Examine individual changes

[ 0 => '{{Short description|Personality disorder of emotional instability}}', 1 => '{{cs1 config|name-list-style=vanc|display-authors=6}}', 2 => '{{Use dmy dates|date=November 2022}}', 3 => '{{Infobox medical condition (new)', 4 => '| name = Borderline personality disorder', 5 => '| image = File:Despair Edvard Munch 1894.jpeg', 6 => '| image_size = ', 7 => '| alt = ', 8 => '| caption = ''Despair'' by [[Edvard Munch]] (1894), who is presumed to have had borderline personality disorder<ref>{{cite book|title=Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art|trans-title=Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder|isbn=978-87-983524-1-9| vauthors = Aarkrog T |year=1990|publisher=Lundbeck Pharma A/S|location=Danmark}}</ref><ref>{{cite journal | vauthors = Wylie HW | title = Edvard Munch | journal = The American Imago; A Psychoanalytic Journal for the Arts and Sciences | volume = 37 | issue = 4 | pages = 413–443 | year = 1980 | pmid = 7008567 | url = https://www.jstor.org/stable/26303797 | publisher = [[Johns Hopkins University Press]] | jstor = 26303797 | access-date = 10 August 2021 | archive-date = 10 August 2021 | archive-url = https://web.archive.org/web/20210810104208/https://www.jstor.org/stable/26303797 | url-status = live }}</ref>', 9 => '| field = [[Psychiatry]], [[clinical psychology]]', 10 => '| synonyms = {{plainlist|', 11 => '* Emotionally unstable personality disorder – impulsive or borderline type<ref name=Maj2005>{{cite book | vauthors = Cloninger RC | veditors = Maj M, Akiskal HS, Mezzich JE |chapter=Antisocial Personality Disorder: A Review |title=Personality disorders |date=2005 |publisher=[[John Wiley & Sons]] |location=New York City |isbn=978-0-470-09036-7 |page=126 |chapter-url=https://books.google.com/books?id=9fgwbCW7OQMC&pg=PA126 |access-date=5 June 2020 |archive-date=4 December 2020 |archive-url=https://web.archive.org/web/20201204232038/https://books.google.com/books?id=9fgwbCW7OQMC&pg=PA126 |url-status=live }}</ref>', 12 => '* Emotional intensity disorder<ref>{{cite book| vauthors = Blom JD |title=A Dictionary of Hallucinations |date=2010|publisher=Springer|location=New York|isbn=978-1-4419-1223-7|page=74|edition=1st|url=https://books.google.com/books?id=KJtQptBcZloC&pg=PA74|access-date=5 June 2020|archive-date=4 December 2020|archive-url=https://web.archive.org/web/20201204232039/https://books.google.com/books?id=KJtQptBcZloC&pg=PA74|url-status=live}}</ref>', 13 => '* [[Hysteria]]<ref>{{cite book|url=https://psycnet.apa.org/record/2000-07204-000|vauthors=Bollas C|title=Hysteria|publisher=Taylor & Francis|collaboration=American Psychological Association|edition=1st|date=2000|accessdate=December 14, 2022|archive-date=15 December 2022|archive-url=https://web.archive.org/web/20221215023801/https://psycnet.apa.org/record/2000-07204-000|url-status=live}}</ref>', 14 => '* Hysteric personality – Hysteroid<ref name=NLM>{{cite journal | vauthors = Novais F, Araújo A, Godinho P | title = Historical roots of histrionic personality disorder | journal = Frontiers in Psychology | volume = 6 | issue = 1463 | pages = 1463 | date = 25 September 2015 | pmid = 26441812 | pmc = 4585318 | doi = 10.3389/fpsyg.2015.01463 | doi-access = free }}</ref>', 15 => '* [[Negative affectivity]]/[[neuroticism]]<ref name=ICD11>{{cite web|title=ICD-11 - ICD-11 for Mortality and Morbidity Statistics|url=https://icd.who.int/browse11/l-m/en#/https%3a%2f%2f1.800.gay%3a443%2fhttp%2fid.who.int%2ficd%2fentity%2f953246526|access-date=6 October 2021|publisher=World Health Organization|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/https%3a%2f%2f1.800.gay%3a443%2fhttp%2fid.who.int%2ficd%2fentity%2f953246526|url-status=live}}</ref>', 16 => '}}', 17 => '| symptoms = Unstable [[interpersonal relationships|relationships]], distorted [[self-image|sense of self]], and intense [[affect (psychology)|emotions]]; [[impulsivity]]; recurrent suicidal and [[self-harm]]ing behavior; fear of [[abandonment (emotional)|abandonment]]; chronic feelings of [[emptiness]]; inappropriate [[anger]]; [[Dissociation (psychology)|dissociation]]<ref name=NIH2016/><ref name="DSM53"/>', 18 => '| complications = Suicide, self harm<ref name=NIH2016/>', 19 => '| onset = Early adulthood<ref name="DSM53"/>', 20 => '| duration = Long term<ref name=NIH2016/>', 21 => '| causes = Genetic, neurobiologic, psychosocial<ref name="Caspi McClay Moffitt Mill 2002 pp. 851–854">{{cite journal | last=Caspi | first=Avshalom | last2=McClay | first2=Joseph | last3=Moffitt | first3=Terrie E. | last4=Mill | first4=Jonathan | last5=Martin | first5=Judy | last6=Craig | first6=Ian W. | last7=Taylor | first7=Alan | last8=Poulton | first8=Richie | title=Role of Genotype in the Cycle of Violence in Maltreated Children | journal=Science | volume=297 | issue=5582 | date=2002-08-02 | issn=0036-8075 | doi=10.1126/science.1072290 | pages=851–854}}</ref>', 22 => '| risks = Family history, childhood trauma<ref name="Caspi McClay Moffitt Mill 2002 pp. 851–854">{{cite journal | last=Caspi | first=Avshalom | last2=McClay | first2=Joseph | last3=Moffitt | first3=Terrie E. | last4=Mill | first4=Jonathan | last5=Martin | first5=Judy | last6=Craig | first6=Ian W. | last7=Taylor | first7=Alan | last8=Poulton | first8=Richie | title=Role of Genotype in the Cycle of Violence in Maltreated Children | journal=Science | volume=297 | issue=5582 | date=2002-08-02 | issn=0036-8075 | doi=10.1126/science.1072290 | pages=851–854}}</ref>', 23 => '| diagnosis = Based on reported symptoms<ref name=NIH2016/>', 24 => '| differential = See [[#Differential diagnosis and comorbidity|§ Differential diagnosis]]<!--[[Bipolar disorder]], [[attachment disorder]], [[dissociative identity disorder]], [[identity disorder]], [[mood disorder]]s, [[post-traumatic stress disorder]], [[complex post-traumatic stress disorder|CPTSD]], [[substance use disorder]]s, [[attention deficit hyperactivity disorder|ADHD]], [[Personality disorder#Cluster B (emotional or erratic disorders)|histrionic, narcissistic, or antisocial personality disorder]]<ref name="DSM53"/><ref>{{cite web |title=Borderline Personality Disorder Differential Diagnoses |url=https://emedicine.medscape.com/article/913575-differential |publisher=[[Medscape]] |date=5 November 2018 | vauthors = Lubit RH |access-date=10 March 2020 |archive-date=29 April 2011 |archive-url=https://web.archive.org/web/20110429130848/https://emedicine.medscape.com/article/913575-differential |url-status=live }}</ref>-->', 25 => '| prevention = ', 26 => '| treatment = [[Behaviour therapy]]<ref name=NIH2016/>', 27 => '| medication = ', 28 => '| prognosis = Improves over time,<ref name="DSM53”/> remission occurred in 45% of patients over a wide range of follow-up periods<ref name="Skodol Siever Livesley Gunderson 2002 pp. 951–963">{{cite journal | last=Skodol | first=Andrew E | last2=Siever | first2=Larry J | last3=Livesley | first3=W.John | last4=Gunderson | first4=John G | last5=Pfohl | first5=Bruce | last6=Widiger | first6=Thomas A | title=The borderline diagnosis II: biology, genetics, and clinical course | journal=Biological Psychiatry | volume=51 | issue=12 | date=2002 | doi=10.1016/S0006-3223(02)01325-2 | pages=951–963}}</ref><ref name="Skodol Bender Pagano Shea 2007 pp. 1102–1108">{{cite journal | last=Skodol | first=Andrew E. | last2=Bender | first2=Donna S. | last3=Pagano | first3=Maria E. | last4=Shea | first4=M. Tracie | last5=Yen | first5=Shirley | last6=Sanislow | first6=Charles A. | last7=Grilo | first7=Carlos M. | last8=Daversa | first8=Maria T. | last9=Stout | first9=Robert L. | last10=Zanarini | first10=Mary C. | last11=McGlashan | first11=Thomas H. | last12=Gunderson | first12=John G. | title=Positive Childhood Experiences: Resilience and Recovery From Personality Disorder in Early Adulthood | journal=The Journal of Clinical Psychiatry | volume=68 | issue=07 | date=2007-07-15 | issn=0160-6689 | pmid=17685749 | pmc=2705622 | doi=10.4088/JCP.v68n0719 | pages=1102–1108}}</ref><ref