{"id":1721,"date":"2020-09-09T16:32:52","date_gmt":"2020-09-09T16:32:52","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=1721"},"modified":"2025-07-07T19:28:01","modified_gmt":"2025-07-07T19:28:01","slug":"borderline-personality-disorder","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/borderline-personality-disorder\/","title":{"raw":"Borderline Personality Disorder","rendered":"Borderline Personality Disorder"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe the characteristics and diagnosis of borderline personality disorder<\/li>\r\n<\/ul>\r\n<\/div>\r\nSo far, we have reviewed the Type B personality disorders related to impulsive, dramatic, emotional, or erratic behavior. Now we'll take a closer look at borderline personality disorder (BPD).\r\n<table summary=\"A table provides basic descriptions of the DSM-5 personality disorders and their associated clusters. Cluster A includes Paranoid (harbors a pervasive and unjustifiable suspiciousness and mistrust of others; reluctant to confide in or become close to others; reads hidden demeaning or threatening meaning into benign remarks or events; takes offense easily and bears grudges; not due to schizophrenia or other psychotic disorders), Schizoid (lacks interest and desire to form relationships with others; aloof and shows emotional coldness and detachment; indifferent to approval or criticism of others; lacks close friends or confidants; not due to schizophrenia or other psychotic disorders, not an autism spectrum disorder), and Schizotypal (exhibits eccentricities in thought, perception, emotion, speech, and behavior; shows suspiciousness or paranoia; has unusual perceptual experiences; speech is often idiosyncratic; displays inappropriate emotions; lacks friends or confidants; not due to schizophrenia or other psychotic disorder, or to autism spectrum disorder). Cluster B includes Antisocial (continuously violates the rights of others; history of antisocial tendencies prior to age 15; often lies, fights, and has problems with the law; impulsive and fails to think ahead; can be deceitful and manipulative in order to gain profit or pleasure; irresponsible and often fails to hold down a job or pay financial debts; lacks feelings for others and remorse over misdeeds), Histrionic (excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others\u2019 attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse; emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention), Narcissistic (overinflated and unjustified sense of self-importance and preoccupied with fantasies of success; believes he is entitled to special treatment from others; shows arrogant attitudes and behaviors; takes advantage of others; lacks empathy), and Borderline (unstable in self-image, mood, and behavior; cannot tolerate being alone and experiences chronic feelings of emptiness; unstable and intense relationships with others; behavior is impulsive, unpredictable, and sometimes self-damaging; shows inappropriate and intense anger; makes suicidal gestures). Cluster C includes Avoidant (socially inhibited and oversensitive to negative evaluation; avoids occupations that involve interpersonal contact because of fears of criticism or rejection; avoids relationships with others unless guaranteed to be accepted unconditionally; feels inadequate and views self as socially inept and unappealing; unwilling to take risks or engage in new activities if they may prove embarrassing), Dependent (allows others to take over and run her life; is submissive, clingy, and fears separation; cannot make decisions without advice and reassurance from others; lacks self-confidence; cannot do things on her own; feels uncomfortable or helpless when alone), and Obsessive-Compulsive (pervasive need for perfectionism that interferes with the ability to complete tasks; preoccupied with details, rules, order, and schedules; excessively devoted to work at the expense of leisure and friendships; rigid, inflexible, and stubborn; insists things be done his way; miserly with money).\"><caption>Table 1. DSM-5 Personality Disorders<\/caption>\r\n<thead><\/thead>\r\n<tbody>\r\n<tr>\r\n<td>Antisocial<\/td>\r\n<td>continuously violates the rights of others; history of antisocial tendencies prior to age 15; often lies, fights, and has problems with the law; impulsive and fails to think ahead; can be deceitful and manipulative in order to gain profit or pleasure; irresponsible and often fails to hold down a job or pay financial debts; lacks feelings for others and remorse over misdeeds<\/td>\r\n<td>B<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Histrionic<\/td>\r\n<td>excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others\u2019 attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse; emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention<\/td>\r\n<td>B<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Narcissistic<\/td>\r\n<td>overinflated and unjustified sense of self-importance and preoccupied with fantasies of success; feels entitled to special treatment from others; shows arrogant attitudes and