Borderline personality disorder (BPD)

Borderline personality disorder (BPD) is a disorder associated with neurodevelopment. It is thought to be the result of the interaction between biologically determined vulnerability and a series of stressful environmental circumstances that compromise an individual’s emotional maturation process. During adolescence, the person demonstrates a lower capacity to manage negative emotions than might be expected for their age and develops a pattern of interpersonal relationships characterised by instability and dependence. In this context, behaviours begin to manifest themselves that show little ability to adapt in order to control discomfort, such as self-harm or drug use, which have a negative effect on the way the person functions at different levels: family relationships, academic performance, affective life and social life. In addition, early manifestations of BPD tend to be associated with greater impulsiveness, meaning that the risk of suicidal behaviour is very high. Left untreated, the evolution of the disorder throughout life is associated with significant deficiencies at all levels and will require more complex therapeutic approaches compared to those that may be applied in adolescents or young adults.

Symptoms

The psychopathology of BPD can be placed into three clinical groups according to the diagnostic criteria of the disorder:

1. Emotional dysregulation, which includes affective instability, inappropriate anger and fear of abandonment.

2. Altered relationships, which include unstable relationships, change of identity, chronic feelings of emptiness and cognitive alterations related to stress.

3. Behavioural dysregulation, which includes self-harming and impulsive behaviour in at least two adaptive areas.

How is affected by the condition?

The prevalence of BPD in the general adult population is between 1.4% and 5.9%, making it the most diagnosed Personality Disorder (PD) at the different healthcare levels. Among adolescents, BPD has a prevalence of between 0.7 and 2.7%. Females are more frequently diagnosed with BPD. Males with BPD are often diagnosed with other disorders in error and thus there is not thought to be any real difference between the sexes.

Diagnosis

Diagnosis is based on clinical criteria identified during a strict medical history conducted by specialists. It is important to identify the presence of dysfunctional personal traits from adolescence or early adulthood. It is advisable to supplement the medical history with structured interviews to explore the psychopathology of the BPD as well as the other PDs and psychopathological disorders of a similar clinical nature, to make a differential diagnosis and to be able to treat it properly.

Typical treatment

The treatment of choice is psychotherapeutic. Psychopharmaceuticals, especially atypical antipsychotics, increase the efficacy of psychotherapy by facilitating patient control. There are psychotherapies specifically designed to treat BPD, such as dialectical behaviour therapy (DBT), mentalisation based treatment and transference focused psychotherapy. The aim of these therapies is to improve the capacity to manage negative emotions and interpersonal relationships.

Typical tests

Clinical history. Structured psychopathology interview. Neuropsychological examination. Blood test and urinalysis. Vital signs and anthropometric measurements.

Prevention

Early identification and treatment of behaviours or disorders associated with a greater risk of developing BPD are important, such as self-harming or Attention Deficit Hyperactivity Disorder (ADHD). Strategies aimed at avoiding drug and alcohol consumption should be explored, as these are the main factors contributing to a poor prognosis in BPD. Adults with a long history of BPD should work towards preventing deterioration of psychosocial functioning.