Borderline personality disorder

Personality disorder characterized by unstable emotions, relationships, and self-image

Medical condition

Borderline personality disorder

Other names|

*     * Emotionally unstable personality disorder – impulsive or borderline type[1]
* Emotional intensity disorder[2]
* Hysteria[3]
* Hysteric personality – Hysteroid[4]
* Negative affectivity/neuroticism[5]

The Brooch by Edvard Munch (1903), who is suggested to have had borderline personality disorder[6][7]
Specialty| Psychiatry, clinical psychology
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[8][9]
Complications| Suicide, self-harm[8]
Usual onset| Early adulthood[9]
Duration| Long term[8]
Causes| Genetic, neurobiologic, and psychosocial theories proposed
Diagnostic method| Based on reported symptoms[8]
Differential diagnosis| See § Differential diagnosis
Treatment| Behaviour therapy[8]
Prognosis| Improves over time,[9] remission occurs in 45% of patients over a wide range of follow-up periods[10][11][12][13][14]
Frequency| 5.9% (lifetime prevalence)[8]
Personality disorders

Cluster A (odd)

* Paranoid
* Schizoid
* Schizotypal

Cluster B (dramatic)

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)

* Avoidant
* Dependent
* Obsessive–compulsive

ICD-11 classification

* Mild
* Moderate
* Severe
* Severity unspecified

* Negative affectivity
* Detachment
* Dissociality
* Disinhibition
* Anankastia
* Borderline pattern

Other and unspecified

* Other specified
* Unspecified
* Trait specified

Depressive

* Depressive
* Cyclothymic

Others

* Passive–aggressive
* Masochistic
* Sadistic
* Psychopathy
* Haltlose
* Immature
* Post-traumatic organic

* v
* t
* e

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, an acute fear of abandonment, and intense emotional outbursts.[9][15][16] People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline.[17][18][19] Symptoms such as dissociation (a feeling of detachment from reality), a pervasive sense of emptiness, and distorted sense of self are prevalent among those affected.[15]

The onset of BPD symptoms can be triggered by events that others might perceive as normal,[15] with the disorder typically manifesting in early adulthood and persisting across diverse contexts.[9] BPD is often comorbid with substance use disorders,[20][21] depressive disorders, and eating disorders.[15] BPD is associated with a substantial risk of suicide;[9][15] studies estimated that up to 10 percent of people with BPD die by suicide.[22][23] Despite its severity, BPD faces significant stigmatization in both media portrayals and the psychiatric field, potentially leading to underdiagnosis and insufficient treatment.[24][25]

The causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development.[8][26] The current hypothesis suggests BPD to be caused by an interaction between genetic factors and adverse childhood experiences.[27][28] BPD is significantly more common in people with a family history of BPD, particularly immediate relatives, suggesting a possible genetic predisposition.[29] The American Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies BPD in cluster B ("dramatic, emotional, or erratic" PDs) among personality disorders.[9] There is a risk of misdiagnosis, with BPD most commonly confused with a mood disorder, substance use disorder, or other mental health disorders.[9]

Therapeutic interventions for BPD predominantly involve psychotherapy, with dialectical behavior therapy (DBT) and schema therapy the most effective modalities.[8][25] Although pharmacotherapy cannot cure BPD, it may be employed to mitigate associated symptoms,[8] with atypical antipsychotics (e.g., Quetiapine) and selective serotonin reuptake inhibitor (SSRI) antidepressants commonly being prescribed, though their efficacy is unclear. A 2020 meta-analysis found the use of medications was still unsupported by evidence.[30]

BPD has a point prevalence of 1.6% and a lifetime prevalence of 5.9% of the global population,[9][8][31][32] with a higher incidence rate among women compared to men in the clinical setting of up to three times.[9][31] Despite the high utilization of healthcare resources by people with BPD,[33] up to half may show significant improvement over ten years with appropriate treatment.[9] The name of the disorder, particularly the suitability of the term borderline, is a subject of ongoing debate. Initially, the term reflected historical ideas of borderline insanity and later described patients on the border between neurosis and psychosis. These interpretations are now regarded as outdated and clinically imprecise.[8][34]

## Signs and symptoms

[edit]

One of the symptoms of BPD is an intense fear of emotional abandonment.

The distinguishing characteristics of BPD include a pervasive pattern of instability in one's interpersonal relationships and in one's self-image, with frequent oscillation between extremes of idealization and devaluation of others, alongside fluctuating moods and difficulty regulating intense emotional reactions. Dangerous or impulsive behaviors are commonly associated with BPD.

Additional symptoms may encompass uncertainty about one's 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).[35]

### Mood and affect

[edit]

Further information: Emotional dysregulation

Individuals with BPD exhibit emotional dysregulation. Emotional dysregulation is characterized by an inability to flexibly respond to and manage emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.[36][37][38][39]

A core characteristic of BPD is affective instability, which manifests as rapid and frequent shifts in mood of high affect intensity and rapid onset of emotions, triggered by environmental stimuli. The return to a stable emotional state is notably delayed, exacerbating the challenge of achieving emotional equilibrium. This instability is further intensified by an acute sensitivity to psychosocial cues, leading to significant challenges in managing emotions effectively.[40][41][42]

As the first component of emotional dysregulation, individuals with BPD are shown to have increased emotional sensitivity, especially towards negative mood states such as fear, anger, sadness, rejection, criticism, isolation, and perceived failure.[39][43] This increased sensitivity results in an intensified response to environmental cues, including the emotions of others.[39] Studies have identified a negativity bias in those with BPD, showing a predisposition towards recognizing and reacting more strongly to negative emotions in others, along with an attentional bias towards processing negatively-valenced stimuli.[39] Without effective coping mechanisms, individuals might resort to self-harm or suicidal behaviors to manage or escape from these intense negative emotions.[44][39] While conscious of the exaggerated nature of their emotional responses, individuals with BPD face challenges in regulating these emotions. To mitigate further distress, there may be an unconscious suppression of emotional awareness, which paradoxically hinders the recognition of situations requiring intervention.[41]

A second component of emotional dysregulation in BPD is high levels of negative affectivity, stemming directly from the individual's emotional sensitivity to negative emotions.[25] This negative affectivity causes emotional reactions that diverge from socially accepted norms, in ways that are disproportionate to the environmental stimuli presented.[39] Those with BPD find it difficult to tolerate the distress that is encountered in daily life, and they are prone to engage in maladaptive strategies to try to reduce the distress experienced. Maladaptive coping strategies include rumination, thought suppression, experiential avoidance, emotional isolation, as well as impulsive and self-injurious behaviours.[39]

American psychologist Marsha Linehan highlights that while the sensitivity, intensity, and duration of emotional experiences in individuals with BPD can have positive outcomes, such as exceptional enthusiasm, idealism, and capacity for joy and love, they also predispose them to be overwhelmed by negative emotions.[41][45] This includes experiencing profound grief instead of mere sadness, intense shame instead of mild embarrassment, rage rather than annoyance, and panic over nervousness.[45] Research indicates that individuals with BPD endure chronic and substantial emotional suffering.[35]

Emotional dysregulation is a significant feature of BPD, yet Fitzpatrick et al. (2022) suggest that such dysregulation may also be observed in other disorders, like generalized anxiety disorder (GAD). Nonetheless, their findings imply that individuals with BPD particularly struggle with disengaging from negative emotions and achieving emotional equilibrium.[46]

Euphoria, or transient intense joy, can occur in those with BPD, but they are more commonly afflicted by dysphoria (a profound state of unease or dissatisfaction), depression, and pervasive distress. Zanarini et al. identified four types of dysphoria characteristic of BPD: intense emotional states, destructiveness or self-destructiveness, feelings of fragmentation or identity loss, and perceptions of victimization.[47] A diagnosis of BPD is closely linked with experiencing feelings of betrayal, lack of control, and self-harm.[47]

Moreover, emotional lability, indicating variability or fluctuations in emotional states, is frequent among those with BPD. Although emotional lability may imply rapid alternations between depression and elation, mood swings in BPD are more commonly between anger and anxiety or depression and anxiety.[48]

### Interpersonal relationships

[edit]

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[49] towards perceived criticism or harm.[50] 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.[51] This pattern, referred to as "splitting", can significantly influence the dynamics of interpersonal relationships.[52][53] 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.[54]

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.[55] 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,[56] contributing to a sense of alienation within the family unit.[54] 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.[57]

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.[58] 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.[59] 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.[59] 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.[60]

Individuals with BPD express higher levels of jealousy towards their partners in romantic relations.[61][62]

### Behavior

[edit]

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.[63] 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.[63] However, such actions typically result in feelings of shame and guilt, contributing to a recurrent cycle.[63] 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.[63] 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.[63] 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.[64]

### Self-harm and suicide

[edit]

Self-harm and suicidal behaviors are core diagnostic criteria for BPD as outlined in the DSM-5.[9] Between 50% and 80% of individuals diagnosed with BPD engage in self-harm, with cutting being the most common method.[65] Other methods, such as bruising, burning, head banging, or biting, are also prevalent.[65] It is hypothesized that individuals with BPD might experience a sense of emotional relief following acts of self-harm.[66]

Estimates of the lifetime risk of death by suicide among individuals with BPD range between 3% and 10%, varying with the method of investigation.[67][54][68] There is evidence that a significant proportion of males who die by suicide may have undiagnosed BPD.[69]

The motivations behind self-harm and suicide attempts among individuals with BPD are reported to differ.[44] 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.[44][non-primary source needed] Conversely, true suicide attempts by individuals with BPD frequently are motivated by the notion that others will be better off in their absence.[44][non-primary source needed]

### Sense of self and self-concept

[edit]

Individuals diagnosed with BPD frequently experience significant difficulties in maintaining a stable self-concept.[70] This instability manifests as uncertainty in personal values, beliefs, preferences, and interests.[71] 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.[71] 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.[72]

### Dissociation and cognitive challenges

[edit]

The heightened emotional states experienced by individuals with BPD can impede their ability to concentrate and cognitively function.[71] Additionally, individuals with BPD may frequently dissociate, which can be regarded as a mild to severe disconnection from physical and emotional experiences.[73] 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.[73]

### Psychotic symptoms

[edit]

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.[74] 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.[74][75] 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.[74][76]

The DSM-5 identifies transient paranoia, exacerbated by stress, as a symptom of BPD.[9] 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.[75] Further, phenomenological analysis indicates that auditory verbal hallucinations in BPD patients are indistinguishable from those observed in schizophrenia.[75][76] This has led to suggestions of a potential shared etiological basis for hallucinations across BPD and other disorders, including psychotic and affective disorders.[75]

## Causes

[edit]

The etiology, or causes, of BPD is multifaceted, with no consensus on a singular cause.[77] BPD may share a connection with post-traumatic stress disorder (PTSD), with both having a traumatic substrate.[78] 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.[77][79]

### Genetics and heritability

[edit]

Compared to other major psychiatric conditions, the exploration of genetic underpinnings in BPD remains novel.[80] Estimates suggest the heritability of BPD ranges from 37% to 69%,[81] 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.[82]

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.[83] A twin study found that BPD ranks as the third most heritable among ten surveyed personality disorders.[83]

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.[84]

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.[85] This research identified a linkage to genetic markers on chromosome 9 as relevant to BPD characteristics,[85] underscoring a significant genetic contribution to the variability observed in BPD features.[85] 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.[85]

Among specific genetic variants under scrutiny as of 2012[update], the DRD4 7-repeat polymorphism (of the dopamine receptor D4) 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.[86] Additionally, potential links to chromosome 5 are being explored, further emphasizing the complex genetic landscape influencing BPD development and manifestation.[87][88]

### Psychosocial factors

[edit]

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.[89][90][91] 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.[92] These individuals are significantly more prone to recount experiences of verbal, emotional, physical, or sexual abuse by caregivers,[93] alongside a notable frequency of incest and loss of caregivers in early childhood.[94]

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.[94] 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.[94] 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.[95]

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.[96] 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.[97]

### Brain and neurobiologic factors

[edit]

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.[86]

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.[86]

#### Neurological patterns

[edit]

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.[98]

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.[98] This emotional volatility is consistently linked to disparities in several brain regions, emphasizing the neurobiological underpinnings of BPD.[99]

### Mediating and moderating factors

[edit]

#### Executive function and social rejection sensitivity

[edit]

High sensitivity to social rejection is linked to more severe symptoms of BPD, with executive function playing a mediating role.[100] 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.[100] Conversely, higher executive function may mitigate the impact of rejection sensitivity, potentially offering protection against BPD symptoms.[100]