name="Zanarini Frankenburg Hennen Reich 2006 pp. 827–832">{{cite journal | last=Zanarini | first=Mary C. | last2=Frankenburg | first2=Frances R. | last3=Hennen | first3=John | last4=Reich | first4=D. Bradford | last5=Silk | first5=Kenneth R. | title=Prediction of the 10-Year Course of Borderline Personality Disorder | journal=American Journal of Psychiatry | volume=163 | issue=5 | date=2006 | issn=0002-953X | doi=10.1176/ajp.2006.163.5.827 | pages=827–832}}</ref><ref name="Zanarini Frankenburg Reich Fitzmaurice 2010 pp. 663–667">{{cite journal | last=Zanarini | first=Mary C. | last2=Frankenburg | first2=Frances R. | last3=Reich | first3=D. Bradford | last4=Fitzmaurice | first4=Garrett | title=Time to Attainment of Recovery From Borderline Personality Disorder and Stability of Recovery: A 10-year Prospective Follow-Up Study | journal=American Journal of Psychiatry | volume=167 | issue=6 | date=2010 | issn=0002-953X | pmid=20395399 | pmc=3203735 | doi=10.1176/appi.ajp.2009.09081130 | pages=663–667}}</ref><ref name="Zanarini Frankenburg Reich Fitzmaurice 2012 pp. 476–483">{{cite journal | last=Zanarini | first=Mary C. | last2=Frankenburg | first2=Frances R. | last3=Reich | first3=D. Bradford | last4=Fitzmaurice | first4=Garrett | title=Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study | journal=American Journal of Psychiatry | volume=169 | issue=5 | date=2012 | issn=0002-953X | pmid=22737693 | pmc=3509999 | doi=10.1176/appi.ajp.2011.11101550 | pages=476–483}}</ref>', 29 => '| frequency = 5.9% ([[lifetime prevalence]])<ref name=NIH2016/>', 30 => '| deaths = ', 31 => '}}', 32 => '{{Personality disorders sidebar}}', 33 => '<!-- Definition and symptoms -->', 34 => ''''Borderline personality disorder''' ('''BPD'''), also known as '''emotionally unstable personality disorder''' ('''EUPD'''),<ref name="NICEGuidelines20092">{{cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK55415/ |title=Borderline personality disorder NICE Clinical Guidelines, No. 78 |date=2009 |publisher=British Psychological Society |access-date=11 September 2017 |archive-url=https://web.archive.org/web/20201112031402/https://www.ncbi.nlm.nih.gov/books/NBK55415/ |archive-date=12 November 2020 |url-status=live}}</ref> is a [[personality disorder]] characterized by a pervasive, long-term pattern of significant [[interpersonal relationship]] instability, a distorted [[sense of self]], and intense [[Emotional response|emotional responses]].<ref name="DSM53">{{harvnb|American Psychiatric Association|2013|pages=[https://archive.org/details/diagnosticstatis0005unse/page/645 645, 663–6]}}</ref><ref name="NIH20163">{{cite web |title=Borderline Personality Disorder |url=http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |url-status=live |archive-url=https://web.archive.org/web/20160322130612/http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |archive-date=22 March 2016 |access-date=16 March 2016 |website=NIMH}}</ref><ref>{{cite journal | vauthors = Chapman AL | title = Borderline personality disorder and emotion dysregulation | journal = Development and Psychopathology | volume = 31 | issue = 3 | pages = 1143–1156 | date = August 2019 | pmid = 31169118 | doi = 10.1017/S0954579419000658 | url = https://www.cambridge.org/core/product/identifier/S0954579419000658/type/journal_article | url-status = live | publisher = [[Cambridge University Press]] | s2cid = 174813414 | access-date = 5 April 2020 | archive-url = https://web.archive.org/web/20201204232023/https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/borderline-personality-disorder-and-emotion-dysregulation/EA2CB1C041307A34392F49279C107987 | archive-date = 4 December 2020 | url-access = subscription }}</ref> Individuals diagnosed with BPD frequently exhibit [[Self-harm|self-harming]] behaviours and engage in risky activities, primarily due to challenges in regulating emotional states to a healthy, stable baseline.