Borderline personality disorder* is a mental disorder that results in four groups of behavioral symptoms:
- excessive, unstable and poorly regulated emotional responses, especially anger;
- impulsive behaviors that are harmful to you or to others, such as spending sprees, excessive use of alcohol or drugs, self-injurious acts, and sexual indiscretions;
- suspiciousness, misperceptions, an unstable self-image, a poor sense of your identity, and difficulty in reasoning under stress; and
- tumultuous relationships that vary from extreme fear of abandonment to episodes of excessive anger directed towards a person very close to you, and the desire to get away from that person.
*The term borderline disorder is primarily used on this website because many patients and family members find the inclusion of the word “personality” in the name of the disorder to be offensive. In addition, there is ongoing debate about this issue among the leading professionals in the field.
The symptoms of borderline personality disorder usually first occur in the teenage years and early twenties. However, onset may occur in some adults after the age of thirty, and behavioral precursors are evident in some children.
Borderline disorder often results in devastating effects for those who suffer from it, as well as for their families and friends. The behaviors associated with borderline personality disorder may be extremely disruptive to your life in many ways, and to your family as well, resulting in frequent arguments, fights, running away, absences from and poor performance at school and work, frequent job changes and divorces. The children of those with borderline personality disorder are especially affected.
The results of the largest, and recently published, National Institute of Mental Helath study21 suggests that the lifetime prevalence rate of borderline disorder is about 6%, and occurs equally in men and women. These results are in contrast to those of former, much smaller studies, which reported prevalences of 1 to 2%, and rates three times more common in women than in men. This increases the estimated range of prevalence of the disorder to 2 to 6% of the general population. To place these numbers in perspective, at a prevalence of 4%, approximately, 1 in every 25 individuals would suffer from the disorder. Most people personally know more than one person with borderline disorder, and about one family in five has someone in the family with the disorder.
People with borderline disorder are much more likely to seek medical help for physical and emotional symptoms than other people in the general population. For example, about 6% of patients seen in primary care settings suffer from borderline disorder, a rate significantly higher than that of the general population. Ten percent of all psychiatric outpatients, and 20% of psychiatric inpatients suffer from borderline disorder, though the diagnosis is often not made.
Borderline disorder is also associated with a much higher rate of other psychiatric disorders, such as depression, anxiety disorders, substance abuse, and ADHD than the prevalence of these disorders in the general population. In addition, about 9% of people with borderline disorder commit suicide.
There are biological and environmental factors that increase the risk of someone developing borderline disorder. The most common biological risk factors are transmitted genetically. 10 The importance of biological factors in borderline disorder is indicated, in part, by the findings of numerous neuroimaging (brain scan) studies. These have shown significant abnormalities in specific pathways in the brains of people with borderline disorder compared to people in the general population. Neglectful parenting, and repeated physical, emotional and sexual abuse are very common environmental risk factors for borderline disorder. It now seems apparent that in most instances, biological and environmental factors interact to result in the disorder.
Effective treatments are now available for people who suffer from borderline disorder. The main treatments utilized are medications in combination with borderline disorder-specific individual and group psychotherapies. It is now increasingly well recognized that structured family involvement in the treatment process substantially improves the results and shortens the length of intensive treatment.
With effective treatment, most people with borderline disorder experience a significant reduction in symptoms and improvement in their lives.8 At this time there are no complete cures for the disorder. The periods of improvement are often referred to as partial remissions, because all of the symptoms may not improve entirely, and symptoms that have been relieved may return to some degree under stress. This recurrence and significant worsening of symptoms, referred to as a relapse, usually requires brief periods of additional medications, therapy and other supportive measures.
It is often difficult for people with borderline disorder, and the people who love them, to find sufficient, valid information about the disorder and help in its treatment. For example, it is difficult to locate psychiatrists and other mental health professionals who are experienced in treating the disorder. Sources of additional information about borderline disorder, and guidelines for locating effective care, are provided on this website. Click here for borderline disorder resources.
In spite of a considerable amount of sound research evidence to the contrary, there are a number of popular myths about borderline disorder. Unfortunately, these myths increase the stigma associated with the disorder and discourage people with it from seeking effective care. These myths are presented and discussed on this website.