behaviors; takes advantage of others; lacks empathy<\/td>\r\n<td>B<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Borderline<\/strong><\/td>\r\n<td>unstable in self-image, mood, and behavior; cannot tolerate being alone and experiences chronic feelings of emptiness; unstable and intense relationships with others; behavior is impulsive, unpredictable, and sometimes self-damaging; shows inappropriate and intense anger; makes suicidal gestures<\/td>\r\n<td>B<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Borderline Personality Disorder<\/h2>\r\n<b>Borderline personality disorder<\/b>\u00a0<strong>(BPD)<\/strong>\u00a0is a\u00a0mental illness\u00a0characterized by a long-term pattern of unstable\u00a0relationships, distorted\u00a0sense of self, and strong\u00a0emotional\u00a0reactions.\u00a0Those affected often engage in\u00a0self-harm\u00a0and other dangerous behavior.\u00a0They may also struggle with a feeling of\u00a0emptiness, fear of\u00a0abandonment, and\u00a0detachment from reality.\r\n\r\n[caption id=\"attachment_4095\" align=\"alignright\" width=\"446\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\"><img class=\"wp-image-4095\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\" alt=\"Photograph of a woman's face as she holds a mask in front of half her face.\" width=\"446\" height=\"286\" \/><\/a> <strong>Figure 1<\/strong>. Those with borderline personality disorder may quickly change their mood or behavior.[\/caption]\r\n\r\nThe DSM-5 diagnostic criteria for\u00a0borderline personality disorder is\r\n\r\nA. A pervasive pattern of instability of interpersonal relationships, self-image, and affects as well as marked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following:\r\n<ol>\r\n \t<li class=\"half_rhythm\">Intense fear of abandonment. This may lead to frantic efforts to keep people from leaving or pulling away, even if the fear isn\u2019t based in reality.<\/li>\r\n \t<li class=\"half_rhythm\">Unstable and intense relationships. A person may swing between idealizing others (seeing them as perfect) and devaluing them (seeing them as cruel or uncaring), often in a short span of time.<\/li>\r\n \t<li class=\"half_rhythm\">Unclear or shifting sense of self. The person may struggle to define who they are or what they value, and their goals, opinions, or identity may change frequently.<\/li>\r\n \t<li class=\"half_rhythm\">Risky or impulsive behaviors. These might include reckless spending, risky sex, substance use, binge eating, or unsafe driving. These behaviors are typically aimed at managing emotions but can cause serious harm.<\/li>\r\n \t<li class=\"half_rhythm\">Self-harming or suicidal behavior. Many people with BPD experience thoughts of suicide or engage in self-injury, such as cutting or burning, especially during emotional crises. This criteria is its <span class=\"s1\">own separate criterion, <\/span>not to be double-counted in impulsivity or fear of abandonment.<\/li>\r\n \t<li class=\"half_rhythm\">Extreme emotional reactivity. Moods may shift rapidly \u2014 for example, going from feeling okay to deeply sad or angry \u2014 often in response to interpersonal stress. These mood changes usually last for hours or a day, not weeks.<\/li>\r\n \t<li class=\"half_rhythm\">Chronic feelings of emptiness. Some people with BPD describe feeling \u201chollow\u201d or like they don\u2019t exist, even when life seems to be going well.<\/li>\r\n \t<li class=\"half_rhythm\">Explosive or inappropriate anger. This can include frequent temper outbursts, sarcasm, bitterness, or physical fights that are hard to control or out of proportion to the situation.<\/li>\r\n \t<li class=\"half_rhythm\">Paranoia or disconnection from reality. Under stress, a person might feel suspicious of others, disconnected from their surroundings, or unsure of what\u2019s real (a symptom known as dissociation).<\/li>\r\n<\/ol>\r\n<h3 id=\"_article-27054_s8_\" class=\"ui-helper-clearfix\">Differential Diagnosis<\/h3>\r\nWhen considering a diagnosis of borderline personality disorder, the differential diagnosis should always include other personality disorders since overlap is common, especially within Cluster B. Other diagnostic considerations include\r\n<ul>\r\n \t<li class=\"half_rhythm\">\r\n<div>substance use disorder<\/div><\/li>\r\n \t<li class=\"half_rhythm\">\r\n<div>non-suicidal self-injury disorder (a time-limited phenomenon in many patients)<\/div><\/li>\r\n \t<li class=\"half_rhythm\">\r\n<div>bipolar disorder (five times less prevalent, but comorbidity approaches 15%)<\/div><\/li>\r\n \t<li class=\"half_rhythm\">\r\n<div>autism spectrum disorder (patients with congenital deficits in theory of mind may also show severe mood dysregulation)<\/div><\/li>\r\n<\/ul>\r\n<div class=\"textbox examples\">\r\n<h3>Watch IT<\/h3>\r\nThis video provides an overview of borderline personality disorder and also explains how it is differentiated from bipolar disorder.