<ref>{{cite journal | vauthors = Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S | title = The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective | journal = Frontiers in Psychiatry | volume = 12 | pages = 721361 | date = 23 September 2021 | pmid = 34630181 | pmc = 8495240 | doi = 10.3389/fpsyt.2021.721361 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Cattane N, Rossi R, Lanfredi M, Cattaneo A | title = Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms | journal = BMC Psychiatry | volume = 17 | issue = 1 | pages = 221 | date = June 2017 | pmid = 28619017 | pmc = 5472954 | doi = 10.1186/s12888-017-1383-2 | doi-access = free }}</ref><ref>{{cite web |date=December 2017 |title=Borderline Personality Disorder |url=https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |access-date=25 February 2021 |publisher=The National Institute of Mental Health |quote=Other signs or symptoms may include: [...] Impulsive and often dangerous behaviors [...] Self-harming behavior [...]. Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public. |archive-date=29 March 2023 |archive-url=https://web.archive.org/web/20230329213453/http://nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |url-status=live }}</ref> Symptoms such as [[Dissociation (psychology)|dissociation]]—a feeling of [[Emotional detachment|detachment]] from reality, a pervasive sense of [[emptiness]], and an acute fear of [[Abandonment (emotional)|abandonment]] are prevalent among those affected.<ref name="NIH20163" />', 35 => '', 36 => 'The onset of BPD symptoms can be triggered by events that others might perceive as normal,<ref name="NIH20163" /> with the disorder typically manifesting in early adulthood and persisting across diverse contexts.<ref name="DSM53" /> BPD is often [[Comorbidity|comorbid]] with [[substance use disorders]],<ref>{{cite journal | vauthors = Helle AC, Watts AL, Trull TJ, Sher KJ | title = Alcohol Use Disorder and Antisocial and Borderline Personality Disorders | journal = Alcohol Research: Current Reviews| volume = 40 | issue = 1 | pages = arcr.v40.1.05 |year = 2019 | pmid = 31886107 | pmc = 6927749 | doi = 10.35946/arcr.v40.1.05 }}</ref> [[depressive disorders]], and [[Eating disorder|eating disorders]].<ref name="NIH20163" /> BPD is associated with a substantial risk of [[suicide]];<ref name="DSM53" /><ref name="NIH20163" /> an estimated at 8 to 10 percent of individuals with BPD die by suicide, with males affected at twice the rate of females.<ref name="Kreisman J, Strauss H 2004 206">{{cite book |url=https://archive.org/details/sometimesiactcra00jero |title=Sometimes I Act Crazy. Living With Borderline Personality Disorder |vauthors=Kreisman J, Strauss H |publisher=Wiley & Sons |year=2004 |isbn=978-0-471-22286-6 |page=[https://archive.org/details/sometimesiactcra00jero/page/206 206] |url-access=registration}}</ref> Despite its severity, BPD faces significant [[stigmatization]] in both media portrayals and within the psychiatric field, potentially leading to its underdiagnosis.<ref>{{cite journal | vauthors = Aviram RB, Brodsky BS, Stanley B | title = Borderline personality disorder, stigma, and treatment implications | journal = Harvard Review of Psychiatry | volume = 14 | issue = 5 | pages = 249–256 |year = 2006 | pmid = 16990170 | doi = 10.1080/10673220600975121 | s2cid = 23923078 }}</ref><!--Cause, mechanism, diagnosis-->', 37 => '', 38 => '<!-- Cause, mechanism, diagnosis -->The causes of BPD are unclear and complex, implicating genetic, neurological, and psychosocial conditions in its development.<ref name=NIH2016/><ref name=CP2013>{{cite book|title=Clinical Practice Guideline for the Management of Borderline Personality Disorder | publisher=National Health and Medical Research Council|year=2013|isbn=978-1-86496-564-3|location=Melbourne|pages=40–41|quote=In addition to the evidence identified by the systematic review, the Committee also considered a recent narrative review of studies that have evaluated biological and environmental factors as potential risk factors for BPD (including prospective studies of children and adolescents, and studies of young people with BPD)}}</ref> A [[genetic predisposition]] is evident, with the disorder being significantly more common in individuals with a family history of BPD, particularly immediate relatives.