Borderline Personality Disorder

Individuals with borderline personality disorder suffer from instability in relationships, self-image, affect, and impulse control.

Epidemiology

Lifetime prevalence is 1 % to 2% of the general population.

Etiology

Borderline personality disorder is about five times as common among first-degree relatives of borderline patients. In addition, this disorder shows increased rates in families of alcoholics and families of individuals with ASP, as well as in families with mood disorders. Females with borderline personality disorder frequently have suffered from sexual or physical abuse or both.

Clinical Manifestations

History and Mental Status Examination
Individuals with borderline personality disorder suffer from a legion of symptoms. Their relationships are infused with anger, fear of abandonment, and shifting idealization and devaluation. Their self- image is inchoate, fragmented, and unstable with consequent unpredictable changes in relationships, goals, and values. They are affectively unstable and reactive, with anger, depression, and panic prominent. Their impulsiveness can result in many unsafe behaviors, including drug use, promiscuity, gambling, and other risk-taking behavior. Their self-destructive urges result in frequent suicidal and parasuicidal behavior (such as superficial cutting or burning or nonfatal overdoses in which the intent is not lethal).

They also demonstrate brief paranoia and dissociative symptoms. Suicide attempts can be frequent before the age of 30, and suicide rates approach 10% over a lifetime. The principal intrapsychic defenses they use are primitive with gross denial, distortion, projection, and splitting prominent. Patients may have a broad range of comorbid illnesses, including substance abuse, mood disorders, and eating disorders.

Differential Diagnosis

Mood disorders and behavioral changes due to active substance abuse are the principal differential diagnostic considerations. The diagnostic clues are unstable relationships, unstable self-image, unstable affect, and unstable or impulsive behaviors.