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?ad_autoplay=0&amp;ad_default_source_volume_control=0&amp;ad_source_volume_control=0&amp;mf=5576211&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=DueVQLcrFPU&amp;video_src=&amp;video_target=tpm-plugin-yjky65ei-DueVQLcrFPU\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WhatIsBorderlinePersonalityDisorder_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"What is Borderline Personality Disorder?\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h3>Epidemiology<\/h3>\r\nThe behavior in BPD typically begins by early adulthood and occurs across a variety of situations.<sup id=\"cite_ref-DSM5_5-5\" class=\"reference\"><\/sup>\u00a0Substance abuse,\u00a0depression, and\u00a0eating disorders\u00a0are commonly associated with BPD.\u00a0<sup id=\"cite_ref-NIH2016_4-11\" class=\"reference\"><\/sup>Approximately 10% of people affected with the disorder commit suicide.\u00a0<sup id=\"cite_ref-NIH2016_4-12\" class=\"reference\"><\/sup><sup id=\"cite_ref-DSM5_5-6\" class=\"reference\"><\/sup>There is a genetic predisposition for the disorder. Twin studies show over 50% heritability (greater than that for major depression). Twin studies performed in 2000 and 2008 both demonstrated higher\u00a0concordance of the rate of\u00a0borderline\u00a0personality disorder\u00a0for monozygotic versus dizygotic twins. Environmental factors that have been identified as contributing to the development of\u00a0borderline\u00a0personality disorder\u00a0include primarily childhood maltreatment (physical, sexual, or neglect), found in up to 70% of people with BPD, as well as maternal separation, poor maternal attachment, inappropriate family boundaries, parental substance abuse, and serious parental psychopathology.\r\n\r\nApproximately\u00a01.6% of people have BPD in a given year, with some estimates as high as 6%.\u00a0Women are diagnosed about three times as often as men.\u00a0The disorder appears to become less common among older people.\u00a0Up to half of those with BPD improve over a 10-year period.\r\n<h3>Etiology<\/h3>\r\nThe causes of BPD are unclear but seem to involve genetic, environmental, and social factors.\u00a0It occurs about five times more often in a person who has an affected close relative.\u00a0<sup id=\"cite_ref-NIH2016_4-14\" class=\"reference\"><\/sup>Adverse life events appear to also play a role.<sup id=\"cite_ref-Lei2011_7-1\" class=\"reference\"><\/sup>\r\n\r\nAs is the case with other mental disorders, the causes of BPD are complex and not fully agreed upon.\u00a0Evidence suggests that BPD and PTSD may be related in some way.\u00a0Most researchers agree that a history of childhood trauma can be a contributing factor.\r\n<h3>Comorbidity<\/h3>\r\nPatients with borderline personality disorder have been shown to have high rates of comorbid disorders:\r\n<ul>\r\n \t<li>mood disorders: 80% to 96%\r\n\r\n[caption id=\"attachment_4319\" align=\"alignright\" width=\"162\"]<img class=\"wp-image-4319\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/09\/13061815\/venn-diagram-41217_1280-286x300.png\" alt=\"A venn-diagram with three overlapping circles.\" width=\"162\" height=\"170\" \/> <strong>Figure 2.<\/strong> BPD can exist simultaneously with other disorders in a patient.[\/caption]<\/li>\r\n \t<li>anxiety disorders: 88%<\/li>\r\n \t<li>substance abuse disorders: 64%<\/li>\r\n \t<li>eating disorders: 53%<\/li>\r\n \t<li>attention deficit hyperactivity disorder (ADHD): 10\u201330%<\/li>\r\n \t<li>bipolar disorder: 15%<\/li>\r\n \t<li>somatoform disorders: 10%<\/li>\r\n<\/ul>\r\n<span style=\"color: #6c64ad; font-size: 1em; font-weight: 600;\">Treatment<\/span>\r\n\r\nTreatment of borderline personality disorder\u00a0relies on psychotherapy. Three evidence-based therapies are effective for patients with\u00a0borderline personality disorder. First, mentalizing-based therapy (MBT) helps patients manage emotion dysregulation by feeling understood, allowing them to be more curious and make fewer assumptions about the intentions of the people around them. A second therapy, dialectical behavior therapy (DBT) combines mindfulness practices with concrete interpersonal and emotion regulation skills. Third, transference-focused psychotherapy (TFP) focuses on using the patient\u2013therapist relationship to develop the patient's awareness of problematic interpersonal dynamics. MBT and DBT each incorporate individual and group treatment over 12 to 18 months. For adolescents, family therapy may be an appropriate substitute for group therapy, though not always.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/d7bd23ed-607d-490b-8c9e-879c265e79c5\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/500ec2b7-223f-4668-8853-0dcb6cb327f3\r\n\r\n<\/div>\r\n<section>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways:\u00a0borderline\u00a0personality disorder<\/h3>\r\n<h4>DSM-5 Criteria:<\/h4>\r\nCharacterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior.\r\n<h4>Epidemiology:<\/h4>\r\nThe prevalence of borderline personality disorder in the general population is 1.6% with a lifetime prevalence of 5.9%.\r\n<h4>Etiology:<\/h4>\r\nBorderline personality disorder is multifactorial in etiology, including genetic, environmental, and social factors.