite journal |last1=Shaw |first1=Clare |last2=Proctor |first2=Gillian |title=I. Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder |journal=Feminism & Psychology |date=November 2005 |volume=15 |issue=4 |pages=483–490 |doi=10.1177/0959-353505057620 }}</ref>
The relationship between BPD and ethnicity continues to be ambiguous, with divergent findings reported in the United States.<ref name="Wolters Kluwer" /> The overall prevalence of BPD in the U.S. prison population is thought to be 17%.<ref name="BPD_fact_sheet">{{cite web|year=2013|title=BPD Fact Sheet|url=http://www.borderlinepersonalitydisorder.com/understading-bpd/bpd-fact-sheet/|url-status=live|archive-url=https://web.archive.org/web/20130104231941/http://www.borderlinepersonalitydisorder.com/understading-bpd/bpd-fact-sheet/|archive-date=4 January 2013|publisher=National Educational Alliance for Borderline Personality Disorder}}</ref> Sexual minorities (i.e., lesbian, gay, bisexual) are up to 3.82 times more likely to be diagnosed with BPD<ref name=":10">{{cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Morgan |first2=Theresa A. |last3=Zimmerman |first3=Mark |title=A Population-Based Examination of Criterion-Level Disparities in the Diagnosis of Borderline Personality Disorder Among Sexual Minority Adults |journal=Assessment |date=June 2021 |volume=28 |issue=4 |pages=1097–1109 |doi=10.1177/1073191121991922 |pmid=33583188 }}</ref> and gender minorities (i.e, transgender and gender diverse) are up to 4.05 times more likely to be diagnosed.<ref name=":11">{{cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Morgan |first2=Theresa A. |last3=Zimmerman |first3=Mark |title=Transgender and Gender Diverse Patients Are Diagnosed with Borderline Personality Disorder More Frequently Than Cisgender Patients Regardless of Personality Pathology |journal=Transgender Health |date=December 2024 |volume=9 |issue=6 |pages=554–565 |doi=10.1089/trgh.2023.0062 |pmc=11669633 |pmid=39735379}}</ref> These disparities persist even when symptom levels are comparable, suggesting diagnostic bias and the potential pathologizing of minority stress.<ref name=":10" /><ref name=":11" />
===Gender=== {{see also|Gender differences in suicide}}
In a clinic, up to 80% of patients are women, but this might not necessarily reflect the gender distribution in the entire population.<ref>{{cite book |title=Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice |vauthors=Paris J |publisher=The Guilford Press |year=2008 |page=21}}</ref> 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 substance use disorder and psychopathy, but tend not to seek treatment as often. Additionally, men and women with similar symptoms may manifest them differently. Men frequently 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 antisocial personality disorder and borderline personality disorder, which may share similar underlying pathologies but present different symptoms influenced by gender.<ref name="Paris J 2008 21–22" />{{Verify source|date=November 2025|reason=It is unclear if the source supported material removed by me from the end of this paragraph or all of the paragraph.}}
There are also sex differences in personality traits and Axis I and II comorbidity.<ref name="Sansone_2011">{{cite journal |vauthors=Sansone RA, Sansone LA |date=May 2011 |title=Gender patterns in borderline personality disorder |journal=Innovations in Clinical Neuroscience |volume=8 |issue=5 |pages=16–20 |pmc=3115767 |pmid=21686143 |quote=Men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking. For Axis I comorbidity, 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. Concerning Axis II comorbidity, 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 use disorders. Women are more likely to have treatment histories characterized by more pharmacotherapy and psychotherapy.}}</ref> Men with BPD are more likely to use substances recreationally, have explosive temper, high levels of novelty seeking and have (especially) antisocial, narcissistic, passive–aggressive or sadistic personality traits (male BPD being characterised by antisocial overtones<ref name="Sansone_2011" />). Women with BPD are more likely to have eating, mood, anxiety, and post-traumatic stress disorders.<ref name="Sansone_2011" />