## Diagnosis

[edit]

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.[101]

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.[54]

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.[102] The diagnosis relies on both the individual's self-reported symptoms and the clinician's observations.[102] 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.[102] The International Classification of Diseases (ICD-10) categorizes the condition as emotionally unstable personality disorder, with diagnostic criteria similar to those in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where the disorder's name remains unchanged from previous editions.[9]

### DSM-5

[edit]

Further information: Personality disorder § DSM-5, and Alternative DSM-5 model for personality disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has eliminated the multiaxial diagnostic system, integrating all disorders, including personality disorders, into Section II of the manual. For a diagnosis of BPD, an individual must meet five out of nine specified diagnostic criteria.[103][104] The DSM-5 characterizes BPD as a pervasive pattern of instability in interpersonal relationships, self-image, affect, and a significant propensity towards impulsive behavior.[103][104] Moreover, the DSM-5 introduces alternative diagnostic criteria for BPD in its Alternative DSM-5 Model for Personality Disorders (AMPD), located in Section III.[105] These criteria are rooted in trait research and necessitate the identification of at least four out of seven maladaptive traits.[106] 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.[107] To mitigate these challenges, Linehan categorizes BPD symptoms into five principal areas of dysregulation: emotions, behavior, interpersonal relationships, sense of self, and cognition.[107]

### International Classification of Diseases (ICD)

[edit]

Further information: ICD-11 classification of personality disorders and Personality disorder § ICD-10

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 (6D10) with severity specifiers, along with specifiers for prominent personality traits or patterns (6D11).[108] Among these is the borderline pattern (6D11.5), which is similar to the diagnosis of BPD.[109] 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".[110] Borderline personality disorder has been found to be primarily associated with the ICD-11 trait domains of Negative Affectivity (6D11.0) and Disinhibition (6D11.3), reflecting core features such as emotional instability and impulsivity.[111] Previously, the ICD-10 had identified a condition akin to BPD, termed Emotionally unstable personality disorder (EUPD) (F60.3).[112]

The ICD-11 borderline pattern diagnosis has been criticized for being "indissociable" from negative affectivity upon undergoing regression and factor analyses.[113] 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.[113] 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”".[111] 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".[111]

### Millon's subtypes

[edit]

Psychologist Theodore Millon proposed four subtypes of BPD, where individuals with BPD would exhibit none, one, or multiple subtypes.[114]

Subtype  | Features  | Personality 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 or 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 or masochistic features  | Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide

### Misdiagnosis

[edit]

Main article: 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.[115][116][failed verification] 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.[117] Consequently, misdiagnosis may deprive individuals of access to suitable psychiatric medications or evidence-based psychological interventions tailored to their specific disorders.[118]

### Adolescence and prodrome

[edit]

The onset of BPD symptoms typically occurs during adolescence or early adulthood, with possible early signs in childhood.[119] Predictive symptoms in adolescents include body image issues, extreme sensitivity to rejection, behavioral challenges, non-suicidal self-injury, seeking exclusive relationships, and profound shame.[54] 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.[54]

BPD is recognized as a stable and valid diagnosis during adolescence, supported by the DSM-5 and ICD-11.[120][121][122][123] 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.[122][124][125]

Historically, diagnosing BPD during adolescence was met with caution,[122][126][127] due to concerns about the accuracy of diagnosing young individuals,[128][129] the potential misinterpretation of normal adolescent behaviors, stigma, and the stability of personality during this developmental stage.[122] Despite these challenges, research has confirmed the validity and clinical utility of the BPD diagnosis in adolescents,[120][121][122][123] though misconceptions persist among mental health care professionals,[130][131][132] contributing to clinical reluctance in diagnosing and a key barrier to the provision of effective treatment BPD in this population.[130][133][134]

A diagnosis of BPD in adolescence can indicate the persistence of the disorder into adulthood,[135][136] with outcomes varying among individuals. Some maintain a stable diagnosis over time, while others may not consistently meet the diagnostic criteria.[137] Early diagnosis facilitates the development of effective treatment plans,[135][136] including family therapy, to support adolescents with BPD.[138]

### Differential diagnosis and comorbidity

[edit]

Lifetime co-occurring (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),[139] somatic symptom disorder, and the dissociative disorders.[140] 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.[141]

#### Comorbid Axis I disorders

[edit]

Gender variations in lifetime prevalence of comorbid Axis I disorders among individuals diagnosed with BPD: A comparative study between 2008[142] and 1998[143] Axis I diagnosis | Overall (%) | Male (%) | Female (%)

|
|
|

Mood disorders | 75.0 | 68.7 | 80.2
Major depressive disorder | 32.1 | 27.2 | 36.1
Dysthymia | 09.7 | 07.1 | 11.9
Bipolar I disorder | 31.8 | 30.6 | 32.7
Bipolar II disorder | 07.7 | 06.7 | 08.5
Anxiety disorders | 74.2 | 66.1 | 81.1
Panic disorder with agoraphobia | 11.5 | 07.7 | 14.6
Panic disorder without agoraphobia | 18.8 | 16.2 | 20.9
Social phobia | 29.3 | 25.2 | 32.7
Specific phobia | 37.5 | 26.6 | 46.6
PTSD | 39.2 | 29.5 | 47.2
Generalized anxiety disorder | 35.1 | 27.3 | 41.6
Obsessive–compulsive disorder** | 15.6 | – | –
Substance use disorders | 72.9 | 80.9 | 66.2
Any alcohol use disorder | 57.3 | 71.2 | 45.6
Any non-alcohol substance use disorder | 36.2 | 44.0 | 29.8
Eating disorders** | 53.0 | 20.5 | 62.2
Anorexia nervosa** | 20.8 | 07 * | 25 *
Bulimia nervosa** | 25.6 | 10 * | 30 *
Eating disorder not otherwise specified** | 26.1 | 10.8 | 30.4
Somatoform disorders** | 10.3 | 10 * | 10 *
Somatization disorder** | 04.2 | – | –
Hypochondriasis** | 04.7 | – | –
Somatoform pain disorder** | 04.2 | – | –
Psychotic disorders** | 01.3 | 01 * | 01 *
* Approximate values
** Values from 1998 study[140]
– Value not provided by from both studies

A 2008 study stated that 75% of individuals with BPD at some point meet criteria for mood disorders, notably major depression and bipolar I, with a similar percentage for anxiety disorders.[142][non-primary source needed] They found that 73% of individuals with BPD meet criteria for substance use disorders, and about 40% for PTSD.[142] A higher proportion of males meet criteria for substance use disorders, whereas females are more likely to have PTSD and eating disorders.[142] 38% of individuals with BPD were found to meet criteria for ADHD,[139] and 15% for autism spectrum disorder (ASD) in separate studies.[144][non-primary source needed]

#### Mood disorders

[edit]

Seventy-five percent (75%) of individuals with BPD concurrently experience mood disorders, notably major depressive disorder (MDD) or bipolar disorder (BD),[53] complicating diagnostic clarity due to overlapping symptoms.[145][146][147] 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 behaviours are likely to subside as mood normalises in BD to euthymia, but typically are pervasive in BPD.[148]

Differences between BPD and BD mood swings include their duration, with BD episodes typically lasting for at least two weeks at a time,[a] in contrast to the rapid and transient mood shifts seen in BPD.[148][151][150] 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.[151] Furthermore, the euphoria in BPD lacks the racing thoughts and reduced need for sleep characteristic of BD,[151] though sleep disturbances have been noted in BPD.[152]

Historically, BPD was considered a milder form of BD,[153][154] 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.[155] Research indicates only a modest association between BPD and BD, challenging the notion of a close spectrum relationship.[156][157]

#### Premenstrual dysphoric disorder

[edit]

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.[158][159] While PMDD, affecting 3–8% of women,[160] 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

[edit]

Approximately 74% of individuals with BPD also fulfill criteria for another personality disorder during their lifetime, according to research conducted in 2008.[142] 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.[142] 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.[142]

## Management

[edit]

Main article: Management of borderline personality disorder

The main approach to managing BPD is through psychotherapy, tailored to the individual's specific needs rather than applying a one-size-fits-all model based on the diagnosis alone.[28] While medications do not directly treat BPD, they are beneficial in managing comorbid conditions like depression and anxiety.[161] 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.[162]

### Psychotherapy

[edit]

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.[163] 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.[164]

Available treatments for BPD include dynamic deconstructive psychotherapy (DDP),[165] mentalization-based treatment (MBT), schema therapy, transference-focused psychotherapy, dialectical behavior therapy (DBT), and general psychiatric management.[54][166] The effectiveness of these therapies does not significantly vary between more intensive and less intensive approaches.[167]

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.[168] 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.[168][169][166]

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.[8]

Mentalization-based therapy and transference-focused psychotherapy draw from psychodynamic principles, while DBT is rooted in cognitive-behavioral principles and mindfulness.[163] General psychiatric management integrates key aspects from these treatments and is seen as more accessible and less resource-intensive.[54] 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.[170][171][163]

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.[172]

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.[173][174][175][176]

### Medications

[edit]

A 2010 Cochrane review found that no medications were effective for the core symptoms of BPD, such as chronic feelings of emptiness, identity disturbances, and fears of abandonment. Some medications might impact isolated symptoms of BPD or those of comorbid conditions.[177] A 2017 systematic review[178] and a 2020 Cochrane review[179] confirmed these findings.[178][179] This 2020 Cochrane review found that while some medications, like mood stabilizers and second-generation antipsychotics, showed some benefits, SSRIs and SNRIs lacked high-level evidence of effectiveness.[179] The review concluded that stabilizers and second-generation antipsychotics may effectively treat some symptoms and associated psychopathology of BPD, but these drugs are not effective for the overall severity of BPD; as such, pharmacotherapy should target specific symptoms.[179]

Specific medications have shown varied effectiveness on BPD symptoms: haloperidol and flupenthixol for anger and suicidal behavior reduction; aripiprazole for decreased impulsivity and interpersonal problems;[177] and olanzapine and quetiapine for reducing affective instability, anger, and anxiety, though olanzapine showed less benefit for suicidal ideation than a placebo.[177][178] Mood stabilizers like valproate and topiramate showed some improvements in depression, impulsivity, and anger, but the effect of carbamazepine was not significant. Of the antidepressants, amitriptyline may reduce depression, but mianserin, fluoxetine, fluvoxamine, and phenelzine sulfate showed no effect. Omega-3 fatty acid may ameliorate suicidality and improve depression. As of 2017[update], trials with these medications had not been replicated, and the effect of long-term use had not been assessed.[177][178] Lamotrigine[30] and other medications like IV ketamine[180][181] for unresponsive depression require further research for their effects on BPD.