\r\n<h4>Treatment:<\/h4>\r\nLong-term psychotherapy is currently the treatment of choice for BPD.<sup id=\"cite_ref-BPD_therapies_141-0\" class=\"reference\"><\/sup>\r\n\r\n<\/div>\r\n<div class=\"textbox exercises\">\r\n<h3>Case Study: BPD<\/h3>\r\nA 23-year-old woman, Nikki, reacted with depressive symptoms and suicidal thoughts\u00a0after the death of her grandfather. She was treated with antidepressant medication without addressing the loss. Three years later and after a suicidal attempt, she was admitted to a hospital where she first presented with depressed mood and suicidal thoughts, but quickly engaged in vivid conversations with the other patients. Nikki was discharged with the diagnosis of personality disorder, but soon re-admitted because of suicidal thoughts, and referred to an outpatient program specialized in the treatment of personality disorders.\r\n\r\nSince childhood, Nikki has displayed unstable moods, aggressive temperament, and self-destructive behaviors (headbanging). At the age of 10, she was sexually abused by an older man. Suicidal thoughts and urges to kill herself\u00a0were first experienced at age 11. Since age 13, she has had multiple sexual partners but also\u00a0a seven-year long relationship, which was quite unstable with frequent conflicts and impulsive acts. Nikki dropped out of school and has been living on\u00a0disability benefits, interrupted by short periods of employment.\r\n\r\nIn a two-year psychoanalytic treatment program, with one individual session and one group session each week,<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Nikki worked together with other patients on identifying and understanding the characteristic features of borderline personality disorder.\u00a0Her self-destructive behavior tapered off after three months as she began to process her feelings of aggression and sadness. The pharmacological treatment terminated after six months and she quickly became less sedated and anxious. Nikki resumed school towards the end of the first year of treatment, with the intention of taking a degree in teaching. The relationship with her boyfriend stabilized. Contacts with class became more satisfying, and conflicts with her teachers stopped. Her ability to begin to contain feelings increased dramatically.<\/span>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/d52d8734-7955-4d77-bbf1-40566f0386dc\r\n\r\n<\/div>\r\n<\/section>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>borderline personality disorder: <\/strong>characterized by instability in interpersonal relationships, self-image, and mood, as well as impulsivity; key features include intolerance of being alone and fear of abandonment, unstable relationships, unpredictable behavior and moods, and intense and inappropriate anger\r\n\r\n<strong>personality disorders:<\/strong> a\u00a0class of\u00a0mental disorders\u00a0characterized by enduring\u00a0maladaptive\u00a0patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture; patterns develop early, are inflexible, and are associated with significant distress or disability\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe the characteristics and diagnosis of borderline personality disorder<\/li>\n<\/ul>\n<\/div>\n<p>So far, we have reviewed the Type B personality disorders related to impulsive, dramatic, emotional, or erratic behavior. Now we&#8217;ll take a closer look at borderline personality disorder (BPD).<\/p>\n<table summary=\"A table provides basic descriptions of the DSM-5 personality disorders and their associated clusters. Cluster A includes Paranoid (harbors a pervasive and unjustifiable suspiciousness and mistrust of others; reluctant to confide in or become close to others; reads hidden demeaning or threatening meaning into benign remarks or events; takes offense easily and bears grudges; not due to schizophrenia or other psychotic disorders), Schizoid (lacks interest and desire to form relationships with others; aloof and shows emotional coldness and detachment; indifferent to approval or criticism of others; lacks close friends or confidants; not due to schizophrenia or other psychotic disorders, not an autism spectrum disorder), and Schizotypal (exhibits eccentricities in thought, perception, emotion, speech, and behavior; shows suspiciousness or paranoia; has unusual perceptual experiences; speech is often idiosyncratic; displays inappropriate emotions; lacks friends or confidants; not due to schizophrenia or other psychotic disorder, or to autism spectrum disorder). Cluster B includes Antisocial (continuously violates the rights of others; history of antisocial tendencies prior to age 15; often lies, fights, and has problems with the law; impulsive and fails to think ahead; can be deceitful and manipulative in order to gain profit or pleasure; irresponsible and often fails to hold down a job or pay financial debts; lacks feelings for others and remorse over misdeeds), Histrionic (excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others\u2019 attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse; emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention), Narcissistic (overinflated and unjustified sense of self-importance and preoccupied with fantasies of success; believes he is entitled to special treatment from others; shows arrogant attitudes and behaviors; takes advantage of others; lacks empathy), and Borderline (unstable in self-image, mood, and behavior; cannot tolerate being alone and experiences chronic feelings of emptiness; unstable and intense relationships with others; behavior is impulsive, unpredictable, and sometimes self-damaging; shows inappropriate and intense anger; makes suicidal gestures). Cluster C includes Avoidant (socially inhibited and oversensitive to negative evaluation; avoids occupations that involve interpersonal contact because of fears of criticism or rejection; avoids relationships with others unless guaranteed to be accepted unconditionally; feels inadequate and views self as socially inept and unappealing; unwilling to take risks or engage in new activities if they may prove embarrassing), Dependent (allows others to take over and run her life; is submissive, clingy, and fears separation; cannot make decisions without advice and reassurance from others; lacks self-confidence; cannot do things on her own; feels uncomfortable or helpless when alone), and Obsessive-Compulsive (pervasive need for perfectionism that interferes with the ability to complete tasks; preoccupied with details, rules, order, and schedules; excessively devoted to work at the expense of leisure and friendships; rigid, inflexible, and stubborn; insists things be done his way; miserly with money).\">\n<caption>Table 1. DSM-5 Personality Disorders<\/caption>\n<thead><\/thead>\n<tbody>\n<tr>\n<td>Antisocial<\/td>\n<td>continuously violates the rights of others; history of antisocial tendencies prior to age 15; often lies, fights, and has problems with the law; impulsive and fails to think ahead; can be deceitful and manipulative in order to gain profit or pleasure; irresponsible and often fails to hold down a job or pay financial debts; lacks feelings for others and remorse over misdeeds<\/td>\n<td>B<\/td>\n<\/tr>\n<tr>\n<td>Histrionic<\/td>\n<td>excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others\u2019 attention; behavior is often inappropriately seductive or provocative; speech is highly emotional but often vague and diffuse; emotions are shallow and often shift rapidly; may alienate friends with demands for constant attention<\/td>\n<td>B<\/td>\n<\/tr>\n<tr>\n<td>Narcissistic<\/td>\n<td>overinflated and unjustified sense of self-importance and preoccupied with fantasies of success; feels entitled to special treatment from others; shows arrogant attitudes and behaviors; takes advantage of others; lacks empathy<\/td>\n<td>B<\/td>\n<\/tr>\n<tr>\n<td><strong>Borderline<\/strong><\/td>\n<td>unstable in self-image, mood, and behavior; cannot tolerate being alone and experiences chronic feelings of emptiness; unstable and intense relationships with others; behavior is impulsive, unpredictable, and sometimes self-damaging; shows inappropriate and intense anger; makes suicidal gestures<\/td>\n<td>B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Borderline Personality Disorder<\/h2>\n<p><b>Borderline personality disorder<\/b>\u00a0<strong>(BPD)<\/strong>\u00a0is a\u00a0mental illness\u00a0characterized by a long-term pattern of unstable\u00a0relationships, distorted\u00a0sense of self, and strong\u00a0emotional\u00a0reactions.\u00a0Those affected often engage in\u00a0self-harm\u00a0and other dangerous behavior.\u00a0They may also struggle with a feeling of\u00a0emptiness, fear of\u00a0abandonment, and\u00a0detachment from reality.<\/p>\n<div id=\"attachment_4095\" style=\"width: 456px\" class=\"wp-caption alignright\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4095\" class=\"wp-image-4095\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\" alt=\"Photograph of a woman's face as she holds a mask in front of half her face.\" width=\"446\" height=\"286\" \/><\/a><\/p>\n<p id=\"caption-attachment-4095\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Those with borderline personality disorder may quickly change their mood or behavior.<\/p>\n<\/div>\n<p>The DSM-5 diagnostic criteria for\u00a0borderline personality disorder is<\/p>\n<p>A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects as well as marked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following:<\/p>\n<ol>\n<li class=\"half_rhythm\">Intense fear of abandonment. This may lead to frantic efforts to keep people from leaving or pulling away, even if the fear isn\u2019t based in reality.<\/li>\n<li class=\"half_rhythm\">Unstable and intense relationships. A person may swing between idealizing others (seeing them as perfect) and devaluing them (seeing them as cruel or uncaring), often in a short span of time.<\/li>\n<li class=\"half_rhythm\">Unclear or shifting sense of self. The person may struggle to define who they are or what they value, and their goals, opinions, or identity may change frequently.