==History== [[File:Edvard Munch - Salomé.jpg|thumb|Devaluation in Edvard Munch's ''Salome'' (1903). Idealization and devaluation of others in personal relations are common traits of BPD. The painter Edvard Munch depicted his new friend, the violinist Eva Mudocci, in both ways within days. First as "a woman seen by a man in love", then as "a bloodthirsty and cannibalistic Salome".{{cite quote}} In modern times, Munch has been suggested to have had BPD.<ref name="auto"/><ref>{{cite book |title=Edvard Munch: the life of a person with borderline personality as seen through his art |vauthors=Aarkrog T |publisher=Lundbeck Pharma A/S |year=1990 |isbn=978-87-983524-1-9 |location=Denmark |pages=34–35}}</ref>]] The coexistence of intense, divergent moods within an individual was recognized by Homer, Hippocrates, and Aretaeus, the last describing the vacillating presence of impulsive anger, melancholia, and mania within a single person. Swiss physician Théophile Bonet revived the concept in 1684, and used the term {{Lang|fr|folie maniaco-mélancolique}}<ref>{{Harvnb|Millon|Grossman|Meagher|2004|p=172}}</ref> to describe 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".<ref>{{cite journal|vauthors=Hughes CH|year=1884|title=Borderline psychiatric records – prodromal symptoms of psychical impairments|journal=Alienists & Neurology|volume=5|pages=85–90|oclc=773814725 |url=https://www.proquest.com/openview/c3f1768b436255959d7e045be9d3ba9d/ }}</ref> In 1921, Emil Kraepelin identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.<ref name="millon">{{Harvnb|Millon|1996|pp= 645–690}}</ref>
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.<ref name="David W Jones history of borderline">{{cite journal |last1=Jones |first1=David W. |title=A history of borderline: disorder at the heart of psychiatry |journal=Journal of Psychosocial Studies |date=August 2023 |volume=16 |issue=2 |pages=117–134 |doi=10.1332/147867323X16871713092130 |url=https://oro.open.ac.uk/90946/1/90946.pdf }}</ref> The first formal definition of borderline disorder is widely acknowledged to have been written by Adolph Stern in 1938.<ref name="stern">{{cite journal|vauthors=Stern A|year=1938|title=Psychoanalytic investigation of and therapy in the borderline group of neuroses|journal=Psychoanalytic Quarterly|volume=7|issue=4|pages=467–489|doi=10.1080/21674086.1938.11925367}}</ref><ref name="alberto">{{cite journal |last1=Stefana |first1=Alberto |title=Adolph Stern, father of the term 'borderline personality' |journal=Minerva Psichiatrica |date=June 2015 |volume=56 |issue=2 |page=95 |hdl=11562/936153 |url=https://www.minervamedica.it/en/journals/minerva-psychiatry/article.php?cod=R17Y2015N02A0095 |url-access=subscription }}</ref> He described a group of patients who he felt to be on the ''borderline'' between neurosis and psychosis, 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 borderline schizophrenia to thinking of it as a borderline affective disorder (mood disorder), on the fringes of bipolar disorder, cyclothymia, and dysthymia. In the DSM-II, stressing the intensity and variability of moods, it was called cyclothymic personality (affective personality).<ref name="DSM-IV-TR" /> While the term "borderline" was evolving to refer to a distinct category of disorder, psychoanalysts such as Otto Kernberg were using it to refer to a broad spectrum of issues, describing an intermediate level of personality organization<ref name="millon" /> between neurosis and psychosis.<ref name="pmid3898174">{{cite journal|vauthors=Aronson TA|title=Historical perspectives on the borderline concept: a review and critique|journal=Psychiatry|volume=48|issue=3|pages=209–222|date=August 1985|pmid=3898174|doi=10.1080/00332747.1985.11024282}}</ref>
After standardized criteria were developed by John Gunderson<ref>{{cite journal|vauthors=Gunderson JG, Kolb JE, Austin V|title=The diagnostic interview for borderline patients|journal=The American Journal of Psychiatry|volume=138|issue=7|pages=896–903|date=July 1981|pmid=7258348|doi=10.1176/ajp.138.7.896}}</ref> to distinguish it from mood disorders and other Axis I disorders, BPD became a personality disorder diagnosis in 1980 with the publication of the DSM-III.<ref name="PToverview">{{cite journal |last1=Oldham |first1=John M. |title=Borderline Personality Disorder: An Overview |journal=Psychiatric Times |date=July 2004 |volume=21 |issue=8 |pages=43 |id={{Gale|A120051807}} |url=http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0 |url-status=live |archive-url=https://web.archive.org/web/20131021180803/http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0 |archive-date=21 October 2013 }}</ref> The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder".<ref name="pmid3898174" /> 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.<ref name="DSM53" /> However, the term "borderline" has been described as uniquely inadequate for describing the symptoms characteristic of this disorder.<ref>{{cite book|vauthors=Stone MH|year=2005|chapter=Borderline Personality Disorder: History of the Concept|veditors=Zanarini MC|title=Borderline personality disorder|pages=1–18|publisher=Taylor & Francis|location=Boca Raton, Florida|isbn=978-0-8247-2928-8 |doi=10.1201/b14134 }}</ref>