Quetiapine showed some benefits for BPD severity, psychosocial impairment, aggression, and manic symptoms at doses of 150 mg/day to 300 mg/day,[30] but the evidence is mixed.[179]

Despite the lack of solid evidence, SSRIs and SNRIs are prescribed off-label for BPD[30][182] and are typically considered adjunctive to psychotherapy.[182]

Given the weak evidence and potential for serious side effects, the UK National Institute for Health and Clinical Excellence (NICE) recommends against using drugs specifically for BPD or its associated behaviors and symptoms. Medications may be considered for treating comorbid conditions within a broader treatment plan.[183] Reviews suggest minimizing the use of medications for BPD to very low doses and short durations, emphasizing the need for careful evaluation and management of drug treatment in BPD.[184][185]

### Health care services

[edit]

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.[186] 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.[187]

In the context of psychiatric hospitalizations, individuals with BPD constitute approximately 20% of admissions.[188] 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.[189]

Service experiences vary among individuals with BPD.[190] 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.[191] About half of all individuals who commit suicide are diagnosed with a personality disorder, with BPD being the most common association.[192]

## Prognosis

[edit]

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.[193][194] Remission rates are about 50 to 70% over five years.[195] 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.[196]

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.[197]

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.[198]

## Epidemiology

[edit]

BPD has a point prevalence of 1.6%[194] and a lifetime prevalence of 5.9% of the global population.[142][9][8][31][32] Within clinical settings, the occurrence of BPD is 6.4% among urban primary care patients,[199] 9.3% among psychiatric outpatients,[200] and approximately 20% among psychiatric inpatients.[201] Utilization of healthcare resources by individuals with BPD is high.[33] 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.[9]

Regarding gender distribution, women are diagnosed with BPD three times more frequently than men in clinical environments.[9][31] Nonetheless, epidemiological research in the United States indicates no significant gender difference in the lifetime prevalence of BPD within the general population.[202][142] The relationship between BPD and ethnicity continues to be ambiguous, with divergent findings reported in the United States.[31] The overall prevalence of BPD in the U.S. prison population is thought to be 17%.[203]

## History

[edit]

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".[204] In modern times, Munch has been suggested to have had BPD.[205][206]

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 folie maniaco-mélancolique,[207] 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".[208] In 1921, Emil Kraepelin identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.[209]

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.[210] The first formal definition of borderline disorder is widely acknowledged to have been written by Adolph Stern in 1938.[211][212] 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).[135] 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[209] between neurosis and psychosis.[213]

After standardized criteria were developed by John Gunderson[214] 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.[194] The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder".[213] 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.[9] However, the term "borderline" has been described as uniquely inadequate for describing the symptoms characteristic of this disorder.[215]

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.[216] 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.[217] 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.[218] Masterson hypothesized that the disorder resulted from core developmental problems with separation-individuation.[219] More recently, Mark L. Ruffalo has advanced the hypothesis that BPD is fundamentally a disorder of paradox or self-contradiction.[220]

### Etymology

[edit]

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.[221] 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.[222][223] Borderline personality disorder was included in DSM-III (1980) despite not being universally recognized as a valid diagnosis.[224]

## Controversies

[edit]

### Credibility and validity of testimony

[edit]

The credibility of individuals with personality disorders has been questioned at least since the 1960s.[225]: 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.[226]

#### Dissociation

[edit]

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.[227] 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".[227][228]

### Gender

[edit]

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.[229] 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. 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.[69]

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.[230]

There are also sex differences in personality traits and Axis I and II comorbidity.[231] 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[231]). Women with BPD are more likely to have eating, mood, anxiety, and post-traumatic stress disorders.[231]

### Manipulative behavior

[edit]

Manipulative behavior to obtain nurturance is considered by the DSM-IV-TR and many mental health professionals to be a defining characteristic of borderline personality disorder.[232] In one research study, 88% of therapists reported that they have experienced manipulation attempts from patient(s).[233] 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.[234] 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.[234]

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.[235]

### Stigma

[edit]

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.[24]

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.[236] One camp[who?] argues that it would be better to diagnose these people with post-traumatic stress disorder (PTSD), as this would acknowledge the impact of abuse on their behavior.[citation needed] Critics of the PTSD diagnosis argue that it medicalizes abuse rather than addressing the root causes in society.[237] Regardless, a diagnosis of PTSD does not encompass all aspects of the disorder (see brain abnormalities and terminology).

#### Physical violence

[edit]

The stigma surrounding borderline personality disorder includes the belief that people with BPD are prone to violence toward others.[238] 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.[238] Although people with BPD often struggle with experiences of intense anger, a defining characteristic of BPD is that they direct it inward toward themselves.[239]

One 2020 study found that BPD is individually associated with psychological, physical, and sexual forms of intimate partner violence (IPV), especially amongst men.[240][non-primary source needed] In terms of the AMPD trait facets, hostility (negative affectivity), suspiciousness (negative affectivity) and risk-taking (disinhibition) were most strongly associated with IPV perpetration for the total sample.[240]

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.[239] Their extreme aversion to violence can cause many people with BPD to overcompensate and experience difficulties being assertive and expressing their needs.[239] This is one reason why people with BPD often choose to harm themselves over potentially causing harm to others.[239][44][238]

#### Mental health care providers

[edit]

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.[241] A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with and more difficult than other client groups.[242][non-primary source needed] This largely negative view of BPD can result in people with BPD being terminated from treatment early, being provided harmful treatment, not being informed of their diagnosis of BPD, or being misdiagnosed.[243] With healthcare providers contributing to the stigma of a BPD diagnosis, seeking treatment can often result in the perpetuation of BPD features.[243] Efforts are ongoing to improve public and staff attitudes toward people with BPD.[244][245]

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.[246] Indeed, mental health professionals frequently refuse to provide services to those who have received a BPD diagnosis.[247]

### Terminology

[edit]

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,[248] since many who are labelled with borderline personality disorder find the name unhelpful, stigmatizing, or inaccurate.[248][249]

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.[250] 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.[91] 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.[251]

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.[252]

## Society and culture

[edit]

### Literature

[edit]

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).[253][254][255]

### Film

[edit]

Films have also attempted to portray BPD, with characters in Margot at the Wedding (2007), Mr. Nobody (2009), Cracks (2009),[256] Truth (2013), Wounded (2013), Welcome to Me (2014),[257][258] and Tamasha (2015)[259] 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.[260] Films like Play Misty for Me (1971)[261] and Girl, Interrupted (1999, based on the memoir of the same name) suggest emotional instability characteristic of BPD,[262] while Single White Female (1992) highlights aspects such as identity disturbance and fear of abandonment.[261]: 235 Clementine in Eternal Sunshine of the Spotless Mind (2004) is noted to show classic BPD behavior,[263][264] and Carey Mulligan's portrayal in Shame (2011) is praised for its accuracy regarding BPD characteristics by psychiatrists.[265]

### Television

[edit]

Television series like Crazy Ex-Girlfriend (2015) and the miniseries Maniac (2018) depict characters with BPD.[266] 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).[267] In The Sopranos (1999), Livia Soprano is diagnosed with BPD,[268] and even the portrayal of Bruce Wayne/Batman in the show Titans (2018) is said to include aspects of the disorder.[269] The animated series BoJack Horseman (2014) also features a main character with symptoms of BPD.[270]

### Awareness

[edit]

Awareness of BPD has been growing, with the U.S. House of Representatives declaring May as Borderline Personality Disorder Awareness Month in 2008.[271] People with BPD will share their personal experiences of living with the disorder on social media to raise awareness of the condition.[272]

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.[273]

## See also

[edit]

* Psychology portal

* Affective empathy – Capacity to understand or feel what another person is experiencingPages displaying short descriptions of redirect targets
* Obsessive love – Possessiveness and inability to accept disinterest or rejection
* Pseudohallucination – Hallucination recognised as unreal by patient

## Notes

[edit]

1. ^ An exception is rapid-cycling BD, which can be challenging to differentiate from the affective lability found in BPD.[149][150][148]

## Citations

[edit]

