Borderline Personality Disorder
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Beginning no later than adolescence or early adulthood, borderline personality disorder (BPD) is a consistent and pervasive pattern of labile affect and sense of self, impulsivity, and volatile interpersonal relationships (1):
- Common behaviors and variations:
- Self-mutilation: Pinching, scratching, cutting
- Suicide: Ideation, history of attempts, plans
- Splitting: Idealizing then devaluing others
- Presentation of helplessness or victimization
- High utilization of emergency department and resultant inpatient hospitalizations for psychiatric treatment (2)
- BPD patients are frequent users of primary care (3).
- High rate of associated mental disorders
- Typically display little insight into behavior
Illness (both acute and chronic) may exacerbate BPD and may lead to intense feelings of fear and helplessness.
Diagnosis is rarely made in children. Axis I disorders and general medical conditions are more probable.
Physical, emotional, and social concerns may transiently mimic symptoms of BPD: Consider delay in diagnosis until pregnancy completed. Pregnancy may also induce stress or increased fears, resulting in escalation of borderline behaviors.
Predominant age: Onset no later than adolescence or early adulthood (may go undiagnosed for years)Prevalence
- Genetic factors contribute; however, no specific genes have yet been identified as causative (3).
- Childhood sexual and/or physical abuse and neglect
- Disrupted family life
- Physical illness and external social factors may exacerbate borderline personality behaviors.
1st-degree relatives are at greater risk for this disorder (undetermined if due to genetic or psychosocial factors).
- Tends to be a multigenerational problem
- Children, caregivers, and significant others should have some time and activities away from the borderline individual, which may protect them.
Undetermined, but generally accepted that psychiatric disorders are due to a combination of the following:
- Hereditary temperamental traits
- Environment (i.e., history of childhood sexual and/or physical abuse, history of childhood neglect, ongoing conflict in home)
- Stress is theorized to exert damaging effects on the brain, specifically the hippocampus (3,4).
- Neurobiological research of BPD continues to increase the understanding of the etiology:
Commonly Associated Conditions
Other psychiatric disorders, including:
- Co-occurring personality disorders, frequent
- Mood disorders, common
- Anxiety disorders, common
- Substance-related disorders, common
- Eating disorders, common
- Posttraumatic stress disorder, common
- BPD does not appear to be independently associated with increased risk of violence.