Psychodynamic theorists have historically offered the most comprehensive theoretical models of BPD. Gunderson emphasized the patient's fundamental interpersonal hypersensitivity, which he viewed as partially genetic.<ref>{{Cite journal|last1=Gunderson|first1=John G.|last2=Lyons-Ruth|first2=Karlen|date=February 2008|title=BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model|journal=Journal of Personality Disorders|volume=22|issue=1|pages=22–41|doi=10.1521/pedi.2008.22.1.22 |pmc=2596628|pmid=18312121}}</ref> Kernberg sees the disorder as one involving disturbed object relations, marked by an excess of aggression and use of primitive defenses, such as splitting, projection, and projective identification.<ref>{{cite journal |last1=Kernberg |first1=Otto F. |last2=Michels |first2=Robert |title=Borderline Personality Disorder |journal=American Journal of Psychiatry |date=May 2009 |volume=166 |issue=5 |pages=505–508 |doi=10.1176/appi.ajp.2009.09020263 |pmid=19411373 }}</ref> Gerald Adler, writing from a self psychology perspective, viewed the disorder as resulting from the failure of evocative memory and characterized by an intolerance of aloneness.<ref>{{Cite journal|last1=Adler|first1=G.|last2=Buie|first2=D. H.|year=1979|title=Aloneness and borderline psychopathology: the possible relevance of child development issues|journal=The International Journal of Psycho-Analysis|volume=60|issue=1|pages=83–96 |pmid=457345 |url=https://www.proquest.com/openview/dfc68175c4c95ec78d889f2ab62d6d4d/ }}</ref> Masterson hypothesized that the disorder resulted from core developmental problems with separation-individuation.<ref>{{cite journal |last1=Lenzenweger |first1=Mark F. |title=The Personality Disorders: A New Look at the Developmental Self and Object Relations Approach |journal=American Journal of Psychiatry |date=October 2001 |volume=158 |issue=10 |pages=1755–a–1756 |doi=10.1176/appi.ajp.158.10.1755-a }}</ref> More recently, Fonagy and Bateman have proposed that the disorder stems from deficits in mentalization.<ref>{{Cite journal |last1=Bateman |first1=Anthony |last2=Fonagy |first2=Peter |date=February 2010 |title=Mentalization based treatment for borderline personality disorder |journal=World Psychiatry|volume=9 |issue=1 |pages=11–15 |doi=10.1002/j.2051-5545.2010.tb00255.x |pmc=2816926 |pmid=20148147}}</ref>
===Etymology=== Earlier versions of the DSM—before the multiaxial diagnosis system—classified most people with mental health problems into two categories: the psychotics and the neurotics. Clinicians noted a certain class of neurotics who, when in crisis, appeared to straddle the borderline into psychosis.<ref>{{cite book|vauthors=Moll T|title=Mental Health Primer|isbn=978-1-7205-1057-4|page=43|date=29 May 2018|publisher=CreateSpace Independent Publishing Platform}}{{self-published inline|date=March 2026}}</ref> The term "borderline personality disorder" was coined in American psychiatry in the 1960s. It became the preferred term over several competing names, such as "emotionally unstable character disorder" and "borderline schizophrenia", during the 1970s.<ref>{{cite journal |last1=Schulz |first1=S. Charles |last2=Goldberg |first2=Solomon C. |title=Is borderline personality disorder an illness? |journal=Psychopharmacology Bulletin |date=1984 |volume=20 |issue=3 |pages=554–560 |url={{GBurl|_kOnSecueiYC|p=554}} |pmid=6473661 }}</ref><ref>{{cite journal |last1=Spitzer |first1=Robert L. |last2=Endicott |first2=J |last3=Gibbon |first3=M |title=Crossing the Border Into Borderline Personality and Borderline Schizophrenia: The Development of Criteria |journal=Archives of General Psychiatry |date=January 1979 |volume=36 |issue=1 |pages=17–24 |doi=10.1001/archpsyc.1979.01780010023001 |pmid=760694 }}</ref> Borderline personality disorder was included in DSM-III (1980) despite not being universally recognized as a valid diagnosis.