Borderline Personality Disorder

About Borderline Personality Disorder

Borderline personality disorder is characterized by a pervasive pattern of instability in relationships, self image and emotions, together with marked impulsivity, beginning by early adulthood. DSM-5 lists nine criteria, of which at least five are required: frantic efforts to avoid real or imagined abandonment, intense and unstable relationships that alternate between idealization and devaluation, an unstable sense of self, impulsivity in potentially self damaging areas, recurrent suicidal behavior or self harm, intense and rapidly shifting moods, chronic feelings of emptiness, intense or poorly controlled anger, and stress related paranoid thoughts or dissociation. Emotional dysregulation is often seen as the core feature. Self harm is common and often serves to relieve overwhelming distress, and the risk of suicide is substantially elevated, which makes access to effective care important. Research has described heightened amygdala reactivity and reduced prefrontal regulation of emotion. Dialectical behavior therapy, developed by the American psychologist Marsha Linehan, has the strongest evidence base and teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills. Mentalization based treatment, schema therapy and transference focused psychotherapy are other structured approaches. No medication is approved specifically for the disorder, but medications may be used for co occurring conditions. Long term studies show that many people improve considerably over time, challenging the older view that the condition is untreatable.