<ref name=NIH2016>{{cite web|url=http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml|title=Borderline Personality Disorder|website=NIMH|access-date=16 March 2016|url-status=live|archive-url=https://web.archive.org/web/20160322130612/http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml|archive-date=22 March 2016}}</ref> Psychosocial factors, particularly adverse life events like [[adverse childhood experiences]], also play a role.<ref name=Lei2011/> Neurologically, the underlying mechanism appears to involve the frontolimbic neuronal network of the [[limbic system]].<ref name=Lei2011>{{cite journal | vauthors = Leichsenring F, Leibing E, Kruse J, New AS, Leweke F | title = Borderline personality disorder | journal = [[Lancet (journal)|Lancet]] | volume = 377 | issue = 9759 | pages = 74–84 | date = January 2011 | pmid = 21195251 | doi = 10.1016/s0140-6736(10)61422-5 | s2cid = 17051114 }}</ref> The American [[Diagnostic and Statistical Manual of Mental Disorders|''Diagnostic and Statistical Manual of Mental Disorders'']] (DSM) classifies BPD as a [[Personality disorder#Cluster B (emotional or erratic disorders)|cluster B]] [[personality disorder]], alongside [[antisocial personality disorder|antisocial]], [[histrionic personality disorder|histrionic]], and [[narcissistic personality disorder|narcissistic personality disorders]].<ref name="DSM53"/> There exists a small risk of [[misdiagnosis]], with BPD most commonly confused with a [[mood disorder]], [[substance use disorders|substance use disorder]], or other mental health disorder.<ref name="DSM53"/><!-- Treatment -->', 39 => '', 40 => 'Therapeutic interventions for BPD predominantly involve [[psychotherapy]], with [[cognitive behavioral therapy]] (CBT) or [[dialectical behavior therapy]] (DBT) being the most effective modalities.<ref name="NIH2016" /> This psychotherapy can occur one-on-one or in a [[group therapy|group]].<ref name="NIH2016" /> Although [[pharmacotherapy]] cannot cure BPD, it may be employed to mitigate associated symptoms,<ref name="NIH2016" /> with [[quetiapine]] and [[selective serotonin reuptake inhibitor]] (SSRI) antidepressants being commonly prescribed even though their efficacy is unclear. A 2002 study found [[fluvoxamine]] (an SSRI) significantly decreased rapid mood shifts in females with BPD,<ref>{{cite journal |vauthors=Rinne T, van den Brink W, Wouters L, van Dyck R |date=December 2002 |title=SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder |journal=The American Journal of Psychiatry |volume=159 |issue=12 |pages=2048–2054 |doi=10.1176/appi.ajp.159.12.2048 |pmid=12450955|citeseerx=10.1.1.621.525 }}</ref> while a more recent meta-analysis found the use of medications was still unsupported by evidence.<ref name="stofferswinterling20" /> In severe cases, hospitalization may be necessitated, even if for only short periods.<ref name="NIH2016" /><!-- Epidemiology, prognosis, and culture -->', 41 => '', 42 => 'BPD has a [[point prevalence]] of 1.6% and a [[lifetime prevalence]] of 5.9% of the global population,<ref name="DSM53" /><ref name="NIH2016" /><ref name="Wolters Kluwer">{{Cite book |url=https://uptodate.com/ |title=UpToDate |publisher=[[Wolters Kluwer]] |chapter=Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis |access-date=13 March 2024 |chapter-url=https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis |url-access=subscription |archive-date=6 January 2009 |archive-url=https://web.archive.org/web/20090106134307/http://uptodate.com/ |url-status=live }}</ref><!