<ref>{{cite book |last1=Merskey |first1=Harold |title=Psychiatric Illness: Diagnosis, Management and Treatment for General Practitioners and Students |date=1980 |publisher=Baillière Tindall |isbn=978-0-7020-0790-3 |oclc=561462199 |page=415 |quote=Borderline personality disorder is a very controversial and confusing American term, best avoided. }}</ref> Its validity was firmly established by the 1990s.<ref>{{Cite journal |last=Gunderson |first=John G. |date=May 2009 |title=Borderline personality disorder: ontogeny of a diagnosis |journal=The American Journal of Psychiatry |volume=166 |issue=5 |pages=530–539 |doi=10.1176/appi.ajp.2009.08121825 |pmc=3145201 |pmid=19411380}}</ref>
==Society and culture==
===Stigma=== {{see also|Social stigma}}
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 "attention seeking", are often used and may become a self-fulfilling prophecy, as the negative treatment of these individuals may trigger further self-destructive behavior.<ref name="Borderline personality disorder, st" />
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.<ref>{{cite journal |vauthors=Nehls N |year=1998 |title=Borderline personality disorder: gender stereotypes, stigma, and limited system of care |journal=Issues in Mental Health Nursing |volume=19 |issue=2 |pages=97–112 |doi=10.1080/016128498249105 |pmid=9601307 }}</ref> Certain experts, like Dr. Gillian Proctor and Dr. Karen Williams, argue 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, especially in light of BPD's prevalence in women who have experienced sexual abuse, as well as reduce stigma.<ref>{{Cite news |last=Shimo |first=Alexandra |date=2019-03-27 |title=Are sexual abuse victims being diagnosed with a mental disorder they don't have? |url=https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have |access-date=2025-09-03 |work=The Guardian |language=en-GB }}</ref><ref>{{Cite news |last=May |first=Natasha |date=2024-05-11 |title=Is this actually PTSD? Clinicians divided over redefining borderline personality disorder |url=https://www.theguardian.com/society/article/2024/may/12/is-this-actually-ptsd-clinicians-divided-over-redefining-borderline-personality-disorder |access-date=2025-09-03 |work=The Guardian |language=en-GB }}</ref> Critics of the PTSD diagnosis argue that it medicalizes abuse rather than addressing the root causes in society.<ref>{{cite journal |vauthors=Becker D |date=October 2000 |title=When she was bad: borderline personality disorder in a posttraumatic age |journal=The American Journal of Orthopsychiatry |volume=70 |issue=4 |pages=422–432 |doi=10.1037/h0087769 |pmid=11086521}}</ref> Regardless, a diagnosis of PTSD does not encompass all aspects of the disorder (see brain abnormalities and terminology).{{Citation needed|date=December 2025}}
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 pejorative label 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.<ref>{{cite journal |vauthors=Nehls N |date=August 1999 |title=Borderline personality disorder: the voice of patients |journal=Research in Nursing & Health |volume=22 |issue=4 |pages=285–293 |doi=10.1002/(SICI)1098-240X(199908)22:4<285::AID-NUR3>3.0.CO;2-R |pmid=10435546}}</ref>
====Physical violence==== The stigma surrounding borderline personality disorder includes the belief that people with BPD are prone to violence toward others.<ref name="Chapman_31">{{harvnb|Chapman|Gratz|2007|page=31}}</ref> 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 harm others physically.<ref name="Chapman_31" /> Although people with BPD often struggle with experiences of intense anger, a defining characteristic of BPD is that they direct it inward toward themselves.<ref name="Chapman_32">{{harvnb|Chapman|Gratz|2007|page=32}}</ref>
One 2020 study found that BPD is individually associated with psychological, physical, and sexual forms of intimate partner violence (IPV), especially amongst men.<ref name="MunroMartin">{{cite journal |vauthors=Munro OE, Sellbom M |date=August 2020 |title=Elucidating the relationship between borderline personality disorder and intimate partner violence |journal=Personality and Mental Health |volume=14 |issue=3 |pages=284–303 |doi=10.1002/pmh.1480 |hdl=10523/10488 |pmid=32162499 }}</ref>{{Primary source inline|date=April 2025}} 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.<ref name="MunroMartin" />
