Table of contents
Expand All Topics
Borderline personality disorder
What's new
Updated 2024 APA guidelines for the management of borderline personality disorder .
Background
Overview
Definition
Borderline personality disorder is a mental health disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image.
1
Pathophysiology
The pathogenesis of borderline personality disorder is complex and not fully understood. It is believed to involve interactions among genetic, neurobiological, and environmental factors. Genetic factors and adverse life events, such as physical and sexual abuse during childhood, are thought to contribute to the development of the disorder.
2
3
Epidemiology
The lifetime prevalence of borderline personality disorder in the US is estimated at 5.9%.
4
Risk factors
Risk factors for borderline personality disorder are multifaceted and include temperamental factors, including high impulsivity and emotional instability; environmental factors, including maltreatment such as physical, emotional, and sexual abuse; and genetic factors.
5
6
Disease course
Clinically, borderline personality disorder is marked by emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies. Other key manifestations include intense mood swings, fear of abandonment, unstable relationships, and a distorted self-image.
1
7
Prognosis and risk of recurrence
The prognosis of borderline personality disorder is variable. While the disorder is traditionally considered chronic and intractable, up to 85% of patients remit over a 10-year period.
8
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of borderline personality disorder are prepared by our editorial team based on guidelines from the American Psychiatric Association (APA 2024), the American Academy of Family Physicians (AAFP 2022), and the National Health and Medical Research Council of Australia (NHMRC 2019).
1
2
3
4
5
6
7
8
9
10
11
Screening and diagnosis
Indications for screening: as per NHMRC 2019 guidelines, consider obtaining an assessment for borderline personality disorder, or referring for psychiatric assessment, in adult patients with any of the following:
frequent suicidal or self-harming behavior
marked emotional instability
multiple co-occurring psychiatric conditions
nonresponse to established treatments for current psychiatric symptoms
a high level of functional impairment.
C
Diagnostic investigations
Initial assessment
As per APA 2024 guidelines:
Include the following in the initial assessment of patients with possible borderline personality disorder:
the reason the individual is presenting for evaluation
the patient's goals and preferences for treatment
a review of psychiatric symptoms, including core features of personality disorders and common co-occurring disorders
a psychiatric treatment history
an assessment of physical health
an assessment of psychosocial and cultural factors
a mental status examination
an assessment of the risk of suicide, self-injury, and aggressive behaviors
B
Consider using a quantitative measure to identify and determine the severity of symptoms and impairments of functioning in the initial psychiatric evaluation of patients with possible borderline personality disorder.
C
Medical management
General principles
As per APA 2024 guidelines:
Engage patients with borderline personality disorder in a collaborative discussion about their diagnosis and treatment, including psychoeducation related to borderline personality disorder.
B
Provide a documented, comprehensive, and person-centered treatment plan for patients with borderline personality disorder.
B
More topics in this section
Pharmacotherapy
Management of co-occurring health conditions
Inpatient care
Nonpharmacologic interventions
Safety planning for suicide: as per AAFP 2022 guidelines, advise on safety planning to reduce suicide risk, as suicidality is higher in patients with borderline personality disorder than in the general population.
B
More topics in this section
Psychotherapy
Specific circumstances
Pediatric and adolescent patients, management: as per NHMRC 2019 guidelines, offer time-limited structured psychological therapies specifically designed for borderline personality disorder in patients aged 14-18 years with borderline personality disorder or with clinically significant features of borderline personality disorder.
B
Show 3 more
More topics in this section
Pediatric and adolescent patients (evaluation)