Borderline Personality Disorder
Borderline personality disorder (BPD) involves a pervasive pattern of instability in relationships, self-image, and emotions, defined per DSM-5, affecting roughly 0.7-2.7% of adults.
Symptoms
Frantic efforts to avoid abandonment, unstable and intense relationships that swing between idealization and devaluation, an unstable self-image, impulsivity, recurrent self-harm or suicidal behavior, emotional instability, chronic emptiness, intense anger, and transient paranoid or dissociative symptoms under stress -- 5 or more of 9 DSM-5 features are required for diagnosis.
Causes and risk
A combination of genetic vulnerability and environmental factors; per JAMA review data, people with BPD are roughly 13 times more likely to report childhood adversity.
How it is evaluated
Diagnosis follows DSM-5 criteria, requiring 5 of 9 characteristic features present across multiple contexts.
Treatment
Dialectical behavior therapy (DBT) is the best-supported first-line treatment, shown in systematic review and meta-analysis data to reduce self-harm, suicidality, hospitalization, and overall symptom severity. No medication is FDA-approved for BPD itself -- medication may help a co-occurring condition but does not treat the core disorder.
When to seek care
Any suicide attempt or serious self-harm is a medical emergency -- call 911 or go to the nearest emergency room. Ongoing thoughts of suicide or self-harm should prompt immediate contact with the 988 Suicide and Crisis Lifeline, distinct from lower-risk self-injury which still deserves prompt clinical attention.