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.<ref name="Chapman_32" /> Their extreme aversion to violence can cause many people with BPD to overcompensate and experience difficulties being assertive and expressing their needs.<ref name="Chapman_32" /> This is one reason why people with BPD often choose to harm themselves over potentially causing harm to others.<ref name="Chapman_32" /><ref name="reasons_NSSI" /><ref name="Chapman_31" />
===Credibility and validity of testimony=== The credibility of individuals with personality disorders has been questioned at least since the 1960s.<ref name="Goodwin">{{cite book |url=https://archive.org/details/childhoodanteced00kluf |title=Childhood antecedents of multiple personality |vauthors=Goodwin J |date=1985 |publisher=American Psychiatric Press |isbn=978-0-88048-082-6 |veditors=Kluft RP |chapter=Chapter 1: Credibility problems in multiple personality disorder patients and abused children |chapter-url=https://archive.org/details/childhoodanteced00kluf |url-access=registration}}</ref>{{rp|2}} Two concerns are the incidence of dissociation episodes among people with BPD and the belief that lying is not uncommon in those diagnosed with the condition.<ref>{{cite journal |last1=Dike |first1=Charles C. |last2=Baranoski |first2=Madelon |last3=Griffith |first3=Ezra E. H. |title=Pathological lying revisited |journal=The Journal of the American Academy of Psychiatry and the Law |date=2005 |volume=33 |issue=3 |pages=342–349 |pmid=16186198 }}</ref>
===Terminology=== 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,<ref name="borderlinepersonalitytoday.com">{{cite news |title=Borderline Personality Disorder Label Creates Stigma |url=http://www.borderlinepersonalitytoday.com/main/label.htm |archive-url=https://web.archive.org/web/20150502181810/http://www.borderlinepersonalitytoday.com/main/label.htm |archive-date=2 May 2015 |vauthors=Bogod E}}</ref> since many who are labelled with borderline personality disorder find the name unhelpful, stigmatizing, or inaccurate.<ref name="borderlinepersonalitytoday.com" /><ref>{{cite web |year=2004 |title=Understanding Borderline Personality Disorder |url=http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=12 |archive-url=https://web.archive.org/web/20130526035257/http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=12 |archive-date=26 May 2013 |publisher=Treatment and Research Advancements Association for Personality Disorder}}</ref>
Alternative suggestions for names include ''emotional regulation disorder'' or ''emotional dysregulation disorder''. ''Impulse disorder'' and ''interpersonal regulatory disorder'' are other valid alternatives, according to John G. Gunderson of McLean Hospital in the United States.<ref>{{cite book |url=https://archive.org/details/understandingtre00john |title=Understanding and Treating Borderline Personality Disorder A Guide for Professionals and Families |vauthors=Gunderson JG, Hoffman PD |publisher=American Psychiatric Publishing |year=2005 |isbn=978-1-58562-135-4 |location=Arlington, Virginia |url-access=registration}}{{Page needed|date=July 2013}}</ref> Another term suggested by psychiatrist Carolyn Quadrio 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.<ref name="AxisOne/AxisTwo" /> However, although many with BPD do have traumatic histories, some do not report any traumatic event, which suggests that BPD is not necessarily a trauma spectrum disorder.<ref name="Gratz2007">{{harvnb|Chapman|Gratz|2007|page=52}}</ref>
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.<ref name="DSM-5-borderline-663">{{harvnb|American Psychiatric Association|2013|pages=663–666}}</ref>
=== Media === In literature, characters believed to exhibit signs of BPD include Catherine in ''Wuthering Heights'' (1847), Smerdyakov in ''The Brothers Karamazov'' (1880), and Harry Haller in ''Steppenwolf'' (1927).