<\/li>\n<li class=\"half_rhythm\">Risky or impulsive behaviors. These might include reckless spending, risky sex, substance use, binge eating, or unsafe driving. These behaviors are typically aimed at managing emotions but can cause serious harm.<\/li>\n<li class=\"half_rhythm\">Self-harming or suicidal behavior. Many people with BPD experience thoughts of suicide or engage in self-injury, such as cutting or burning, especially during emotional crises. This criteria is its <span class=\"s1\">own separate criterion, <\/span>not to be double-counted in impulsivity or fear of abandonment.<\/li>\n<li class=\"half_rhythm\">Extreme emotional reactivity. Moods may shift rapidly \u2014 for example, going from feeling okay to deeply sad or angry \u2014 often in response to interpersonal stress. These mood changes usually last for hours or a day, not weeks.<\/li>\n<li class=\"half_rhythm\">Chronic feelings of emptiness. Some people with BPD describe feeling \u201chollow\u201d or like they don\u2019t exist, even when life seems to be going well.<\/li>\n<li class=\"half_rhythm\">Explosive or inappropriate anger. This can include frequent temper outbursts, sarcasm, bitterness, or physical fights that are hard to control or out of proportion to the situation.<\/li>\n<li class=\"half_rhythm\">Paranoia or disconnection from reality. Under stress, a person might feel suspicious of others, disconnected from their surroundings, or unsure of what\u2019s real (a symptom known as dissociation).<\/li>\n<\/ol>\n<h3 id=\"_article-27054_s8_\" class=\"ui-helper-clearfix\">Differential Diagnosis<\/h3>\n<p>When considering a diagnosis of borderline personality disorder, the differential diagnosis should always include other personality disorders since overlap is common, especially within Cluster B. Other diagnostic considerations include<\/p>\n<ul>\n<li class=\"half_rhythm\">\n<div>substance use disorder<\/div>\n<\/li>\n<li class=\"half_rhythm\">\n<div>non-suicidal self-injury disorder (a time-limited phenomenon in many patients)<\/div>\n<\/li>\n<li class=\"half_rhythm\">\n<div>bipolar disorder (five times less prevalent, but comorbidity approaches 15%)<\/div>\n<\/li>\n<li class=\"half_rhythm\">\n<div>autism spectrum disorder (patients with congenital deficits in theory of mind may also show severe mood dysregulation)<\/div>\n<\/li>\n<\/ul>\n<div class=\"textbox examples\">\n<h3>Watch IT<\/h3>\n<p>This video provides an overview of borderline personality disorder and also explains how it is differentiated from bipolar disorder.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?ad_autoplay=0&amp;ad_default_source_volume_control=0&amp;ad_source_volume_control=0&amp;mf=5576211&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=DueVQLcrFPU&amp;video_src=&amp;video_target=tpm-plugin-yjky65ei-DueVQLcrFPU\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WhatIsBorderlinePersonalityDisorder_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;What is Borderline Personality Disorder?&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h3>Epidemiology<\/h3>\n<p>The behavior in BPD typically begins by early adulthood and occurs across a variety of situations.<sup id=\"cite_ref-DSM5_5-5\" class=\"reference\"><\/sup>\u00a0Substance abuse,\u00a0depression, and\u00a0eating disorders\u00a0are commonly associated with BPD.\u00a0<sup id=\"cite_ref-NIH2016_4-11\" class=\"reference\"><\/sup>Approximately 10% of people affected with the disorder commit suicide.\u00a0<sup id=\"cite_ref-NIH2016_4-12\" class=\"reference\"><\/sup><sup id=\"cite_ref-DSM5_5-6\" class=\"reference\"><\/sup>There is a genetic predisposition for the disorder. Twin studies show over 50% heritability (greater than that for major depression). Twin studies performed in 2000 and 2008 both demonstrated higher\u00a0concordance of the rate of\u00a0borderline\u00a0personality disorder\u00a0for monozygotic versus dizygotic twins. Environmental factors that have been identified as contributing to the development of\u00a0borderline\u00a0personality disorder\u00a0include primarily childhood maltreatment (physical, sexual, or neglect), found in up to 70% of people with BPD, as well as maternal separation, poor maternal attachment, inappropriate family boundaries, parental substance abuse, and serious parental psychopathology.<\/p>\n<p>Approximately\u00a01.6% of people have BPD in a given year, with some estimates as high as 6%.\u00a0Women are diagnosed about three times as often as men.\u00a0The disorder appears to become less common among older people.\u00a0Up to half of those with BPD improve over a 10-year period.<\/p>\n<h3>Etiology<\/h3>\n<p>The causes of BPD are unclear but seem to involve genetic, environmental, and social factors.\u00a0It occurs about five times more often in a person who has an affected close relative.\u00a0<sup id=\"cite_ref-NIH2016_4-14\" class=\"reference\"><\/sup>Adverse life events appear to also play a role.<sup id=\"cite_ref-Lei2011_7-1\" class=\"reference\"><\/sup><\/p>\n<p>As is the case with other mental disorders, the causes of BPD are complex and not fully agreed upon.\u00a0Evidence suggests that BPD and PTSD may be related in some way.