Emotionally unstable personality disorder

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. Individuals diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation (a feeling of detachment from reality), a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

The onset of BPD symptoms can be triggered by events that others might perceive as normal, with the disorder typically manifesting in early adulthood and persisting across diverse contexts. BPD is often comorbid with substance use disorders, depressive disorders, and eating disorders. BPD is associated with a substantial risk of suicide; an estimated 8 to 10 percent of individuals with BPD die by suicide, with males affected at twice the rate of females. Despite its severity, BPD faces significant stigmatization in both media portrayals and within the psychiatric field, potentially leading to its underdiagnosis.

The causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development. A genetic predisposition is evident, with the disorder being significantly more common in individuals with a family history of BPD, particularly immediate relatives. Psychosocial factors, particularly adverse childhood experiences, have been proposed. Neurologically, the underlying mechanism appears to involve the frontolimbic neuronal network of the limbic system. The American Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies BPD as a cluster B personality disorder, alongside antisocial, histrionic, and narcissistic personality disorders. There exists a small risk of misdiagnosis, with BPD most commonly confused with a mood disorder, substance use disorder, or other mental health disorders.

Therapeutic interventions for BPD predominantly involve psychotherapy, with cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) being the most effective modalities. This psychotherapy can occur one-on-one or in a group. Although pharmacotherapy cannot cure BPD, it may be employed to mitigate associated symptoms, with quetiapine and selective serotonin reuptake inhibitor (SSRI) antidepressants being commonly prescribed even though their efficacy is unclear. A 2020 meta-analysis found the use of medications was still unsupported by evidence. In severe cases, hospitalization may be necessitated, even if for only short periods.

BPD has a point prevalence of 1.6% and a lifetime prevalence of 5.9% of the global population, with a higher incidence rate among women compared to men in the clinical setting of up to three times. Despite the high utilization of healthcare resources by individuals with BPD, up to half may show significant improvement over a ten-year period with appropriate treatment. The naming of the disorder, particularly the suitability of the term borderline, is a subject of ongoing debate. Initially, the term reflected historical notions referring to borderline insanity and later described patients on the border between neurosis and psychosis. These interpretations are now regarded as outdated and clinically imprecise.