Borderline Personality Disorder
Introduction[edit | edit source]
Borderline personality disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as “a pervasive pattern of instability in interpersonal relationships, self-image, and affects, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts.”[1]
The DSM categorizes borderline personality disorder as one of 10 personality disorders, which are separate mental illnesses that all cause difficulty with the patients ability to relate to others in healthy ways, resulting in distress or impact on functioning.[2] To note, the 2019 revision of the International Classification of Diseases (ICD-11) does not recognize borderline personality disorder as a separate condition, instead classing all personality disorders as one condition classified by severity.[3] However, at present borderline personality disorder is still treated as a recognized specific condition both in practice and in research. [4]
Etiology[edit | edit source]
It is believed borderline personality disorder is caused by the combination of genetic predisposition, neurobiological dysfunction and environmental factors. [5]
There is a higher risk if it runs in your immediate family, with one study finding a 46% heritability.[6] So far, research has identified two genes DPYD and PKP4 linked with increasing the risk of developing BPD, but it is worth noting these are also linked with the risk of developing schizophrenia and bipolar disorder.[7] The amygdala, hippocampus and orbitofrontal cortex have been identified as either being smaller or having unusual levels of activity in many patients with borderline personality disorder.[8] Impaired serotonin function has also been found in this patient group.[5]The environmental risk factors are predominantly from childhood, including physical or sexual assault, neglect, parental mental illness or substance abuse, poor maternal attachment or separation and inappropriate family boundaries. [5]
Epidemiology[edit | edit source]
The prevalence of borderline personality disorder is estimated to be 1.6% in the general population and around 20% in the inpatient psychiatric population.[5]
Characteristics/Clinical Presentation[edit | edit source]
According to the National Institute of Mental Health, patients with borderline personality disorder may present with:[9]
- A long term pattern of intense and unstable relationships with family, friends, and loved ones.
- Short term episodes of variable and extreme moods.
- Trying to avoid real or perceived abandonment, including starting and ending relationships very quickly and without warning.
- Impaired sense of self.
- Anger management issues.
- Feelings of dissociation from oneself.
- Feelings of emptiness.
- Impulsive / dangerous behaviors, including with finances, binge eating, unsafe sexual practices and substance abuse.
Associated Co-morbidities[edit | edit source]
- Bipolar disorder.[10]
- Suicidal behaviors and self-harm.[11][12]
- Other personality disorders, mood disorders/depression, anxiety, substance-related disorders, somatic symptom disorders, and eating disorders. [2][13]
- Physical co-morbidities significantly associated are arteriosclerosis, hypertension, hepatic disease, cardiovascular disease, gastrointestinal disease and arthritis. [14]
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Physiotherapy Management[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
- Bipolar disorder
- Depression
- Schizophrenia
- Attention-deficit disorder
- Post-traumatic stress disorder[15]
Resources
[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.
- ↑ 2.0 2.1 Kristalyn Salters-Pedneault, PhD. What are Personality Disorders in the DSM-5? Feb 2022. https://www.verywellmind.com/personality-disorders-a2-425427
- ↑ International Statistical Classification of Diseases and Related Health Problems, 11th ed,; ICD-11; World Health Organization, 2019.
- ↑ Mind Jan 2020 https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/
- ↑ 5.0 5.1 5.2 5.3 Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. In: StatPearls Publishing; 2022
- ↑ Skoglund, C., Tiger, A., Rück, C. et al. Familial risk and heritability of diagnosed borderline personality disorder: a register study of the Swedish population. Mol Psychiatry. 2021
- ↑ Witt SH, Streit F, Jungkunz M, et al. Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia. Transl Psychiatry. 2017
- ↑ NHS. Borderline Personality Disorder. 2019.
- ↑ National Institute of Mental Health. Borderline Personality Disorder. April 2022
- ↑ Fornaro M, Orsolini L, Marini S, De Berardis D, Perna G, Valchera A, et al. The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord. 2016
- ↑ Paris J. Suicidality in Borderline Personality Disorder. Medicina (Kaunas). 2019
- ↑ Oumaya M, Friedman S, Pham A, Abou Abdallah T, Guelfi JD, Rouillon F. Personnalité borderline, automutilations et suicide : revue de la littérature [Borderline personality disorder, self-mutilation and suicide: literature review]. Encephale. 2008
- ↑ Mark Zimmerman. Overview of Personality Disorders. MSD Manual Professional Version 2021
- ↑ El-Gabalawy R, Katz LY, Sareen J. Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med. 2010
- ↑ Paris J. Differential Diagnosis of Borderline Personality Disorder. Psychiatr Clin North Am. 2018.