1. ^ Cloninger RC (2005). "Antisocial Personality Disorder: A Review". In Maj M, Akiskal HS, Mezzich JE (eds.). Personality disorders. New York City: John Wiley & Sons. p. 126\. ISBN 978-0-470-09036-7. Archived from the original on 4 December 2020. Retrieved 5 June 2020.
2. ^ Blom JD (2010). A Dictionary of Hallucinations (1st ed.). New York: Springer. p. 74\. ISBN 978-1-4419-1223-7. Archived from the original on 4 December 2020. Retrieved 5 June 2020.
3. ^ Bollas C, et al. (American Psychological Association) (2000). Hysteria (1st ed.). Taylor & Francis. Archived from the original on 15 December 2022. Retrieved 14 December 2022.
4. ^ Novais F, Araújo A, Godinho P (25 September 2015). "Historical roots of histrionic personality disorder". Frontiers in Psychology. 6 (1463): 1463. doi:10.3389/fpsyg.2015.01463. PMC 4585318. PMID 26441812.
5. ^ "ICD-11 – ICD-11 for Mortality and Morbidity Statistics". World Health Organization. Archived from the original on 1 August 2018. Retrieved 6 October 2021.
6. ^ Aarkrog T (1990). Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art [Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder]. Denmark: Lundbeck Pharma A/S. ISBN 978-87-983524-1-9.
7. ^ Masterson JF (1988). "Chapter 12: The Creative Solution: Sartre, Munch, and Wolfe". Search for the Real Self. Unmasking The Personality Disorders of Our Age. New York: Simon and Schuster. pp. 208–230, especially 212–213. ISBN 978-1-4516-6891-9.
8. ^ a b c d e f g h i j k l m "Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016.
9. ^ a b c d e f g h i j k l m n o p q r American Psychiatric Association 2013, pp. 645, 663–6
10. ^ Skodol AE, Siever LJ, Livesley W, Gunderson JG, Pfohl B, Widiger TA (2002). "The borderline diagnosis II: biology, genetics, and clinical course". Biological Psychiatry. 51 (12): 951–963\. doi:10.1016/S0006-3223(02)01325-2. PMID 12062878.
11. ^ Skodol AE, Bender DS, Pagano ME, Shea MT, Yen S, Sanislow CA, et al. (15 July 2007). "Positive Childhood Experiences: Resilience and Recovery From Personality Disorder in Early Adulthood". The Journal of Clinical Psychiatry. 68 (7): 1102–1108\. doi:10.4088/JCP.v68n0719. ISSN 0160-6689. PMC 2705622. PMID 17685749.
12. ^ Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (2006). "Prediction of the 10-Year Course of Borderline Personality Disorder". American Journal of Psychiatry. 163 (5): 827–832\. doi:10.1176/ajp.2006.163.5.827. ISSN 0002-953X. PMID 16648323.
13. ^ Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G (2010). "Time to Attainment of Recovery From Borderline Personality Disorder and Stability of Recovery: A 10-year Prospective Follow-Up Study". American Journal of Psychiatry. 167 (6): 663–667\. doi:10.1176/appi.ajp.2009.09081130. ISSN 0002-953X. PMC 3203735. PMID 20395399.
14. ^ Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G (2012). "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". American Journal of Psychiatry. 169 (5): 476–483\. doi:10.1176/appi.ajp.2011.11101550. ISSN 0002-953X. PMC 3509999. PMID 22737693.
15. ^ a b c d e "Borderline Personality Disorder". NIMH. Archived from the original on 22 March 2016. Retrieved 16 March 2016.
16. ^ Chapman AL (August 2019). "Borderline personality disorder and emotion dysregulation". Development and Psychopathology. 31 (3). Cambridge University Press: 1143–1156\. doi:10.1017/S0954579419000658. PMID 31169118. S2CID 174813414. Archived from the original on 4 December 2020. Retrieved 5 April 2020.
17. ^ Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S (23 September 2021). "The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective". Frontiers in Psychiatry. 12 721361\. doi:10.3389/fpsyt.2021.721361. PMC 8495240. PMID 34630181.
18. ^ Cattane N, Rossi R, Lanfredi M, Cattaneo A (June 2017). "Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms". BMC Psychiatry. 17 (1) 221. doi:10.1186/s12888-017-1383-2. PMC 5472954. PMID 28619017.
19. ^ "Borderline Personality Disorder". The National Institute of Mental Health. December 2017. Archived from the original on 29 March 2023. Retrieved 25 February 2021. "Other signs or symptoms may include: [...] Impulsive and often dangerous behaviors [...] Self-harming behavior [...]. Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public."
20. ^ Helle AC, Watts AL, Trull TJ, Sher KJ (2019). "Alcohol Use Disorder and Antisocial and Borderline Personality Disorders". Alcohol Research: Current Reviews. 40 (1) arcr.v40.1.05. doi:10.35946/arcr.v40.1.05. PMC 6927749. PMID 31886107.
21. ^ Trull TJ, Freeman LK, Vebares TJ, Choate AM, Helle AC, Wycoff AM (19 September 2018). "Borderline personality disorder and substance use disorders: an updated review". Borderline Personality Disorder and Emotion Dysregulation. 5 (1): 15. doi:10.1186/s40479-018-0093-9. ISSN 2051-6673. PMC 6145127. PMID 30250740.
22. ^ Kreisman J, Strauss H (2004). Sometimes I Act Crazy. Living With Borderline Personality Disorder. Wiley & Sons. p. 206\. ISBN 978-0-471-22286-6.
23. ^ Kaurin A, Dombrovski A, Hallquist M, Wright A (10 December 2020). "Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder". Psychological Medicine. 52 (13): 2702–2712\. doi:10.1017/S0033291720004791. PMC 8190164. PMID 33298227. "People diagnosed with borderline personality disorder (BPD) are at high risk of dying by suicide: almost all report chronic suicidal ideation, 84% of patients with BPD engage in suicidal behavior, 70% attempt suicide, with a mean of 3.4 lifetime attempts per individual, and 5–10% die by suicide (Black et al., 2004; McGirr et al., 2007; Soloff et al., 1994)."
24. ^ a b Aviram RB, Brodsky BS, Stanley B (2006). "Borderline personality disorder, stigma, and treatment implications" (PDF). Harvard Review of Psychiatry. 14 (5): 249–256\. doi:10.1080/10673220600975121. PMID 16990170. S2CID 23923078. Retrieved 24 December 2024. "The stigmatization of BPD is likely to be a result of several characteristics of the BPD syndrome. [... Pejorative] terms such as "difficult," "treatment resistant," "manipulative," "demanding," and "attention seeking" [are used to describe such individuals. This] can have an impact upon the treater's a priori expectations. [... Such] stigmatization is likely to be a result of several [behaviour characteristics of individuals with BPD, and the fact that] psychotherapy with [them] may involve disturbing and frightening behavior, including intense anger, chronic suicidal ideation, self-injury, and suicide attempts. [... Clinicians, under the stigma, may] see lower levels of [their patient's] functioning as deliberate and within [ones] control, or as manipulation, or as a rejection of help, [and may therefore respond] in unintentially damaging ways, [possibly by withdrawing] physically and emotionally. [...] It has been found that when one person has negative expectations of another, the former changes his or her behavior toward the latter. These interpersonal situations have been described as self-fulfilling prophecies."
25. ^ a b c Dixon-Gordon KL, Peters JR, Fertuck EA, Yen S (2017). "Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice". Journal of Psychotherapy Integration. 27 (4): 425–438\. doi:10.1037/int0000044. PMC 5842953. PMID 29527105. "[Clinicians] may hesitate to [provide treatment for BPD patients] due to discomfort working with the high-risk behaviours and intense interpersonal and emotional dysregulation typical of [the disorder. Treatments supported by empirical 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]."
26. ^ Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne: National Health and Medical Research Council. 2013. pp. 40–41\. ISBN 978-1-86496-564-3. "In addition to the evidence identified by the systematic review, the Committee also considered a recent narrative review of studies that have evaluated biological and environmental factors as potential risk factors for BPD (including prospective studies of children and adolescents, and studies of young people with BPD)"
27. ^ Chapman J, Jamil RT, Fleisher C, Torrico TJ (2025), "Borderline Personality Disorder", StatPearls, Treasure Island, Fla.: StatPearls Publishing, PMID 28613633, retrieved 10 June 2025, "The current hypothesis is that BPD is caused by an interaction between genetic factors and adverse childhood experiences affecting brain development via neuropeptides and hormones. The relative importance of these factors is unclear."
28. ^ a b Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (January 2011). "Borderline personality disorder". Lancet. 377 (9759): 74–84\. doi:10.1016/s0140-6736(10)61422-5. PMID 21195251. S2CID 17051114. "The causes are not yet clear. Genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary, and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in [BPD] patients [... As of 2011,] there is no evidence to suggest that one specific form of psychotherapy is more effective than another."
29. ^ Amad A, Ramoz N, Thomas P, Jardri R, Gorwood P (1 March 2014). "Genetics of borderline personality disorder: Systematic review and proposal of an integrative model". Neuroscience & Biobehavioral Reviews. 40: 6–19\. doi:10.1016/j.neubiorev.2014.01.003. ISSN 0149-7634. PMID 24456942. "[We] performed a systematic review of the literature concerning the genetics of BPD, including familial and twin studies, association studies, and gene–environment interaction studies. [...] Familial and twin studies largely support the potential role of a genetic vulnerability at the root of BPD, with an estimated heritability of approximately 40%. [There] is evidence for both gene–environment interactions and correlations. However, association studies for BPD are sparse, making it difficult to draw clear conclusions."
30. ^ a b c d Stoffers-Winterling J, Storebø OJ, Lieb K (2020). "Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies" (PDF). Current Psychiatry Reports. 22 (37) 37. doi:10.1007/s11920-020-01164-1. PMC 7275094. PMID 32504127. Archived (PDF) from the original on 4 May 2022. Retrieved 30 May 2021. "[To evaluate continued drug treatments in people with a diagnosis of BPD,] we identified seven new RCTs [randomized controlled trials] and newly available data for an older RCT [...] The new findings do not support fluoxetine as a treatment option for suicide and self-harm prevention. A large effectiveness study did not detect beneficial effects of lamotrigine in routine care. The prevalent use of medications in BPD is still not reflected or supported by the current evidence. More research is needed regarding [...] SSRIs [and] quetiapine, but also with respect to [individuals with BPD and other] distinct comorbid conditions."
31. ^ a b c d e "Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis". UpToDate. Wolters Kluwer. Archived from the original on 6 January 2009. Retrieved 13 March 2024.
32. ^ a b "NIMH " Personality Disorders". nimh.nih.gov. Archived from the original on 18 June 2022. Retrieved 20 May 2021.
33. ^ a b Bourke J, Murphy A, Flynn D, Kells M, Joyce M, Hurley J (September 2021). "Borderline personality disorder: resource utilisation costs in Ireland". Irish Journal of Psychological Medicine. 38 (3): 169–176\. doi:10.1017/ipm.2018.30. hdl:10468/7005. PMID 34465404.
34. ^ Gunderson JG (May 2009). "Borderline personality disorder: ontogeny of a diagnosis". The American Journal of Psychiatry. 166 (5): 530–539\. doi:10.1176/appi.ajp.2009.08121825. PMC 3145201. PMID 19411380.
35. ^ a b DSM-5 Task Force (2013). Diagnostic and Statistical Manual of Mental Disorders : DSM-5. American Psychiatric Association. ISBN 978-0-89042-554-1. OCLC 863153409.
36. ^ Austin MP, Highet N, Expert Working Group (2017). Mental Health Care in the Perinatal Period. Melbourne: Centre of Perinatal Excellence.
37. ^ Linehan 1993, p. 43
38. ^ Manning 2011, p. 36
39. ^ a b c d e f g Carpenter RW, Trull TJ (January 2013). "Components of Emotion Dysregulation in Borderline Personality Disorder: A Review". Current Psychiatry Reports. 15 (1): 335. doi:10.1007/s11920-012-0335-2. ISSN 1523-3812. PMC 3973423. PMID 23250816.
40. ^ Hooley J, Butcher JM, Nock MK (2017). Abnormal Psychology (17th ed.). London, England: Pearson Education. p. 359\. ISBN 978-0-13-385205-9.
41. ^ a b c Linehan 1993, p. 45
42. ^ Dick AM, Suvak MK (July 2018). "Borderline personality disorder affective instability: What you know impacts how you feel". Personality Disorders: Theory, Research, and Treatment. 9 (4): 369–378\. doi:10.1037/per0000280. ISSN 1949-2723. PMC 6033624. PMID 29461071.
43. ^ Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M (May 2005). "Aversive tension in patients with borderline personality disorder: a computer-based controlled field study". Acta Psychiatrica Scandinavica. 111 (5): 372–9\. doi:10.1111/j.1600-0447.2004.00466.x. PMID 15819731. S2CID 30951552.
44. ^ a b c d e Brown MZ, Comtois KA, Linehan MM (February 2002). "Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder". Journal of Abnormal Psychology. 111 (1): 198–202\. doi:10.1037/0021-843X.111.1.198. PMID 11866174. S2CID 4649933.
45. ^ a b Linehan 1993, p. 44
46. ^ Fitzpatrick S, Varma S, Kuo JR (September 2022). "Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm". Psychological Medicine. 52 (12): 2319–2331\. doi:10.1017/S0033291720004225. PMID 33198829. S2CID 226988308.
47. ^ a b Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG (1998). "The pain of being borderline: dysphoric states specific to borderline personality disorder". Harvard Review of Psychiatry. 6 (4): 201–7\. doi:10.3109/10673229809000330. PMID 10370445. S2CID 10093822.
48. ^ Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, et al. (May 2002). "Characterizing affective instability in borderline personality disorder". The American Journal of Psychiatry. 159 (5): 784–8\. doi:10.1176/appi.ajp.159.5.784. PMID 11986132.
49. ^ Hepp J, Lane SP, Carpenter RW, Niedtfeld I, Brown WC, Trull TJ (2017). "Interpersonal Problems and Negative Affect in Borderline Personality and Depressive Disorders in Daily Life". Clinical Psychological Science. 5 (3). Sage Publishing: 470–484\. doi:10.1177/2167702616677312. PMC 5436804. PMID 28529826. "[We] assessed the relations between momentary negative affect (hostility, sadness, fear) and interpersonal problems (rejection, disagreement) in a sample of 80 BPD and 51 depressed outpatients at 6 time-points over 28 days [...] Results revealed a mutually reinforcing relationship between disagreement and hostility, rejection and hostility, and between rejection and sadness in both groups, at the momentary and day level. The mutual reinforcement between hostility and rejection/disagreement was significantly stronger in the BPD group."
50. ^ Arntz A (September 2005). "Introduction to special issue: cognition and emotion in borderline personality disorder". Journal of Behavior Therapy and Experimental Psychiatry. 36 (3): 167–72\. doi:10.1016/j.jbtep.2005.06.001. PMID 16018875.
51. ^ Linehan 1993, p. 146