-- Quote (in archived version): 'According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.' --><ref name="nimh.nih.gov">{{cite web|title=NIMH " Personality Disorders|url=https://www.nimh.nih.gov/health/statistics/personality-disorders|access-date=20 May 2021|website=nimh.nih.gov|archive-date=18 June 2022|archive-url=https://web.archive.org/web/20220618193929/https://www.nimh.nih.gov/health/statistics/personality-disorders|url-status=live}}</ref> with a higher [[incidence rate]] among women compared to men in the clinical setting of up to three times.<ref name="DSM53" /><ref name="Wolters Kluwer" /> However, two [[epidemiological studies]] conducted on the general population in the United States have shown that the lifetime prevalence of BPD shows no significant difference between males and females.<ref name="Lenzenweger_2007">{{cite journal | vauthors = Lenzenweger MF, Lane MC, Loranger AW, Kessler RC | title = DSM-IV personality disorders in the National Comorbidity Survey Replication | journal = Biological Psychiatry | volume = 62 | issue = 6 | pages = 553–564 | date = September 2007 | pmid = 17217923 | pmc = 2044500 | doi = 10.1016/j.biopsych.2006.09.019 }}</ref><ref name="Grant_2008">{{cite journal | vauthors = Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ | title = Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions | journal = The Journal of Clinical Psychiatry | volume = 69 | issue = 4 | pages = 533–545 | date = April 2008 | pmid = 18426259 | pmc = 2676679 | doi = 10.4088/JCP.v69n0404 }}</ref> Despite the high utilization of healthcare resources by individuals with BPD,<ref name="Bourke_2018">{{cite journal | vauthors = Bourke J, Murphy A, Flynn D, Kells M, Joyce M, Hurley J | title = Borderline personality disorder: resource utilisation costs in Ireland | journal = Irish Journal of Psychological Medicine | volume = 38 | issue = 3 | pages = 169–176 | date = September 2021 | pmid = 34465404 | doi = 10.1017/ipm.2018.30 | hdl-access = free | hdl = 10468/7005 }}</ref> up to half may show significant improvement over a ten-year period with appropriate treatment.<ref name="DSM53" /> 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.<ref name="NIH2016" /><ref name=":14">{{cite journal | vauthors = Gunderson JG | title = Borderline personality disorder: ontogeny of a diagnosis | journal = The American Journal of Psychiatry | volume = 166 | issue = 5 | pages = 530–539 | date = May 2009 | pmid = 19411380 | pmc = 3145201 | doi = 10.1176/appi.ajp.2009.08121825 }}</ref>', 43 => '{{TOC limit}}', 44 => '', 45 => '==Signs and symptoms==', 46 => '[[File:BPD_1.png|thumb|One of the symptoms of BPD is an intense fear of emotional abandonment.]]', 47 => '', 48 => 'Borderline personality disorder, as outlined in the [[DSM-5]], manifests through nine distinct [[symptoms]], with a [[diagnosis]] requiring at least five of the following criteria to be met:', 49 => '', 50 => '# Frantic efforts to avoid real or imagined [[Abandonment (emotional)|emotional abandonment]].<ref>{{cite journal |vauthors=Fertuck EA, Fischer S, Beeney J |date=December 2018 |title=Social Cognition and Borderline Personality Disorder: Splitting and Trust Impairment Findings |journal=The Psychiatric Clinics of North America |volume=41 |issue=4 |pages=613–632 |doi=10.1016/j.psc.2018.07.003 |pmid=30447728 |s2cid=53948600}}</ref>', 51 => '# Unstable and chaotic interpersonal relationships, often characterized by a pattern of alternating between extremes of [[idealization and devaluation]], also known as '[[Splitting (psychology)|splitting]]'.', 52 => '# A markedly [[Identity disturbance|disturbed sense of identity]] and distorted [[self-image]].<ref name="NIH2016" />', 53 => '# [[Impulsive (behavior)|Impulsive]] or reckless behaviors, including uncontrollable spending, unsafe sexual practices, substance use disorder, reckless driving, and [[binge eating]].