Emotionally unstable personality disorder or borderline personality disorder (BPD) is a personality disorder that affects impulse control, interpersonal relationships, and self-image. BPD is characterized by emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies.
The prevalence of BPD is estimated to be 1.6% in the general population and 20% in the inpatient psychiatric population . It is estimated that 10% of BPD patients commit suicide, which is 50% higher than that of the total population .
What causes borderline personality disorder?
The causes of BPD are complex and involve genetic factors and adverse childhood experiences that alter emotions and cause impulsivity leading to behavioral alterations and psychosocial struggles and deficits.
Studies using neuroimaging technologies identified differences in certain parts of the brain of BPD patients, including the amygdala, hippocampus, and medial temporal lobes. Neurobiological studies suggested the potential implication of serotonin in the pathogenesis of BPD .
1- Genetic Factors
Evidence of the involvement of genetics in BPD was provided by the study of identical and non-identical twins. A study showed that the rate of BPD in Identical twins is 70%, while it was only 7% for non-identical twins . These results were confirmed by other twin studies that reported a genetic heritability of 50% .
2- Adverse Childhood Experiences
Many patients with BPD reported experiences of traumatic neglect and abuse during their childhood, including childhood sexual abuse that represented 40-70% of the reported cases of BPD and difficulties reaching stable attachments or losing attachments figures (e.g., parents) .
Borderline Personality Disorder Symptoms
The symptoms of BPD are complex and involve affective, cognitive, behavioral, and interpersonal symptoms :
1- Affective Symptoms
These symptoms include intense and frequent episodes of uncontrolled and constant anger with repeated fights, chronic feelings of emptiness, and affective instability associated with anxiety and irritability.
1- Cognitive Symptoms
These symptoms are characterized by temporary stress-related feelings of being persecuted or harassed, or the presence of severe dissociative symptoms such as the feeling as if one is outside, one’s body, and loss of memory.
2- Behavioral Symptoms
These symptoms are associated with impulsivity and frequent suicidal behavior, gestures, or threats, or self-mutilating behavior.
3- Interpersonal Symptoms
These symptoms are associated with hysterical efforts to prevent real or imaginary abandonment but also the existence of unstable and intense interpersonal relationships that are characterized by a switch between extreme acts of devaluation and overestimation of an admired aspect of another person.
Diagnosis of Borderline Personality Disorder
Before performing a comprehensive psychiatric assessment, a careful history and physical examination are performed. Diagnostic screening tools for BPD are also used such as the Zanarini Rating Scale for borderline personality disorder . It has also been shown that patients with BPD have high rates of comorbid disorders:
- Mood disorders 80% to 96%
- Anxiety disorders 88%
- Substance abuse disorders 64%
- Eating disorders 53%
- Attention deficit hyperactivity disorder (ADHD) 10%-30%
- Bipolar disorder 15%
- Somatoform disorders 10%
Borderline personality disorder treatment
1- Psychosocial Interventions
These interventions involve mentalizing-based therapy (MBT) to help the emotional aspect of the patients, dialectical behavior therapy (DBT) that combines mindfulness practices with tangible interpersonal and emotion regulation skills, and transference-focused psychotherapy (TFP) to help make the patients aware of problems associated with interpersonal interactions.
So far, there are no medications that are approved to specifically treat BPD; however, medications such as SSRIs, mood stabilizers, and antipsychotics are used for the control of anxiety, depression, sleep disturbance, or psychotic symptoms .
Prognosis of Borderline Personality Disorder
Compared to other mental disorders such as bipolar disorder, BPD seems to have a better prognosis. A study has reported a remission of 75% of hospitalized patients who were included at the start of the study followed up was for 6 years.
The study also reported that only 6% of those who achieved remission had a later recurrence and only 4% of the patients committed suicide within the 6-year study period . Another study that included 290 patients with BPD, reported a remission of 35% after 2 years, 91% after 10 years, and 99% after 16 years.
Although borderline personality disorder is a severe mental disorder characterized by high rates of suicide, psychosocial interventions combined with pharmacotherapy to relieve symptoms such as anxiety, depression, and psychosis, have led to high rates of remission. However, while waiting for better and more cost-effective treatments, early intervention and prevention strategies during childhood or adolescence can certainly help the development of this disorder.
 Amad, A., Ramoz, N., Thomas, P., Jardri, R. and Gorwood, P., 2014. Genetics of borderline personality disorder: systematic review and proposal of an integrative model. Neuroscience & Biobehavioral Reviews, 40, pp.6-19.
 Zanarini, M.C., Yong, L., Frankenburg, F.R., Hennen, J., Reich, D.B., Marino, M.F. and Vujanovic, A.A., 2002. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. The Journal of nervous and mental disease, 190(6), pp.381-387.
 Zanarini, M.C., Frankenburg, F.R., Hennen, J. and Silk, K.R., 2003. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. American Journal of Psychiatry, 160(2), pp.274-283.
 Gunderson, J.G., Stout, R.L., McGlashan, T.H., Shea, M.T., Morey, L.C., Grilo, C.M., Zanarini, M.C., Yen, S., Markowitz, J.C., Sanislow, C. and Ansell, E., 2011. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of general psychiatry, 68(8), pp.827-837.