52. ^ "What Is BPD: Symptoms". National Education Alliance for Borderline Personality Disorder. Archived from the original on 10 February 2013. Retrieved 31 January 2013.
53. ^ a b Robinson DJ (2005). Disordered Personalities. Rapid Psychler Press. pp. 255–310\. ISBN 978-1-894328-09-8.
54. ^ a b c d e f g h Gunderson JG (May 2011). "Clinical practice. Borderline personality disorder". The New England Journal of Medicine. 364 (21): 2037–2042\. doi:10.1056/NEJMcp1007358. hdl:10150/631040. PMID 21612472.
55. ^ Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF (2005). "Attachment and borderline personality disorder: implications for psychotherapy". Psychopathology. 38 (2): 64–74\. doi:10.1159/000084813. PMID 15802944. S2CID 10203453.
56. ^ Allen DM, Farmer RG (1996). "Family relationships of adults with borderline personality disorder". Comprehensive Psychiatry. 37 (1): 43–51\. doi:10.1016/S0010-440X(96)90050-4. PMID 8770526.
57. ^ Lester RJ (February 2013). "Lessons from the borderline: Anthropology, psychiatry, and the risks of being human". Feminism & Psychology. 23 (1): 70–77\. doi:10.1177/0959353512467969. ISSN 0959-3535.
58. ^ Daley SE, Burge D, Hammen C (August 2000). "Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity". Journal of Abnormal Psychology. 109 (3): 451–460\. CiteSeerX 10.1.1.588.6902. doi:10.1037/0021-843X.109.3.451. PMID 11016115.
59. ^ a b Ryan K, Shean G (1 January 2007). "Patterns of interpersonal behaviors and borderline personality characteristics". Personality and Individual Differences. 42 (2): 193–200\. doi:10.1016/j.paid.2006.06.010. ISSN 0191-8869.
60. ^ Arvig TJ (April 2011). "Borderline personality disorder and disability". AAOHN Journal. 59 (4): 158–60\. doi:10.1177/216507991105900401. PMID 21462898.
61. ^ Cameranesi M (2016). "Battering typologies, attachment insecurity, and personality disorders: A comprehensive literature review". Aggression and Violent Behavior. 28: 29–46\. doi:10.1016/j.avb.2016.03.005.
62. ^ Stone MH (February 2006). "Management of borderline personality disorder: a review of psychotherapeutic approaches". World Psychiatry. 5 (1): 15–20\. PMC 1472266. PMID 16757985.
63. ^ a b c d e Manning 2011, p. 18
64. ^ Giesen-Bloo, J., van Dyck, R., Spinhoven, P., et al. (2006). Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. doi:10.1001/archpsyc.63.6.649.
65. ^ a b Oumaya M, Friedman S, Pham A, Abou Abdallah T, Guelfi JD, Rouillon F (October 2008). "[Borderline personality disorder, self-mutilation and suicide: literature review]". L'Encéphale (in French). 34 (5): 452–8\. doi:10.1016/j.encep.2007.10.007. PMID 19068333.
66. ^ Ducasse D, Courtet P, Olié E (May 2014). "Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review". Current Psychiatry Reports. 16 (5) 443. doi:10.1007/s11920-014-0443-2. PMID 24633938. S2CID 25918270.
67. ^ Paris J (2019). "Suicidality in Borderline Personality Disorder". Medicina (Kaunas). 55 (6): 223. doi:10.3390/medicina55060223. PMC 6632023. PMID 31142033.
68. ^ Gunderson JG, Links PS (2008). Borderline Personality Disorder: A Clinical Guide (2nd ed.). American Psychiatric Publishing, Inc. p. 9\. ISBN 978-1-58562-335-8.
69. ^ a b Paris J (2008). Treatment of Borderline Personality Disorder. A Guide to Evidence-Based Practice. The Guilford Press. pp. 21–22.
70. ^ Vater A, Schröder M, Weißgerber S, Roepke S, Schütz A (March 2015). "Self-concept structure and borderline personality disorder: Evidence for negative compartmentalization". Journal of Behavior Therapy and Experimental Psychiatry. 46. Elsevier: 50–58\. doi:10.1016/j.jbtep.2014.08.003. PMID 25222626. "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."
71. ^ a b c Manning 2011, p. 23
72. ^ Biskin RS, Paris J (November 2012). "Diagnosing borderline personality disorder". CMAJ. 184 (16): 1789–1794\. doi:10.1503/cmaj.090618. PMC 3494330. PMID 22988153.
73. ^ a b Manning 2011, p. 24
74. ^ a b c Schroeder K, Fisher HL, Schäfer I (January 2013). Pull CB, Janca A (eds.). "Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management".  Current Opinion in Psychiatry. 26 (1): 113–9\. doi:10.1097/YCO.0b013e32835a2ae7. PMID 23168909. S2CID 25546693. "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."
75. ^ a b c d Niemantsverdriet MB, Slotema CW, Blom JD, Franken IH, Hoek HW, Sommer IE, et al. (October 2017). "Hallucinations in borderline personality disorder: Prevalence, characteristics and associations with comorbid symptoms and disorders". Scientific Reports. 7 (1) 13920. Bibcode:2017NatSR...713920N. doi:10.1038/s41598-017-13108-6. PMC 5654997. PMID 29066713.
76. ^ a b Slotema CW, Blom JD, Niemantsverdriet MB, Sommer IE (31 July 2018). "Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review". Frontiers in Psychiatry. 9 347\. doi:10.3389/fpsyt.2018.00347. PMC 6079212. PMID 30108529.
77. ^ a b "Borderline personality disorder". Mayo Clinic. Archived from the original on 30 April 2008. Retrieved 15 May 2008.
78. ^ Gunderson JG, Sabo AN (January 1993). "The phenomenological and conceptual interface between borderline personality disorder and PTSD". The American Journal of Psychiatry. 150 (1): 19–27\. doi:10.1176/ajp.150.1.19. PMID 8417576.
79. ^ Zanarini MC, Frankenburg FR (1997). "Pathways to the development of borderline personality disorder". Journal of Personality Disorders. 11 (1): 93–104\. doi:10.1521/pedi.1997.11.1.93. PMID 9113824. S2CID 20669909.
80. ^ Bassir Nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM (June 2018). "Past, present, and future of genetic research in borderline personality disorder". Current Opinion in Psychology. 21: 60–68\. doi:10.1016/j.copsyc.2017.09.002. PMC 5847441. PMID 29032046.
81. ^ Gunderson JG, Zanarini MC, Choi-Kain LW, Mitchell KS, Jang KL, Hudson JI (August 2011). "Family Study of Borderline Personality Disorder and Its Sectors of Psychopathology". JAMA: The Journal of the American Medical Association. 68 (7): 753–762\. doi:10.1001/archgenpsychiatry.2011.65. PMC 3150490. PMID 3150490.
82. ^ Torgersen S (March 2000). "Genetics of patients with borderline personality disorder". The Psychiatric Clinics of North America. 23 (1): 1–9\. doi:10.1016/S0193-953X(05)70139-8. PMID 10729927.
83. ^ a b Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, et al. (2000). "A twin study of personality disorders". Comprehensive Psychiatry. 41 (6): 416–425\. doi:10.1053/comp.2000.16560. PMID 11086146.
84. ^ Goodman M, New A, Siever L (December 2004). "Trauma, genes, and the neurobiology of personality disorders". Annals of the New York Academy of Sciences. 1032 (1): 104–116\. Bibcode:2004NYASA1032..104G. doi:10.1196/annals.1314.008. PMID 15677398. S2CID 26270818.
85. ^ a b c d "Possible Genetic Causes of Borderline Personality Disorder Identified". sciencedaily.com. 20 December 2008. Archived from the original on 1 May 2014.
86. ^ a b c O'Neill A, Frodl T (October 2012). "Brain structure and function in borderline personality disorder". Brain Structure & Function. 217 (4): 767–782\. doi:10.1007/s00429-012-0379-4. PMID 22252376. S2CID 17970001.
87. ^ Lubke GH, Laurin C, Amin N, Hottenga JJ, Willemsen G, van Grootheest G, et al. (August 2014). "Genome-wide analyses of borderline personality features". Molecular Psychiatry. 19 (8): 923–929\. doi:10.1038/mp.2013.109. PMC 3872258. PMID 23979607.
88. ^ Bassir Nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM (2018). "Past, present, and future of genetic research in borderline personality disorder". Current Opinion in Psychology. 21: 60–68\. doi:10.1016/j.copsyc.2017.09.002. ISSN 2352-2518. PMC 5847441. PMID 29032046.
89. ^ Cohen P (September 2008). "Child Development and Personality Disorder" (PDF). The Psychiatric Clinics of North America. 31 (3): 477–493, vii. doi:10.1016/j.psc.2008.03.005. PMID 18638647. Archived from the original (PDF) on 31 May 2024. Retrieved 8 January 2025.
90. ^ Herman JL (1992). Trauma and recovery. New York: Basic Books. ISBN 978-0-465-08730-3.
91. ^ a b Quadrio C (December 2005). "Axis One/Axis Two: A disordered borderline". Australian and New Zealand Journal of Psychiatry. 39: A97 – A153. doi:10.1111/j.1440-1614.2005.01674_39_s1.x. Archived from the original on 8 January 2025. Retrieved 8 January 2025 - via ResearchGate. Alt URL
92. ^ Ball JS, Links PS (February 2009). "Borderline personality disorder and childhood trauma: evidence for a causal relationship". Current Psychiatry Reports. 11 (1): 63–68\. doi:10.1007/s11920-009-0010-4. PMID 19187711. S2CID 20566309.
93. ^ "Borderline personality disorder: Understanding this challenging mental illness". Mayo Clinic. Archived from the original on 30 August 2017. Retrieved 5 September 2017.
94. ^ a b c Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Lewis RE, Williams AA, et al. (2000). "Biparental failure in the childhood experiences of borderline patients". Journal of Personality Disorders. 14 (3): 264–273\. doi:10.1521/pedi.2000.14.3.264. PMID 11019749.
95. ^ Matthies SD, Philipsen A (2014). "Common ground in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD)–review of recent findings". Borderline Personality Disorder and Emotion Dysregulation. 1 (1): 3. doi:10.1186/2051-6673-1-3. ISSN 2051-6673. PMC 4739390. PMID 26843958.
96. ^ Dozier M, Stovall-McClough KC, Albus KE (1999). "Attachment and psychopathology in adulthood". In Cassidy J, Shaver PR (eds.). Handbook of attachment. New York: Guilford Press. pp. 497–519.
97. ^ Crowell SE, Beauchaine TP, Linehan MM (May 2009). "A Biosocial Developmental Model of Borderline Personality: Elaborating and Extending Linehan's Theory". Psychological Bulletin. 135 (3): 495–510\. doi:10.1037/a0015616. PMC 2696274. PMID 19379027.
98. ^ a b Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF (January 2013). "Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis". Biological Psychiatry. 73 (2): 153–160\. doi:10.1016/j.biopsych.2012.07.014. PMID 22906520. S2CID 8381799.
99. ^ Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, et al. (June 2009). "Neural correlates of emotion processing in borderline personality disorder". Psychiatry Research. 172 (3): 192–199\. doi:10.1016/j.pscychresns.2008.07.010. PMC 4153735. PMID 19394205. "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."
100. ^ a b c Ayduk O, Zayas V, Downey G, Cole AB, Shoda Y, Mischel W (February 2008). "Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features". Journal of Research in Personality. 42 (1): 151–168\. doi:10.1016/j.jrp.2007.04.002. PMC 2390893. PMID 18496604.
101. ^ Post TW (ed.). "Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis". UpToDate. Wolters Kluwer. Archived from the original on 6 January 2009. Retrieved 11 March 2023.
102. ^ a b c "Personality Disorders: Tests and Diagnosis". Mayo Clinic. Archived from the original on 6 June 2013. Retrieved 13 June 2013.
103. ^ a b Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, et al. (2024). "Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies". World Psychiatry. 23 (1): 4–25\. doi:10.1002/wps.21156. ISSN 2051-5545. PMC 10786009. PMID 38214629. "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)."
104. ^ a b American Psychiatric Association 2013, pp. 663–8
105. ^ Rodriguez-Seijas C, Ruggero C, Eaton NR, Krueger RF (September 2019). "The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review". Current Treatment Options in Psychiatry. 6 (4): 284–298\. doi:10.1007/s40501-019-00187-7. ISSN 2196-3061.
106. ^ American Psychiatric Association 2013, pp. 766–7
107. ^ a b Manning 2011, p. 13
108. ^ Bach B, First MB (29 October 2018). "Application of the ICD-11 classification of personality disorders". BMC Psychiatry. 18 (1): 351. doi:10.1186/s12888-018-1908-3. ISSN 1471-244X. PMC 6206910. PMID 30373564.
109. ^ Mulder RT (2021). "ICD-11 Personality Disorders: Utility and Implications of the New Model". Frontiers in Psychiatry. 12 655548\. doi:10.3389/fpsyt.2021.655548. ISSN 1664-0640. PMC 8141634. PMID 34040555.
110. ^ Tyrer P, Mulder R, Kim YR, Crawford MJ (7 May 2019). "The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics". Annual Review of Clinical Psychology. 15: 481–502\. doi:10.1146/annurev-clinpsy-050718-095736. ISSN 1548-5943. PMID 30601688.
111. ^ a b c Simon J, Lambrecht B, Bach B (6 April 2023). "Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings". Frontiers in Psychiatry. 14 1175425\. doi:10.3389/fpsyt.2023.1175425. ISSN 1664-0640. PMC 10116048. PMID 37091704.
112. ^ Lai CM, Leung F, You J, Cheung F (August 2012). "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 of Personality Disorders. 26 (4): 551–567\. doi:10.1521/pedi.2012.26.4.551. ISSN 0885-579X. PMID 22867506. "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)."
113. ^ a b Gutiérrez F, Aluja A, Ruiz Rodríguez J, Peri JM, Gárriz M, Garcia LF, et al. (June 2022). "Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11)". Personality Disorders. 14 (3): 355–359\. doi:10.1037/per0000592. hdl:2445/206520. PMID 35737563. S2CID 249805748. "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."
114. ^ Millon T (2004). Personality Disorders in Modern Life. Hoboken, New Jersey: John Wiley & Sons. pp. 482–88\. ISBN 978-0-471-23734-1.
115. ^ Chanen AM, Thompson KN (April 2016). "Prescribing and borderline personality disorder". Australian Prescriber. 39 (2): 49–53\. doi:10.18773/austprescr.2016.019. PMC 4917638. PMID 27340322.
116. ^ Meaney R, Hasking P, Reupert A (2016). "Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination". PLOS ONE. 11 (6): e0157294. Bibcode:2016PLoSO..1157294M. doi:10.1371/journal.pone.0157294. PMC 4922551. PMID 27348858.
117. ^ Sartorius N (2015). "Why do we need a diagnosis? Maybe a syndrome is enough?". Dialogues in Clinical Neuroscience. 17 (1): 6–7\. doi:10.31887/DCNS.2015.17.1/nsartorius. PMC 4421902. PMID 25987858.
118. ^ Paris J, Black DW (2015). "Borderline Personality Disorder and Bipolar Disorder". The Journal of Nervous and Mental Disease. 203 (1): 3–7\. doi:10.1097/nmd.0000000000000225. ISSN 0022-3018. PMID 25536097. S2CID 2825326.
119. ^ Linehan 1993, p. 49
120. ^ a b Miller AL, Muehlenkamp JJ, Jacobson CM (July 2008). "Fact or fiction: diagnosing borderline personality disorder in adolescents". Clinical Psychology Review. 28 (6): 969–81\. doi:10.1016/j.cpr.2008.02.004. PMID 18358579. Archived from the original on 4 December 2020. Retrieved 23 September 2020.
121. ^ a b National Collaborating Centre for Mental Health (UK) (2009). Young People With Borderline Personality Disorder. British Psychological Society. Archived from the original on 4 December 2020. Retrieved 23 September 2020.
122. ^ a b c d e Kaess M, Brunner R, Chanen A (October 2014). "Borderline personality disorder in adolescence" (PDF). Pediatrics. 134 (4): 782–93\. doi:10.1542/peds.2013-3677. PMID 25246626. S2CID 8274933. Retrieved 23 September 2020.
123. ^ a b Biskin RS (July 2015). "The Lifetime Course of Borderline Personality Disorder". Canadian Journal of Psychiatry. 60 (7): 303–8\. doi:10.1177/070674371506000702. PMC 4500179. PMID 26175388.