<ref>{{cite web |title=Diagnostic criteria for 301.83 Borderline Personality Disorder – Behavenet |url=https://behavenet.com/diagnostic-criteria-30183-borderline-personality-disorder |access-date=23 March 2019 |website=behavenet.com |archive-date=28 March 2019 |archive-url=https://web.archive.org/web/20190328215426/https://behavenet.com/diagnostic-criteria-30183-borderline-personality-disorder |url-status=live }}</ref>', 54 => '# Recurrent [[suicidal ideation]] or behaviors involving self-harm.', 55 => '# Rapidly shifting intense [[emotional dysregulation]].', 56 => '# Chronic feelings of [[emptiness]].', 57 => '# Inappropriate, intense anger that can be difficult to control.', 58 => '# Transient, stress-related [[paranoid ideation]] or severe [[Dissociation (psychology)|dissociative]] symptoms.', 59 => '', 60 => 'The distinguishing characteristics of BPD include a pervasive pattern of instability in one's interpersonal relationships and in one’s self-image, with frequent oscillation between extremes of idealization and devaluation of others, alongside fluctuating moods and difficulty regulating intense emotional reactions. Dangerous or impulsive behaviors are commonly associated with the BPD.', 61 => '', 62 => 'Additional symptoms may encompass uncertainty about one's [[Identity (social science)|identity]], [[values]], [[morals]], and [[Belief|beliefs]]; experiencing paranoid thoughts under stress; episodes of [[depersonalization]]; and, in moderate to severe cases, stress-induced breaks with reality or episodes of [[psychosis]]. It is also common for individuals with BPD to have [[Comorbidity|comorbid conditions]] such as [[Depressive disorder|depressive]] or [[bipolar disorders]], [[substance use disorders]], [[eating disorders]], [[post-traumatic stress disorder]] (PTSD), and [[attention-deficit/hyperactivity disorder]] (ADHD).<ref name="DSM-5 Task Force_2013">{{cite book |author=((DSM-5 Task Force)) |url=http://worldcat.org/oclc/863153409 |title=Diagnostic and Statistical Manual of Mental Disorders : DSM-5 |publisher=American Psychiatric Association |year=2013 |isbn=978-0-89042-554-1 |oclc=863153409 |access-date=23 September 2020 |archive-url=https://web.archive.org/web/20201204232019/https://www.worldcat.org/title/diagnostic-and-statistical-manual-of-mental-disorders-dsm-5/oclc/863153409 |archive-date=4 December 2020 |url-status=live}}</ref>', 63 => '', 64 => '===Emotions===', 65 => 'Individuals diagnosed with BPD are known to experience emotions more profoundly and intensely than others, often for extended periods.<ref>{{harvnb|Linehan|1993|page=43}}</ref><ref name = Manning_36>{{harvnb|Manning|2011|page=36}}</ref> A core characteristic of BPD is affective instability, characterized by exceptionally intense emotional reactions to environmental stimuli and a protracted period of return to a stable emotional state.<ref>{{cite book | vauthors = Hooley J, Butcher JM, Nock MK |title=Abnormal Psychology |date=2017 |publisher=[[Pearson Education]] |location=London, England|isbn=978-0-13-385205-9 |page=359 |edition=17th }}</ref><ref name = Linehan_45>{{harvnb|Linehan|1993|page=45}}</ref> American psychologist [[Marsha Linehan]] highlights that while the sensitivity, intensity, and duration of emotional experiences in individuals with BPD can have positive outcomes, such as exceptional enthusiasm, idealism, and capacity for joy and love, it also predisposes them to be overwhelmed by negative emotions.<ref name = Linehan_45 /><ref name = Linehan_44>{{harvnb|Linehan|1993|page=44}}</ref> This includes experiencing profound [[grief]] instead of mere sadness, intense shame instead of mild embarrassment, rage rather than annoyance, and panic over nervousness.<ref name = Linehan_44 /> Research indicates that individuals with BPD endure chronic and substantial emotional suffering.<ref name="DSM-5 Task Force_2013" /><ref>{{cite journal | vauthors = Fertuck EA, Jekal A, Song I, Wyman B, Morris MC, Wilson ST, Brodsky BS, Stanley B | title = Enhanced 'Reading the Mind in the Eyes' in borderline personality disorder compared to healthy controls | journal = Psychological Medicine | volume = 39 | issue = 12 | pages = 1979–1988 | date = December 2009 | pmid = 19460187 | pmc = 3427787 | doi = 10.1017/S003329170900600X }}</ref>{{irrelevant citation|{{subst:April 2023}}|reason=The study cited investigates differences in facial affective recognition between BPD and healthy controls, which is irrelevant and does not substantiate the statement "...chronic and significant emotional suffering and mental agony."