\u00a0Most researchers agree that a history of childhood trauma can be a contributing factor.<\/p>\n<h3>Comorbidity<\/h3>\n<p>Patients with borderline personality disorder have been shown to have high rates of comorbid disorders:<\/p>\n<ul>\n<li>mood disorders: 80% to 96%\n<div id=\"attachment_4319\" style=\"width: 172px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4319\" class=\"wp-image-4319\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/09\/13061815\/venn-diagram-41217_1280-286x300.png\" alt=\"A venn-diagram with three overlapping circles.\" width=\"162\" height=\"170\" \/><\/p>\n<p id=\"caption-attachment-4319\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong> BPD can exist simultaneously with other disorders in a patient.<\/p>\n<\/div>\n<\/li>\n<li>anxiety disorders: 88%<\/li>\n<li>substance abuse disorders: 64%<\/li>\n<li>eating disorders: 53%<\/li>\n<li>attention deficit hyperactivity disorder (ADHD): 10\u201330%<\/li>\n<li>bipolar disorder: 15%<\/li>\n<li>somatoform disorders: 10%<\/li>\n<\/ul>\n<p><span style=\"color: #6c64ad; font-size: 1em; font-weight: 600;\">Treatment<\/span><\/p>\n<p>Treatment of borderline personality disorder\u00a0relies on psychotherapy. Three evidence-based therapies are effective for patients with\u00a0borderline personality disorder. First, mentalizing-based therapy (MBT) helps patients manage emotion dysregulation by feeling understood, allowing them to be more curious and make fewer assumptions about the intentions of the people around them. A second therapy, dialectical behavior therapy (DBT) combines mindfulness practices with concrete interpersonal and emotion regulation skills. Third, transference-focused psychotherapy (TFP) focuses on using the patient\u2013therapist relationship to develop the patient&#8217;s awareness of problematic interpersonal dynamics. MBT and DBT each incorporate individual and group treatment over 12 to 18 months. For adolescents, family therapy may be an appropriate substitute for group therapy, though not always.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_d7bd23ed-607d-490b-8c9e-879c265e79c5\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/d7bd23ed-607d-490b-8c9e-879c265e79c5?iframe_resize_id=assessment_practice_id_d7bd23ed-607d-490b-8c9e-879c265e79c5\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_500ec2b7-223f-4668-8853-0dcb6cb327f3\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/500ec2b7-223f-4668-8853-0dcb6cb327f3?iframe_resize_id=assessment_practice_id_500ec2b7-223f-4668-8853-0dcb6cb327f3\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<section>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways:\u00a0borderline\u00a0personality disorder<\/h3>\n<h4>DSM-5 Criteria:<\/h4>\n<p>Characterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior.<\/p>\n<h4>Epidemiology:<\/h4>\n<p>The prevalence of borderline personality disorder in the general population is 1.6% with a lifetime prevalence of 5.9%.<\/p>\n<h4>Etiology:<\/h4>\n<p>Borderline personality disorder is multifactorial in etiology, including genetic, environmental, and social factors.<\/p>\n<h4>Treatment:<\/h4>\n<p>Long-term psychotherapy is currently the treatment of choice for BPD.<sup id=\"cite_ref-BPD_therapies_141-0\" class=\"reference\"><\/sup><\/p>\n<\/div>\n<div class=\"textbox exercises\">\n<h3>Case Study: BPD<\/h3>\n<p>A 23-year-old woman, Nikki, reacted with depressive symptoms and suicidal thoughts\u00a0after the death of her grandfather. She was treated with antidepressant medication without addressing the loss. Three years later and after a suicidal attempt, she was admitted to a hospital where she first presented with depressed mood and suicidal thoughts, but quickly engaged in vivid conversations with the other patients. Nikki was discharged with the diagnosis of personality disorder, but soon re-admitted because of suicidal thoughts, and referred to an outpatient program specialized in the treatment of personality disorders.<\/p>\n<p>Since childhood, Nikki has displayed unstable moods, aggressive temperament, and self-destructive behaviors (headbanging). At the age of 10, she was sexually abused by an older man. Suicidal thoughts and urges to kill herself\u00a0were first experienced at age 11. Since age 13, she has had multiple sexual partners but also\u00a0a seven-year long relationship, which was quite unstable with frequent conflicts and impulsive acts. Nikki dropped out of school and has been living on\u00a0disability benefits, interrupted by short periods of employment.<\/p>\n<p>In a two-year psychoanalytic treatment program, with one individual session and one group session each week,<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Nikki worked together with other patients on identifying and understanding the characteristic features of borderline personality disorder.