Description

A psychiatric disorder that begins no later than adolescence or early adulthood, borderline personality disorder (BPD) is a consistent and pervasive pattern of unstable and reactive moods and sense of self, impulsivity, and volatile interpersonal relationships (1):

• Common behaviors and variations:
  • Unstable self-image
  • Unstable goals, aspirations, values, and plans
  • 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
• High rate of associated mental disorders
• Typically display little insight into behavior

Geriatric Considerations
Symptoms generally improve with age. Illness (both acute and chronic) may exacerbate feelings of fear and helplessness.

Pediatric Considerations
Diagnosis is rarely made in children. Axis I disorders and general medical conditions (GMCs) are more probable.

Pregnancy Considerations
Pregnancy may exacerbate stress or increased fears, resulting in escalation of borderline behaviors.

Epidemiology

Onset no later than adolescence or early adulthood (may go undiagnosed for years)

Prevalence

• 0.5–5.9% of U.S. population
• 10% of all psychiatric outpatients and between 15% and 25% of patients in psychiatry inpatient settings have BPD (2).

Etiology and Pathophysiology

Undetermined but generally accepted that BPD is 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, maladaptive parenting styles)
• Insufficient modulation by prefrontal region over limbic structures

Genetics
First-degree relatives are at greater risk for this disorder (undetermined if due to genetic or psychosocial factors).

Risk Factors

• Childhood sexual and/or physical abuse and neglect
• Disrupted family life
• Physical illness and external social factors may exacerbate BPD.

General Prevention

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.

Commonly Associated Conditions

Other psychiatric disorders