124. ^ National Health and Medical Research Council (Australia) (2013). Clinical practice guideline for the management of borderline personality disorder. National Health and Medical Research Council. ISBN 978-1-86496-564-3. OCLC 948783298.
125. ^ "Overview | Borderline personality disorder: recognition and management | Guidance | NICE". nice.org.uk. 28 January 2009. Archived from the original on 11 October 2019. Retrieved 23 September 2020.
126. ^ de Vito E, Ladame F, Orlandini A (1999). "Adolescence and Personality Disorders". In Derksen J, Maffei C, Groen H (eds.). Treatment of Personality Disorders. Boston: Springer US. pp. 77–95\. doi:10.1007/978-1-4757-6876-3_7. ISBN 978-1-4419-3326-3. Archived from the original on 4 December 2020. Retrieved 23 September 2020.
127. ^ Guilé JM, Boissel L, Alaux-Cantin S, de La Rivière SG (23 November 2018). "Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies". Adolescent Health, Medicine and Therapeutics. 9: 199–210\. doi:10.2147/ahmt.s156565. PMC 6257363. PMID 30538595.
128. ^ American Psychiatric Association. Work Group on Borderline Personality Disorder. (2001). Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. OCLC 606593046.
129. ^ World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization. ISBN 978-92-4-068283-2. OCLC 476159430.
130. ^ a b Baltzersen ÅL (August 2020). "Moving forward: closing the gap between research and practice for young people with BPD". Current Opinion in Psychology. 37: 77–81\. doi:10.1016/j.copsyc.2020.08.008. PMID 32916475. S2CID 221636857.
131. ^ Boylan K (August 2018). "Diagnosing BPD in Adolescents: More good than harm". Journal of the Canadian Academy of Child and Adolescent Psychiatry. 27 (3): 155–156\. PMC 6054283. PMID 30038651.
132. ^ Laurenssen EM, Hutsebaut J, Feenstra DJ, Van Busschbach JJ, Luyten P (February 2013). "Diagnosis of personality disorders in adolescents: a study among psychologists". Child and Adolescent Psychiatry and Mental Health. 7 (1): 3. doi:10.1186/1753-2000-7-3. PMC 3583803. PMID 23398887.
133. ^ Chanen AM (August 2015). "Borderline Personality Disorder in Young People: Are We There Yet?". Journal of Clinical Psychology. 71 (8): 778–91\. doi:10.1002/jclp.22205. PMID 26192914. Archived from the original on 4 December 2020. Retrieved 23 September 2020.
134. ^ Koehne K, Hamilton B, Sands N, Humphreys C (January 2013). "Working around a contested diagnosis: borderline personality disorder in adolescence". Health. 17 (1): 37–56\. doi:10.1177/1363459312447253. PMID 22674745. S2CID 1674596.
135. ^ a b c American Psychiatric Association 2000[page needed]
136. ^ a b Netherton SD, Holmes D, Walker CE (1999). Child and Adolescent Psychological Disorders: Comprehensive Textbook. New York: Oxford University Press.[page needed]
137. ^ Miller AL, Muehlenkamp JJ, Jacobson CM (July 2008). "Fact or fiction: diagnosing borderline personality disorder in adolescents". Clinical Psychology Review. 28 (6): 969–981\. doi:10.1016/j.cpr.2008.02.004. PMID 18358579.
138. ^ Linehan 1993, p. 98
139. ^ a b Ferrer M, Andión O, Matalí J, Valero S, Navarro JA, Ramos-Quiroga JA, et al. (December 2010). "Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder". Journal of Personality Disorders. 24 (6): 812–822\. doi:10.1521/pedi.2010.24.6.812. PMID 21158602.[non-primary source needed]
140. ^ a b Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al. (December 1998). "Axis I comorbidity of borderline personality disorder". The American Journal of Psychiatry. 155 (12): 1733–1739\. doi:10.1176/ajp.155.12.1733. PMID 9842784.
141. ^ Vieta E (August 2019). "Bipolar II Disorder: Frequent, Valid, and Reliable". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie. 64 (8): 541–543\. doi:10.1177/0706743719855040. PMC 6681515. PMID 31340672.
142. ^ a b c d e f g h i Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. (April 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions". The Journal of Clinical Psychiatry. 69 (4): 533–545\. doi:10.4088/JCP.v69n0404. PMC 2676679. PMID 18426259.
143. ^ Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al. (December 1998). "Axis I comorbidity of borderline personality disorder". The American Journal of Psychiatry. 155 (12): 1733–1739\. doi:10.1176/ajp.155.12.1733. PMID 9842784.
144. ^ Rydén G, Rydén E, Hetta J (2008). "Borderline personality disorder and autism spectrum disorder in females: A cross-sectional study" (PDF). Clinical Neuropsychiatry. 5 (1): 22–30\. Archived from the original (PDF) on 21 September 2013. Retrieved 7 February 2013.
145. ^ Bolton S, Gunderson JG (September 1996). "Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications". The American Journal of Psychiatry. 153 (9): 1202–1207\. doi:10.1176/ajp.153.9.1202. PMID 8780426.
146. ^ American Psychiatric Association Practice Guidelines (October 2001). "Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association". The American Journal of Psychiatry. 158 (10 Suppl): 1–52\. doi:10.1176/appi.ajp.158.1.1. PMID 11665545. S2CID 20392111.
147. ^ "Differential Diagnosis of Borderline Personality Disorder". BPD Today. Archived from the original on 9 May 2004.
148. ^ a b c Chapman & Gratz 2007, p. 87
149. ^ Mackinnon DF, Pies R (February 2006). "Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders". Bipolar Disorders. 8 (1): 1–14\. doi:10.1111/j.1399-5618.2006.00283.x. PMID 16411976.
150. ^ a b Chapman & Gratz 2007, p. 88
151. ^ a b c Jamison KR, Goodwin FJ (1990). Manic-depressive illness. Oxford: Oxford University Press. p. 108. ISBN 978-0-19-503934-4.
152. ^ Selby EA (October 2013). "Chronic sleep disturbances and borderline personality disorder symptoms". Journal of Consulting and Clinical Psychology. 81 (5): 941–947\. doi:10.1037/a0033201. PMC 4129646. PMID 23731205.
153. ^ Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H (February 1985). "The nosologic status of borderline personality: clinical and polysomnographic study". The American Journal of Psychiatry. 142 (2): 192–198\. doi:10.1176/ajp.142.2.192. PMID 3970243.
154. ^ Gunderson JG, Elliott GR (March 1985). "The interface between borderline personality disorder and affective disorder". The American Journal of Psychiatry. 142 (3): 277–788\. doi:10.1176/ajp.142.3.277. PMID 2857532.
155. ^ Paris J (2004). "Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders". Harvard Review of Psychiatry. 12 (3): 140–145\. doi:10.1080/10673220490472373. PMID 15371068. S2CID 39354034.
156. ^ Jamison KR, Goodwin FJ (1990). Manic-depressive illness. Oxford: Oxford University Press. p. 336. ISBN 978-0-19-503934-4.
157. ^ Benazzi F (January 2006). "Borderline personality-bipolar spectrum relationship". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 30 (1): 68–74\. doi:10.1016/j.pnpbp.2005.06.010. PMID 16019119. S2CID 1358610.
158. ^ Rapkin AJ, Berman SM, London ED (2014). "The Cerebellum and Premenstrual Dysphoric Disorder". AIMS Neuroscience. 1 (2): 120–141\. Bibcode:2014AIMES...1..120R. doi:10.3934/Neuroscience.2014.2.120. PMC 5338637. PMID 28275721.
159. ^ Grady-Weliky TA (January 2003). "Clinical practice. Premenstrual dysphoric disorder". The New England Journal of Medicine. 348 (5): 433–8\. doi:10.1056/NEJMcp012067. PMID 12556546.
160. ^ Rapkin AJ, Lewis EI (November 2013). "Treatment of premenstrual dysphoric disorder". Women's Health. 9 (6): 537–56\. doi:10.2217/whe.13.62. PMID 24161307.
161. ^ "CG78 Borderline personality disorder (BPD): NICE guideline". Nice.org.uk. 28 January 2009. Archived from the original on 11 April 2009. Retrieved 12 August 2009.
162. ^ Paris J (June 2004). "Is hospitalization useful for suicidal patients with borderline personality disorder?". Journal of Personality Disorders. 18 (3): 240–247\. doi:10.1521/pedi.18.3.240.35443. PMID 15237044. S2CID 28921269.
163. ^ a b c Zanarini MC (November 2009). "Psychotherapy of borderline personality disorder". Acta Psychiatrica Scandinavica. 120 (5): 373–377\. doi:10.1111/j.1600-0447.2009.01448.x. PMC 3876885. PMID 19807718.
164. ^ Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P (April 2017). "Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis". JAMA Psychiatry. 74 (4): 319–328\. doi:10.1001/jamapsychiatry.2016.4287. hdl:1871.1/845f5460-273e-4150-b79d-159f37aa36a0. PMID 28249086. S2CID 30118081. Archived from the original on 4 December 2020. Retrieved 12 December 2019.
165. ^ Gabbard GO (2014). Psychodynamic psychiatry in clinical practice (5th ed.). Washington, D.C.: American Psychiatric Publishing. pp. 445–448.
166. ^ a b Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT (2017). "What Works in the Treatment of Borderline Personality Disorder". Current Behavioral Neuroscience Reports. 4 (1): 21–30\. doi:10.1007/s40473-017-0103-z. PMC 5340835. PMID 28331780.
167. ^ Links PS, Shah R, Eynan R (March 2017). "Psychotherapy for Borderline Personality Disorder: Progress and Remaining Challenges". Current Psychiatry Reports. 19 (3) 16. doi:10.1007/s11920-017-0766-x. PMID 28271272. S2CID 1076175.
168. ^ a b Bliss S, McCardle M (1 March 2014). "An Exploration of Common Elements in Dialectical Behavior Therapy, Mentalization Based Treatment and Transference Focused Psychotherapy in the Treatment of Borderline Personality Disorder". Clinical Social Work Journal. 42 (1): 61–69\. doi:10.1007/s10615-013-0456-z. ISSN 0091-1674. S2CID 145079695.
169. ^ Livesay WJ (2017). "Understanding Borderline Personality Disorder". Integrated Modular Treatment for Borderline Personality Disorder. Cambridge, England: Cambridge University Press. pp. 29–38\. doi:10.1017/9781107298613.004. ISBN 978-1-107-29861-3. Archived from the original on 25 December 2020. Retrieved 14 March 2024.
170. ^ Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Archives of General Psychiatry. 63 (7): 757–766\. doi:10.1001/archpsyc.63.7.757. PMID 16818865.
171. ^ Paris J (February 2010). "Effectiveness of different psychotherapy approaches in the treatment of borderline personality disorder". Current Psychiatry Reports. 12 (1): 56–60\. doi:10.1007/s11920-009-0083-0. PMID 20425311. S2CID 19038884.
172. ^ Young JE, Klosko JS, Weishaar ME (2003). "Schema Therapy for Borderline Personality Disorder". Schema Therapy: A Practitioner's Guide. New York: Guilford Press. pp. 306–372\. ISBN 9781593853723.
173. ^ Tang YY, Posner MI (January 2013). "Special issue on mindfulness neuroscience". Social Cognitive and Affective Neuroscience. 8 (1): 1–3\. doi:10.1093/scan/nss104. PMC 3541496. PMID 22956677.
174. ^ Posner MI, Tang YY, Lynch G (2014). "Mechanisms of white matter change induced by meditation training". Frontiers in Psychology. 5 (1220): 1220. doi:10.3389/fpsyg.2014.01220. PMC 4209813. PMID 25386155.
175. ^ Chafos VH, Economou P (October 2014). "Beyond borderline personality disorder: the mindful brain". Social Work. 59 (4): 297–302\. doi:10.1093/sw/swu030. PMID 25365830. S2CID 14256504.
176. ^ Sachse S, Keville S, Feigenbaum J (June 2011). "A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder". Psychology and Psychotherapy. 84 (2): 184–200\. doi:10.1348/147608310X516387. PMID 22903856.
177. ^ a b c d Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K (June 2010). "Pharmacological interventions for borderline personality disorder". The Cochrane Database of Systematic Reviews (6): CD005653. doi:10.1002/14651858.CD005653.pub2. PMC 4169794. PMID 20556762.
178. ^ a b c d Hancock-Johnson E, Griffiths C, Picchioni M (May 2017). "A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder". CNS Drugs. 31 (5): 345–356\. doi:10.1007/s40263-017-0425-0. PMID 28353141. S2CID 207486732.
179. ^ a b c d e Lieb K, Völlm B, Rücker G, Timmer A, Stoffers JM (January 2010). "Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials". Br J Psychiatry. 196 (1): 4–12\. doi:10.1192/bjp.bp.108.062984. PMID 20044651.
180. ^ Purohith AN, Chatorikar SA, Nagaraj AK, Soman S (December 2021). "Ketamine for non-suicidal self-harm in borderline personality disorder with co-morbid recurrent depression: A case report". Journal of Affective Disorders Reports. 6 100280\. doi:10.1016/j.jadr.2021.100280. ISSN 2666-9153.
181. ^ Chen KS, Dwivedi Y, Shelton RC (October 2022). "The effect of IV ketamine in patients with major depressive disorder and elevated features of borderline personality disorder". Journal of Affective Disorders. 315: 13–16\. doi:10.1016/j.jad.2022.07.054. PMID 35905793. S2CID 251117957.
182. ^ a b Pascual JC, Arias L, Soler J (31 May 2023). "Pharmacological Management of Borderline Personality Disorder and Common Comorbidities". CNS Drugs. 37 (6): 489–497\. doi:10.1016/S0140-6736(21)00476-1. PMC 10276775. PMID 37256484.
183. ^ "2009 clinical guideline for the treatment and management of BPD" (PDF). UK National Institute for Health and Clinical Excellence (NICE). Archived from the original (PDF) on 18 June 2012. Retrieved 6 September 2011.
184. ^ Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, et al. (August 2018). "The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial". The American Journal of Psychiatry. 175 (8): 756–764\. doi:10.1176/appi.ajp.2018.17091006. hdl:10044/1/57265. PMID 29621901. S2CID 4588378.
185. ^ Cattarinussi G, Delvecchio G, Prunas C, Moltrasio C, Brambilla P (June 2021). "Effects of pharmacological treatments on emotional tasks in borderline personality disorder: A review of functional magnetic resonance imaging studies". Journal of Affective Disorders. 288: 50–57\. doi:10.1016/j.jad.2021.03.088. PMID 33839558. S2CID 233211413.
186. ^ Johnson RS (26 July 2014). "Treatment of Borderline Personality Disorder". BPDFamily.com. Archived from the original on 14 July 2014. Retrieved 5 August 2014.
187. ^ Friesen L, Gaine G, Klaver E, Burback L, Agyapong V (22 September 2022). "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". PLOS ONE. 17 (9): e0274197. Bibcode:2022PLoSO..1774197F. doi:10.1371/journal.pone.0274197. PMC 9499299. PMID 36137103.
188. ^ Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J (2001). "Treatment histories of borderline inpatients". Comprehensive Psychiatry. 42 (2): 144–150\. doi:10.1053/comp.2001.19749. PMID 11244151.
189. ^ Zanarini MC, Frankenburg FR, Hennen J, Silk KR (January 2004). "Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years". The Journal of Clinical Psychiatry. 65 (1): 28–36\. doi:10.4088/JCP.v65n0105. PMID 14744165.
190. ^ Fallon P (August 2003). "Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services". Journal of Psychiatric and Mental Health Nursing. 10 (4): 393–401\. doi:10.1046/j.1365-2850.2003.00617.x. PMID 12887630.
191. ^ Links PS, Bergmans Y, Warwar SH (1 July 2004). "Assessing Suicide Risk in Patients With Borderline Personality Disorder". Psychiatric Times. Psychiatric Times Vol 21 No 8. 21 (8). Archived from the original on 21 August 2013.
192. ^ Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M (2004). "Borderline personality disorder". Lancet. 364 (9432): 453–461\. doi:10.1016/S0140-6736(04)16770-6. PMID 15288745. S2CID 54280127.