<ref>{{cite journal|vauthors=Morris P|date=April 2013|title=The Depiction of Trauma and its Effect on Character Development in the Brontë Fiction|journal=Brontë Studies|volume=38|issue=2|pages=157–168|doi=10.1179/1474893213Z.00000000062 }}</ref><ref>{{cite journal|vauthors=Ohi SI|date=26 October 2019|title=Personality Disorder of Character Smerdyakov in Novel the Brother Karamazov Bu [sic] Fyodor Dostovesky (Translated by Constance Clara Garnett)|url=https://repository.ung.ac.id/skripsi/show/321412044/personality-disorder-of-character-smerdyakov-in-novel-the-brother-karamazov-bu-fyodor-dostovesky-translated-by-constance-clara-garnett.html|url-status=live|journal=Skripsi|volume=1|issue=321412044|archive-url=https://web.archive.org/web/20230213123501/https://repository.ung.ac.id/skripsi/show/321412044/personality-disorder-of-character-smerdyakov-in-novel-the-brother-karamazov-bu-fyodor-dostovesky-translated-by-constance-clara-garnett.html|archive-date=13 February 2023|access-date=22 May 2022}}</ref><ref>{{cite book|url=https://books.google.com/books?id=RXa0uEkiNbQC&q=borderline+personality+disorder+%22steppenwolf%22&pg=PA74|title=Transpersonal Psychotherapy|vauthors=Wellings N, McCormick EW|date=2000|publisher=SAGE|isbn=978-1-4129-0802-3|access-date=22 May 2022|archive-url=https://web.archive.org/web/20240314152701/https://books.google.com/books?id=RXa0uEkiNbQC&q=borderline+personality+disorder+%22steppenwolf%22&pg=PA74#v=onepage&q=borderline%20personality%20disorder%20%22steppenwolf%22&f=false|archive-date=14 March 2024|url-status=live}}</ref>
Films have also attempted to portray BPD, with characters in ''Margot at the Wedding'' (2007), ''Mr. Nobody'' (2009), ''Cracks'' (2009),<ref name="RobinsonFG">{{cite book|title=The Field Guide to Personality Disorders|vauthors=Robinson DJ|publisher=Rapid Psychler Press|year=1999|isbn=978-0-9680324-6-6|page=113}}</ref> ''Truth'' (2013), ''Wounded (2013)'', ''Welcome to Me'' (2014),<ref>{{cite news|date=7 May 2015|title=Kristen Wiig earns awkward laughs and silence in 'Welcome to Me'|url=https://www.washingtonpost.com/goingoutguide/movies/kristen-wiig-earns-awkward-laughs-and-silence-in-welcome-to-me/2015/05/06/c26d9b78-ef6d-11e4-8abc-d6aa3bad79dd_story.html|url-status=live|archive-url=https://web.archive.org/web/20150604082145/http://www.washingtonpost.com/goingoutguide/movies/kristen-wiig-earns-awkward-laughs-and-silence-in-welcome-to-me/2015/05/06/c26d9b78-ef6d-11e4-8abc-d6aa3bad79dd_story.html|archive-date=4 June 2015|access-date=3 June 2015|newspaper=The Washington Post|vauthors=O'Sullivan M}}</ref><ref>{{cite news|date=11 September 2014|title=Toronto Film Review: 'Welcome to Me': Kristen Wiig plays a woman with borderline personality disorder in this startlingly inspired comedy from Shira Piven|url=https://variety.com/2014/film/festivals/toronto-film-review-welcome-to-me-1201304067/|url-status=live|archive-url=https://web.archive.org/web/20150617215603/http://variety.com/2014/film/festivals/toronto-film-review-welcome-to-me-1201304067/|archive-date=17 June 2015|access-date=3 June 2015|newspaper=Variety|vauthors=Chang J}}</ref> and ''Tamasha'' (2015)<ref>{{cite web|date=9 November 2021|title=Use Your Movie Time To Get Help With Mental Health Issues|url=https://www.femina.in/wellness/mental-health/use-your-movie-time-to-get-help-with-mental-health-issues-211072.html|url-status=live|archive-url=https://web.archive.org/web/20220121130338/https://www.femina.in/wellness/mental-health/use-your-movie-time-to-get-help-with-mental-health-issues-211072.html|archive-date=21 January 2022|access-date=21 January 2022|website=Femina (India)|vauthors=Setia S}}</ref> all suggested to show traits of the disorder. The behavior of Theresa Dunn in ''Looking for Mr. Goodbar'' (1975) is consistent with BPD, as suggested by Robert O. Friedel.<ref>{{cite journal |last1=Friedel |first1=Robert O. |title=Early sea changes in borderline personality disorder |journal=Current Psychiatry Reports |date=February 2006 |volume=8 |issue=1 |pages=1–4 |doi=10.1007/s11920-006-0071-6 |pmid=16513034 }}</ref> Films like ''Play Misty for Me'' (1971)<ref name="Robinson_2003">{{cite book|title=Reel Psychiatry: Movie Portrayals of Psychiatric Conditions|vauthors=Robinson DJ|publisher=Rapid Psychler Press|year=2003|isbn=978-1-894328-07-4|location=Port Huron, Michigan|page=234}}</ref> and ''Girl, Interrupted'' (1999, based on the memoir of the same name) suggest emotional instability characteristic of BPD,<ref>{{cite book|title=Movies and Mental Illness: Using Films to Understand Psychopathology|vauthors=Wedding D, Boyd MA, Niemiec RM|year=2005|publisher=Hogrefe|location=Cambridge, Massachusetts|isbn=978-0-88937-292-4|page=59}}</ref> while ''Single White Female'' (1992) highlights aspects such as identity disturbance and fear of abandonment.