A recent issue of JAMA (Journal of the American Medical Association) includes an article: “Borderline Personality Disorder: A Review.”
Borderline personality disorder (BPD) is characterized by alterations in self-image and interpersonal relationships marked by sudden shifts between extremes of idealization (extremely positive views about the self or others) and devaluation (extremely negative views about the self or others).
People with BPD typically experience intense anxiety, irritability, or dysphoria as well as impulsive behavior with regard to spending, sexual activity, substance misuse, or binge eating. Borderline personality disorder affects approximately 0.7% to 2.7% of adults.
This Review summarizes current evidence regarding the epidemiology, pathophysiology, diagnosis, and treatment of BPD in adults.
Here is the abstract:
Importance Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services.
Observations Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (e.g., experience of unreality of one’s self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semi structured interviews.
Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%).
The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD.
Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between −0.60 and −0.65.
There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, e.g., major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed.
For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam.
Conclusions and Relevance Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
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