193. ^ Zanarini MC, Frankenburg FR, Hennen J, Silk KR (February 2003). "The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder". The American Journal of Psychiatry. 160 (2): 274–283\. doi:10.1176/appi.ajp.160.2.274. PMID 12562573.
194. ^ a b c Oldham JM (July 2004). "Borderline Personality Disorder: An Overview". Psychiatric Times. Archived from the original on 21 October 2013.
195. ^ Álvarez-Tomás I, Ruiz J, Guilera G, Bados A (2019). "Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies". European Psychiatry. 56 (1): 75–83\. doi:10.1016/j.eurpsy.2018.10.010. hdl:2445/175985. PMID 30599336.
196. ^ Leichsenring F, Heim N, Leweke F, Spitzer C, Steinert C, Kernberg OF (28 February 2023). "Borderline Personality Disorder: A Review". JAMA. 329 (8): 670–679\. doi:10.1001/jama.2023.0589. PMID 36853245. "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."
197. ^ Hirsh JB, Quilty LC, Bagby RM, McMain SF (August 2012). "The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder". Journal of Personality Disorders. 26 (4): 616–627\. doi:10.1521/pedi.2012.26.4.616. PMID 22867511. S2CID 33621688.
198. ^ Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (February 2005). "Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years". Journal of Personality Disorders. 19 (1): 19–29\. doi:10.1521/pedi.19.1.19.62178. PMID 15899718.
199. ^ Gross R, Olfson M, Gameroff M, Shea S, Feder A, Fuentes M, et al. (January 2002). "Borderline personality disorder in primary care". Archives of Internal Medicine. 162 (1): 53–60\. doi:10.1001/archinte.162.1.53. PMID 11784220.
200. ^ Zimmerman M, Rothschild L, Chelminski I (October 2005). "The prevalence of DSM-IV personality disorders in psychiatric outpatients". The American Journal of Psychiatry. 162 (10): 1911–1918\. doi:10.1176/appi.ajp.162.10.1911. PMID 16199838.
201. ^ American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
202. ^ Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (September 2007). "DSM-IV personality disorders in the National Comorbidity Survey Replication". Biological Psychiatry. 62 (6): 553–564\. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500. PMID 17217923.
203. ^ "BPD Fact Sheet". National Educational Alliance for Borderline Personality Disorder. 2013. Archived from the original on 4 January 2013.
204. ^ Edvard Munch: the life of a person with borderline personality as seen through his art. Denmark: Lundbeck Pharma A/S. 1990. pp. 34–35\. ISBN 978-87-983524-1-9.
205. ^ Masterson JF (1988). "Chapter 12: The Creative Solution: Sartre, Munch, and Wolfe". Search for the Real Self. Unmasking The Personality Disorders of Our Age. New York: Simon and Schuster. pp. 208–230, especially 212–213. ISBN 978-1-4516-6891-9.
206. ^ Aarkrog T (1990). Edvard Munch: the life of a person with borderline personality as seen through his art. Denmark: Lundbeck Pharma A/S. ISBN 978-87-983524-1-9.
207. ^ Millon, Grossman & Meagher 2004, p. 172
208. ^ Hughes CH (1884). "Borderline psychiatric records – prodromal symptoms of psychical impairments". Alienists & Neurology. 5: 85–90\. OCLC 773814725.
209. ^ a b Millon 1996, pp. 645–690
210. ^ Jones DW (1 August 2023). "A history of borderline: disorder at the heart of psychiatry" (PDF). Journal of Psychosocial Studies. 16 (2): 117–134\. doi:10.1332/147867323X16871713092130. S2CID 259893398. Archived (PDF) from the original on 16 March 2024. Retrieved 25 September 2023.
211. ^ Stern A (1938). "Psychoanalytic investigation of and therapy in the borderline group of neuroses". Psychoanalytic Quarterly. 7 (4): 467–489\. doi:10.1080/21674086.1938.11925367.
212. ^ Stefana A (2015). "Adolph Stern, father of term 'borderline personality'". Minerva Psichiatrica. 56 (2): 95.
213. ^ a b Aronson TA (August 1985). "Historical perspectives on the borderline concept: a review and critique". Psychiatry. 48 (3): 209–222\. doi:10.1080/00332747.1985.11024282. PMID 3898174.
214. ^ Gunderson JG, Kolb JE, Austin V (July 1981). "The diagnostic interview for borderline patients". The American Journal of Psychiatry. 138 (7): 896–903\. doi:10.1176/ajp.138.7.896. PMID 7258348.
215. ^ Stone MH (2005). "Borderline Personality Disorder: History of the Concept". In Zanarini MC (ed.). Borderline personality disorder. Boca Raton, Florida: Taylor & Francis. pp. 1–18\. ISBN 978-0-8247-2928-8.
216. ^ Gunderson JG, Lyons-Ruth K (February 2008). "BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model". Journal of Personality Disorders. 22 (1): 22–41\. doi:10.1521/pedi.2008.22.1.22. ISSN 0885-579X. PMC 2596628. PMID 18312121.
217. ^ Kernberg OF, Michels R (May 2009). "Borderline Personality Disorder". American Journal of Psychiatry. 166 (5): 505–508\. doi:10.1176/appi.ajp.2009.09020263. ISSN 0002-953X. PMID 19411373.
218. ^ Adler G, Buie DH (1979). "Aloneness and borderline psychopathology: the possible relevance of child development issues". The International Journal of Psycho-Analysis. 60 (1): 83–96\. ISSN 0020-7578. PMID 457345.
219. ^ LENZENWEGER MF (October 2001). "The Personality Disorders: A New Look at the Developmental Self and Object Relations Approach". American Journal of Psychiatry. 158 (10): 1755–a. doi:10.1176/appi.ajp.158.10.1755-a. ISSN 0002-953X.
220. ^ Ruffalo ML (2025). "Heads I win, tails you lose: Interpersonal aspects of borderline personality disorder". Bulletin of the Menninger Clinic. 89 (1): 52–69\. doi:10.1521/bumc.2025.89.1.52. ISSN 1943-2828. PMID 40063356.
221. ^ Moll T (29 May 2018). Mental Health Primer. CreateSpace Independent Publishing Platform. p. 43\. ISBN 978-1-7205-1057-4.
222. ^ Psychopharmacology Bulletin. The Clearinghouse. 1966. p. 555\. Archived from the original on 4 December 2020. Retrieved 5 June 2020.
223. ^ Spitzer RL, Endicott J, Gibbon M (January 1979). "Crossing the border into borderline personality and borderline schizophrenia. The development of criteria". Archives of General Psychiatry. 36 (1): 17–24\. doi:10.1001/archpsyc.1979.01780010023001. PMID 760694.
224. ^ Harold Merskey, Psychiatric Illness: Diagnosis, Management and Treatment for General Practitioners and Students, Baillière Tindall (1980), p. 415. "Borderline personality disorder is a very controversial and confusing American term, best avoided.
225. ^ Goodwin J (1985). "Chapter 1: Credibility problems in multiple personality disorder patients and abused children". In Kluft RP (ed.). Childhood antecedents of multiple personality. American Psychiatric Press. ISBN 978-0-88048-082-6.
226. ^ Dike CC, Baranoski M, Griffith EE (2005). "Pathological lying revisited". The Journal of the American Academy of Psychiatry and the Law. 33 (3): 342–349\. PMID 16186198. Archived from the original on 10 January 2023. Retrieved 10 January 2023.
227. ^ a b Jones B, Heard H, Startup M, Swales M, Williams JM, Jones RS (November 1999). "Autobiographical memory and dissociation in borderline personality disorder". Psychological Medicine. 29 (6): 1397–1404\. doi:10.1017/S0033291799001208. PMID 10616945. S2CID 19211244 - via Cambridge Core.
228. ^ Al-Shamali HF, Winkler O, Talarico F, Greenshaw AJ, Forner C, Zhang Y, et al. (13 February 2022). "A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog". Australian and New Zealand Journal of Psychiatry. 56 (10): 1252–1264\. doi:10.1177/00048674221077029. PMC 9511244. PMID 35152771.
229. ^ Paris J (2008). Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice. The Guilford Press. p. 21.
230. ^ Kreisman J, Strauss H (2004). Sometimes I Act Crazy. Living With Borderline Personality Disorder. Wiley & Sons. p. 206. ISBN 978-0-471-22286-6.
231. ^ a b c Sansone RA, Sansone LA (May 2011). "Gender patterns in borderline personality disorder". Innovations in Clinical Neuroscience. 8 (5): 16–20\. PMC 3115767. PMID 21686143. "Men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking. For Axis I 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."
232. ^ American Psychiatric Association 2000, p. 705
233. ^ Mandal E, Kocur D (2013). "Psychological masculinity, femininity, and tactics of manipulation in patients with borderline personality disorder". Archives of Psychiatry and Psychotherapy (1): 45–53\. ISSN 2083-828X. Archived from the original on 14 March 2024. Retrieved 14 March 2024.
234. ^ a b Linehan 1993, p. 14
235. ^ Linehan 1993, p. 15
236. ^ Nehls N (1998). "Borderline personality disorder: gender stereotypes, stigma, and limited system of care". Issues in Mental Health Nursing. 19 (2): 97–112\. doi:10.1080/016128498249105. PMID 9601307.(subscription required)
237. ^ Becker D (October 2000). "When she was bad: borderline personality disorder in a posttraumatic age". The American Journal of Orthopsychiatry. 70 (4): 422–432\. doi:10.1037/h0087769. PMID 11086521.
238. ^ a b c Chapman & Gratz 2007, p. 31
239. ^ a b c d Chapman & Gratz 2007, p. 32
240. ^ a b Munro OE, Sellbom M (August 2020). "Elucidating the relationship between borderline personality disorder and intimate partner violence". Personality and Mental Health. 14 (3): 284–303\. doi:10.1002/pmh.1480. hdl:10523/10488. PMID 32162499. S2CID 212677723.
241. ^ Hinshelwood RD (March 1999). "The difficult patient. The role of 'scientific psychiatry' in understanding patients with chronic schizophrenia or severe personality disorder". The British Journal of Psychiatry. 174 (3): 187–190\. doi:10.1192/bjp.174.3.187. PMID 10448440.
242. ^ Cleary M, Siegfried N, Walter G (September 2002). "Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder". International Journal of Mental Health Nursing. 11 (3): 186–191\. doi:10.1046/j.1440-0979.2002.00246.x. PMID 12510596.
243. ^ a b Campbell K, Clarke KA, Massey D, Lakeman R (19 May 2020). "Borderline Personality Disorder: To diagnose or not to diagnose? That is the question". International Journal of Mental Health Nursing. 29 (5): 972–981\. doi:10.1111/inm.12737. ISSN 1445-8330. PMID 32426937. S2CID 218690798.
244. ^ Deans C, Meocevic E (2006). "Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder". Contemporary Nurse. 21 (1): 43–49\. doi:10.5172/conu.2006.21.1.43. hdl:1959.17/66356. PMID 16594881. S2CID 20500743. Archived from the original on 4 August 2024. Retrieved 16 March 2024.
245. ^ Krawitz R (July 2004). "Borderline personality disorder: attitudinal change following training". The Australian and New Zealand Journal of Psychiatry. 38 (7): 554–559\. doi:10.1111/j.1440-1614.2004.01409.x. PMID 15255829.
246. ^ Nehls N (August 1999). "Borderline personality disorder: the voice of patients". Research in Nursing & Health. 22 (4): 285–293\. doi:10.1002/(SICI)1098-240X(199908)22:4<285::AID-NUR3>3.0.CO;2-R. PMID 10435546.
247. ^ Manning 2011, p. ix
248. ^ a b Bogod E. "Borderline Personality Disorder Label Creates Stigma". Archived from the original on 2 May 2015.
249. ^ "Understanding Borderline Personality Disorder". Treatment and Research Advancements Association for Personality Disorder. 2004. Archived from the original on 26 May 2013.
250. ^ Gunderson JG, Hoffman PD (2005). Understanding and Treating Borderline Personality Disorder A Guide for Professionals and Families. Arlington, Virginia: American Psychiatric Publishing. ISBN 978-1-58562-135-4.[page needed]
251. ^ Chapman & Gratz 2007, p. 52
252. ^ American Psychiatric Association 2013, pp. 663–666
253. ^ Morris P (1 April 2013). "The Depiction of Trauma and its Effect on Character Development in the Brontë Fiction". Brontë Studies. 38 (2): 157–168\. doi:10.1179/1474893213Z.00000000062. S2CID 192230439.
254. ^ Ohi SI (26 October 2019). "Personality Disorder of Character Smerdyakov in Novel the Brother Karamazov Bu [sic] Fyodor Dostovesky (Translated by Constance Clara Garnett)". Skripsi. 1 (321412044). Archived from the original on 13 February 2023. Retrieved 22 May 2022.
255. ^ Wellings N, McCormick EW (1 January 2000). Transpersonal Psychotherapy. SAGE. ISBN 978-1-4129-0802-3. Archived from the original on 14 March 2024. Retrieved 22 May 2022.
256. ^ Robinson DJ (1999). The Field Guide to Personality Disorders. Rapid Psychler Press. p. 113\. ISBN 978-0-9680324-6-6.
257. ^ O'Sullivan M (7 May 2015). "Kristen Wiig earns awkward laughs and silence in 'Welcome to Me'". The Washington Post. Archived from the original on 4 June 2015. Retrieved 3 June 2015.
258. ^ Chang J (11 September 2014). "Toronto Film Review: 'Welcome to Me': Kristen Wiig plays a woman with borderline personality disorder in this startlingly inspired comedy from Shira Piven". Variety. Archived from the original on 17 June 2015. Retrieved 3 June 2015.
259. ^ Setia S (9 November 2021). "Use Your Movie Time To Get Help With Mental Health Issues". Femina (India). Archived from the original on 21 January 2022. Retrieved 21 January 2022.
260. ^ Friedel RO (2006). "Early Sea Changes in Borderline Personality Disorder". Current Psychiatry Reports. 8 (1): 1–4\. doi:10.1007/s11920-006-0071-6. PMID 16513034. S2CID 27719611. Archived from the original on 17 April 2009. Retrieved 17 April 2009.
261. ^ a b Robinson DJ (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Michigan: Rapid Psychler Press. p. 234\. ISBN 978-1-894328-07-4.
262. ^ Wedding D, Boyd MA, Niemiec RM (2005). Movies and Mental Illness: Using Films to Understand Psychopathology. Cambridge, Massachusetts: Hogrefe. p. 59\. ISBN 978-0-88937-292-4.
263. ^ Alberini CM (29 October 2010). "Long-term Memories: The Good, the Bad, and the Ugly". Cerebrum: The Dana Forum on Brain Science. 2010: 21. ISSN 1524-6205. PMC 3574792. PMID 23447766.
264. ^ Young SD (14 March 2012). Psychology at the Movies. doi:10.1002/9781119941149. ISBN 978-1-119-94114-9.
265. ^ Seltzer A (16 April 2012). "Shame and A Dangerous Method reviews". The Art of Psychiatry. Archived from the original on 16 January 2017. Retrieved 13 January 2017.
266. ^ Patton R (26 September 2018). "Netflix's 'Maniac' Is A Trippy Ride with a Lot To Say About Mental Illness". Bustle. Archived from the original on 2 March 2019. Retrieved 1 March 2019.
267. ^ Rosenfield K (30 April 2015). "A Therapist Explains Why Everyone on 'Game of Thrones' Has Serious Issues: Westeros is Basically A Living, Breathing Manual for Mental Illness". MTV News. Archived from the original on 13 May 2019. Retrieved 13 May 2019.
268. ^ Lavery D (2002). This Thing of Ours: Investigating the Sopranos. Wallflower Press. p. 118.
269. ^ "Titans Gives Bruce Wayne a Psychological Diagnosis". 26 August 2021. Archived from the original on 9 August 2022. Retrieved 9 August 2022.
270. ^ Alvernaz A (29 January 2019). "The Depressing Themes Hiding in Bojack Horseman's Closet". Highlander. Archived from the original on 4 January 2024. Retrieved 4 January 2024.
271. ^ "BPD Awareness Month – Congressional History". BPD Today. Mental Health Today. Archived from the original on 8 July 2011. Retrieved 1 November 2010.
272. ^ "When is BPD Awareness Month?". BPD-Aware. Archived from the original on 7 September 2024. Retrieved 7 September 2024.
273. ^ Kim E (16 December 2020). "선미 고백한 '경계선 인격장애' 뭐길래?" [What is the 'borderline personality disorder' that Sunmi confessed to?] (in Korean). Naver TV. Archived from the original on 6 February 2021. Retrieved 16 December 2020.