<ref name="Robinson_2003" />{{rp|235}} Clementine in ''Eternal Sunshine of the Spotless Mind'' (2004) is noted to show classic BPD behavior,<ref>{{cite journal|vauthors=Alberini CM|date=29 October 2010|title=Long-term Memories: The Good, the Bad, and the Ugly|journal=Cerebrum: The Dana Forum on Brain Science|volume=2010|page=21 |pmc=3574792|pmid=23447766}}</ref><ref>{{cite book|vauthors=Young SD|date=14 March 2012|title=Psychology at the Movies|doi=10.1002/9781119941149|isbn=978-1-119-94114-9}}{{pn|date=March 2026}}</ref> and Carey Mulligan's portrayal in ''Shame'' (2011) is praised by psychiatrists for its accuracy regarding BPD characteristics.<ref name="Art of Psychiatry Shame review">{{cite news|vauthors=Seltzer A|title=''Shame'' and ''A Dangerous Method'' reviews|url=http://www.artofpsychiatry.co.uk/shame-and-a-dangerous-method-reviews/|newspaper=The Art of Psychiatry|date=16 April 2012|access-date=13 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170116164632/http://www.artofpsychiatry.co.uk/shame-and-a-dangerous-method-reviews/|archive-date=16 January 2017}}</ref>
Television series like ''Crazy Ex-Girlfriend'' (2015) and the miniseries ''Maniac'' (2018) depict characters with BPD.<ref>{{cite news|date=26 September 2018|title=Netflix's 'Maniac' Is A Trippy Ride with a Lot To Say About Mental Illness|website=Bustle|url=https://www.bustle.com/p/how-netflixs-maniac-uses-mental-illness-to-interrogate-what-it-means-to-be-normal-12019062|url-status=live|access-date=1 March 2019|archive-url=https://web.archive.org/web/20190302024650/https://www.bustle.com/p/how-netflixs-maniac-uses-mental-illness-to-interrogate-what-it-means-to-be-normal-12019062|archive-date=2 March 2019|vauthors=Patton R}}</ref> Traits of BPD and narcissistic personality disorders are observed in characters like Cersei and Jaime Lannister from ''A Song of Ice and Fire'' (1996) and its TV adaptation ''Game of Thrones'' (2011).<ref>{{cite news|publisher=MTV News|title=A Therapist Explains Why Everyone on 'Game of Thrones' Has Serious Issues: Westeros is Basically A Living, Breathing Manual for Mental Illness|date=30 April 2015|vauthors=Rosenfield K|url=http://www.mtv.com/news/2146368/game-of-thrones-mental-illness/|access-date=13 May 2019|archive-date=13 May 2019|archive-url=https://web.archive.org/web/20190513175836/http://www.mtv.com/news/2146368/game-of-thrones-mental-illness/}}</ref> In ''The Sopranos'' (1999), Livia Soprano is diagnosed with BPD,<ref>{{cite book|vauthors=Lavery D|title=This Thing of Ours: Investigating the Sopranos|date=2002|publisher=Wallflower Press|page=118}}</ref> and even the portrayal of Bruce Wayne/Batman in the show ''Titans'' (2018) is said to include aspects of the disorder.<ref>{{cite web|title=Titans Gives Bruce Wayne a Psychological Diagnosis|date=26 August 2021|url=https://www.cbr.com/titans-bruce-wayne-borderline-personality-disorder/|access-date=9 August 2022|archive-date=9 August 2022|archive-url=https://web.archive.org/web/20220809095534/https://www.cbr.com/titans-bruce-wayne-borderline-personality-disorder/|url-status=live}}</ref> The animated series ''BoJack Horseman'' (2014) also features a main character with symptoms of BPD.<ref>{{cite web|last=Alvernaz|first=Adam|date=2019-01-29|title=The Depressing Themes Hiding in Bojack Horseman's Closet|url=https://www.highlandernews.org/34540/depressing-themes-hiding-bojack-horsemans-closet/|access-date=2024-01-04|website=Highlander|archive-date=4 January 2024|archive-url=https://web.archive.org/web/20240104230452/https://www.highlandernews.org/34540/depressing-themes-hiding-bojack-horsemans-closet/|url-status=live}}</ref>
=== Awareness === Awareness of BPD has been growing, with the U.S. House of Representatives declaring May as Borderline Personality Disorder Awareness Month in 2008.<ref>{{cite news|url=http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml|title=BPD Awareness Month – Congressional History|work=BPD Today|publisher=Mental Health Today|access-date=1 November 2010|archive-url=https://web.archive.org/web/20110708083602/http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml|archive-date=8 July 2011}}</ref> Public figures like South Korean singer-songwriter Lee Sun-mi have opened up about their personal experiences with the disorder, bringing further attention to its impact on individuals' lives.<ref>{{cite web|vauthors=Kim E|date=16 December 2020|title=선미 고백한 '경계선 인격장애' 뭐길래?|trans-title=What is the 'borderline personality disorder' that Sunmi confessed to?|language=Korean|url=https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|publisher=Naver TV|access-date=16 December 2020|archive-date=6 February 2021|archive-url=https://web.archive.org/web/20210206162916/https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|url-status=live}}</ref>