\u00a0Her self-destructive behavior tapered off after three months as she began to process her feelings of aggression and sadness. The pharmacological treatment terminated after six months and she quickly became less sedated and anxious. Nikki resumed school towards the end of the first year of treatment, with the intention of taking a degree in teaching. The relationship with her boyfriend stabilized. Contacts with class became more satisfying, and conflicts with her teachers stopped. Her ability to begin to contain feelings increased dramatically.<\/span><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_d52d8734-7955-4d77-bbf1-40566f0386dc\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/d52d8734-7955-4d77-bbf1-40566f0386dc?iframe_resize_id=assessment_practice_id_d52d8734-7955-4d77-bbf1-40566f0386dc\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<\/section>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>borderline personality disorder: <\/strong>characterized by instability in interpersonal relationships, self-image, and mood, as well as impulsivity; key features include intolerance of being alone and fear of abandonment, unstable relationships, unpredictable behavior and moods, and intense and inappropriate anger<\/p>\n<p><strong>personality disorders:<\/strong> a\u00a0class of\u00a0mental disorders\u00a0characterized by enduring\u00a0maladaptive\u00a0patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual&#8217;s culture; patterns develop early, are inflexible, and are associated with significant distress or disability<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1721\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Personality Disorders. <strong>Authored by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:OBtWuv0R@5\/Personality-Disorders\">http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:OBtWuv0R@5\/Personality-Disorders<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@5.48<\/li><li>Self-portrait image. <strong>Authored by<\/strong>: Sodanie Chea. <strong>Provided by<\/strong>: Flickr. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.flickr.com\/photos\/sodaniechea\/7370270038\">https:\/\/www.flickr.com\/photos\/sodaniechea\/7370270038<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Textbook of Psychiatry. <strong>Authored by<\/strong>: Wikibooks. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikibooks.org\/wiki\/Textbook_of_Psychiatry\/Print_version#Cluster_B\">https:\/\/en.wikibooks.org\/wiki\/Textbook_of_Psychiatry\/Print_version#Cluster_B<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Venn diagram. <strong>Authored by<\/strong>: Clker-Free-Vector-Images. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/vectors\/venn-diagram-set-diagram-diagrams-41217\/\">https:\/\/pixabay.com\/vectors\/venn-diagram-set-diagram-diagrams-41217\/<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Pixabay License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>What is Borderline Personality Disorder?. <strong>Authored by<\/strong>: Chi Health. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/youtu.be\/DueVQLcrFPU\">https:\/\/youtu.be\/DueVQLcrFPU<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":29,"menu_order":11,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Personality Disorders\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:OBtWuv0R@5\/Personality-Disorders\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/contents\/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@5.48\"},{\"type\":\"cc\",\"description\":\"Self-portrait image\",\"author\":\"Sodanie Chea\",\"organization\":\"Flickr\",\"url\":\"https:\/\/www.flickr.com\/photos\/sodaniechea\/7370270038\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Textbook of Psychiatry\",\"author\":\"Wikibooks\",\"organization\":\"\",\"url\":\"https:\/\/en.wikibooks.org\/wiki\/Textbook_of_Psychiatry\/Print_version#Cluster_B\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"What is Borderline Personality Disorder?\",\"author\":\"Chi Health\",\"organization\":\"\",\"url\":\"https:\/\/youtu.be\/DueVQLcrFPU\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"cc\",\"description\":\"Venn diagram\",\"author\":\"Clker-Free-Vector-Images\",\"organization\":\"\",\"url\":\"https:\/\/pixabay.com\/vectors\/venn-diagram-set-diagram-diagrams-41217\/\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Pixabay License\"}]","CANDELA_OUTCOMES_GUID":"58ad61b6-ab72-4898-b3d6-2bc3e3649b7a, 1bffb582-0e0c-45a9-910c-5da00e4314a9","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1721","chapter","type-chapter","status-publish","hentry"],"part":154,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1721","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":23,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1721\/revisions"}],"predecessor-version":[{"id":7637,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1721\/revisions\/7637"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/154"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1721\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=1721"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=1721"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=1721"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=1721"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}