## General bibliography

[edit]

* American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association. ISBN 978-0-89042-025-6.
* American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. ISBN 978-0-89042-555-8.
* Chapman AL, Gratz KL (2007). The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD. Oakland, Calif.: New Harbinger Publications. ISBN 978-1-57224-507-5.
* Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Archives of General Psychiatry. 63 (7): 757–66\. doi:10.1001/archpsyc.63.7.757. PMID 16818865.
* Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. ISBN 978-0-89862-183-9.
* Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. ISBN 978-1-59385-607-6.
* Millon T (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley & Sons. ISBN 978-0-471-01186-6.
* Millon T (2004). Personality Disorders in Modern Life. Wiley. ISBN 978-0-471-32355-6.
* Millon T, Grossman S, Meagher SE (2004). Masters of the mind: exploring the story of mental illness from ancient times to the new millennium. John Wiley & Sons. ISBN 978-0-471-46985-8.
* Millon T (2006). "Personality Subtypes". Institute for Advanced Studies in Personology and Psychopathology. Dicandrien, Inc. Archived from the original on 4 November 2010. Retrieved 1 November 2010.

## External links

[edit]

Wikimedia Commons has media related to Borderline personality disorder.

* "Borderline personality disorder". National Institute of Mental Health.
* APA DSM 5 Definition of Borderline personality disorder
* APA Division 12 treatment page for Borderline personality disorder
* ICD-11 definition of Personality disorder, Borderline pattern by the World Health Organization
* NHS
* "Borderline Support UK".

Classification|

* ICD-11: 6D11.5
* ICD-10: F60.3
* ICD-9-CM: 301.83
* MeSH: D001883
* SNOMED CT: 20010003

|

External resources|

* MedlinePlus: 000935
* eMedicine: article/913575
* Patient UK: Borderline personality disorder

* v
* t
* e

Borderline personality disorder

General|

* Dimensional models of personality disorders
* Impulse-control disorders
* Trauma model of mental disorders
* Misdiagnosis of borderline personality disorder

Symptoms and behaviors|

* Dissociation
* Eating disorders
* Emotional dysregulation
* Feelings of emptiness
* Episodic memory
* Hypersexuality
* Idealization and devaluation
* Impulsivity
* Mood swings
* Projection
* Self-harm
* Splitting
* Suicidal ideation

Management|

* Dialectical behavior therapy
* Dynamic deconstructive psychotherapy
* McLean Hospital
* Mentalization-based treatment
* Schema therapy
* Social psychiatry
* Transference-focused psychotherapy

Family challenges|

* BPDFamily (support group)
* Codependency
* Complex PTSD
* Emotional blackmail
* Family estrangement
* Sibling estrangement
* Personal boundaries

* v
* t
* e

Personality disorder classification

General classifications|

* Dimensional
* Categorical
* Multi-axial
* Prototypal
* Relational
* Structural

ICD classifications|

| ICD-10|

| Schizotypal|

* Schizotypal

|

Specific|

* Anankastic personality disorder
* Anxious (avoidant)
* Dependent
* Dissocial
* Emotionally unstable
* Histrionic
* Paranoid
* Schizoid

Other|

* Eccentric
* Haltlose
* Immature
* Narcissistic
* Passive–aggressive
* Psychoneurotic

Organic|

* Organic

Unspecified|

* Unspecified

ICD-11|

| Personality disorder|

* Mild
* Moderate
* Severe
* Severity unspecified

|

Prominent personality traits or patterns|

* Negative affectivity
* Detachment
* Dissociality
* Disinhibition
* Anankastia
* Borderline pattern

DSM classifications|

| DSM-III-R only|

* Sadistic
* Self-defeating (masochistic)

|

DSM-IV only|

Personality disorder not otherwise specified

| Appendix B (proposed)|

* Depressive
* Negativistic (passive–aggressive)

|

DSM-5|

| Cluster A (odd)|

* Paranoid
* Schizoid
* Schizotypal

|

Cluster B (dramatic)|

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)|

* Avoidant
* Dependent
* Obsessive-compulsive

Other|

* Other specified
* Unspecified
* Personality change due to another medical condition

Alternative DSM-5 Model
for Personality Disorders|

| Specific|

* Antisocial
* Avoidant
* Borderline
* Narcissistic
* Obsessive-compulsive
* Schizotypal

|

General|

* Trait Specified

Authority control databases

National|

* Germany
* United States
* France
* BnF data
* Czech Republic
* Israel

Other|

* Yale LUX

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template