== See also == * Classification of personality disorders * {{annotated link|Identity disturbance}} * {{annotated link|Otto Kernberg}}
== Notes == {{notelist}}
== Citations == {{reflist}}
== General bibliography == {{Refbegin}} * {{cite book|author=American Psychiatric Association|author-link=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders|title-link=Diagnostic and Statistical Manual of Mental Disorders|publisher=American Psychiatric Association|year=2000|isbn=978-0-89042-025-6|edition=4th}} * {{cite book|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders|title-link=Diagnostic and Statistical Manual of Mental Disorders|publisher=American Psychiatric Publishing|year=2013|isbn=978-0-89042-555-8|edition=5th}} * {{cite book|vauthors=Chapman AL, Gratz KL|year=2007|title=The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD|location=Oakland, Calif. |publisher=New Harbinger Publications|isbn=978-1-57224-507-5}} * {{cite journal|vauthors=Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N|author-link1=Marsha M. Linehan|date=July 2006|title=Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder|journal=Archives of General Psychiatry|volume=63|issue=7|pages=757–66|pmid=16818865|doi=10.1001/archpsyc.63.7.757|doi-access=free}} * {{cite book|vauthors=Linehan M|author-link=Marsha M. Linehan|year=1993|title=Cognitive-behavioral treatment of borderline personality disorder|location=New York|publisher=Guilford Press|isbn=978-0-89862-183-9}} * {{cite book|vauthors=Manning S|year=2011|title=Loving Someone with Borderline Personality Disorder|publisher=The Guilford Press|isbn=978-1-59385-607-6}} * {{cite book|vauthors=Millon T|author-link=Theodore Millon|year=1996|title=Disorders of Personality: DSM-IV-TM and Beyond|location=New York|publisher=John Wiley & Sons|isbn=978-0-471-01186-6}} * {{cite book|vauthors=Millon T|author-link=Theodore Millon|year=2004|title=Personality Disorders in Modern Life|publisher=Wiley|isbn=978-0-471-32355-6}} * {{cite book|vauthors=Millon T, Grossman S, Meagher SE|author-link1=Theodore Millon|year=2004|title=Masters of the mind: exploring the story of mental illness from ancient times to the new millennium|publisher=John Wiley & Sons|isbn=978-0-471-46985-8}} * {{cite web|vauthors=Millon T|author-link=Theodore Millon|year=2006|title=Personality Subtypes|url=http://millon.net/taxonomy/summary.htm|access-date=1 November 2010|archive-date=4 November 2010|archive-url=https://web.archive.org/web/20101104162306/http://www.millon.net/taxonomy/summary.htm|website=Institute for Advanced Studies in Personology and Psychopathology|publisher=Dicandrien, Inc.}} {{refend}}
== External links == {{sister project links||d=Q208166|c=Category:Borderline personality disorder|n=no|b=no|v=no|voy=no|m=no|mw=no|s=no|wikt=no|species=no}} * {{cite web|url=https://www.nimh.nih.gov/health/topics/borderline-personality-disorder|publisher=National Institute of Mental Health|title=Borderline personality disorder}} * [https://www.bpdfamily.com/content/borderline-personality-disorder APA DSM 5 Definition of Borderline personality disorder] * [https://div12.org/psychological-treatments/disorders/borderline-personality-disorder/ APA Division 12 treatment page for Borderline personality disorder] * [https://psychiatryonline.org/doi/pdf/10.1176/appi.focus.11.2.189 Alternative DSM-5 Model for Personality Disorders] (with AMPD definition of BPD) * [https://icd.who.int/browse/2024-01/mms/en#2006821354 ICD-11 definition of Personality disorder, Borderline pattern by the World Health Organization] * [https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/ NHS] * {{cite web|url=https://borderlinesupport.org.uk|title=Borderline Support UK}}
{{Medical condition classification and resources | ICD10 = {{ICD10|F|60|3|f|60}} | ICD9 = {{ICD9|301.83}} | MeshID = D001883 | ICDO = | OMIM = | OMIM_mult = | MedlinePlus = 000935 | eMedicineSubj = article | eMedicineTopic = 913575 | eMedicine_mult = | SNOMED CT = 20010003 |ICD11={{ICD11|6D11.5}}}} {{Borderline personality disorder}} {{ICD-10 personality disorders}} {{Authority control}}
{{DEFAULTSORT:Borderline personality disorder}} Category:Borderline personality disorder Category:Cluster B personality disorders Category:Wikipedia medicine articles ready to translate Category:Wikipedia neurology articles ready to translate Category:Women and psychology