|date=April 2023}}', 66 => '', 67 => 'Additionally, individuals with BPD display heightened sensitivity to rejection, criticism, isolation, and perceptions of failure.<ref>{{cite journal | vauthors = Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M | title = Aversive tension in patients with borderline personality disorder: a computer-based controlled field study | journal = Acta Psychiatrica Scandinavica | volume = 111 | issue = 5 | pages = 372–9 | date = May 2005 | pmid = 15819731 | doi = 10.1111/j.1600-0447.2004.00466.x | s2cid = 30951552 }}</ref> Prior to adopting alternative [[coping strategies]], attempts to manage or escape from these intense negative emotions may lead to [[emotional isolation]], self-harm, or suicidal behaviors.<ref name = reasons_NSSI /> Often conscious of their disproportionate emotional reactions but unable to regulate them, individuals with BPD may subconsciously suppress their awareness of these emotions to avoid further distress, though this lack of awareness can prevent recognition of problematic situations needing attention.<ref name=Linehan_45 />', 68 => '', 69 => 'Emotional dysregulation is a significant feature of BPD, yet Fitzpatrick et al. (2022) suggest that such dysregulation may also be observed in other disorders, like [[generalized anxiety disorder]]. Nonetheless, their findings imply that individuals with BPD particularly struggle with disengaging from negative emotions and achieving emotional equilibrium.<ref>{{cite journal | vauthors = Fitzpatrick S, Varma S, Kuo JR | title = Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm | journal = Psychological Medicine | volume = 52 | issue = 12 | pages = 2319–2331 | date = September 2022 | pmid = 33198829 | doi = 10.1017/S0033291720004225 | s2cid = 226988308 }}</ref>', 70 => '', 71 => '[[Euphoria]], or transient intense joy, can occur in those with BPD, but they are more commonly afflicted by [[dysphoria]] (a profound state of unease or dissatisfaction), depression, and pervasive distress. Zanarini et al. identify four types of dysphoria characteristic of BPD: intense emotional states, destructiveness or self-destructiveness, feelings of fragmentation or identity loss, and perceptions of [[victimization]].<ref name="dysphoria">{{cite journal | vauthors = Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG | title = The pain of being borderline: dysphoric states specific to borderline personality disorder | journal = Harvard Review of Psychiatry | volume = 6 | issue = 4 | pages = 201–7 | year = 1998 | pmid = 10370445 | doi = 10.3109/10673229809000330 | s2cid = 10093822 }}</ref> A diagnosis of BPD is closely linked with experiencing feelings of betrayal, lack of control, and self-harm.<ref name=dysphoria />', 72 => '', 73 => 'Moreover, emotional ''lability'', indicating variability or fluctuations in emotional states, is frequent among those with BPD. Although this term may imply rapid alternations between depression and elation, [[Mood swing|mood swings]] in BPD are more commonly between anger and anxiety or depression and anxiety.<ref>{{cite journal | vauthors = Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, Silverman JM, Serby M, Schopick F, Siever LJ | title = Characterizing affective instability in borderline personality disorder | journal = The American Journal of Psychiatry | volume = 159 | issue = 5 | pages = 784–8 | date = May 2002 | pmid = 11986132 | doi = 10.1176/appi.ajp.159.5.784 }}</ref>', 74 => '', 75 => '===Interpersonal relationships===', 76 => 'Interpersonal relationships are significantly impacted in individuals with BPD, characterized by a heightened sensitivity to the behavior and actions of others. Individuals with BPD can be very conscious of and susceptible to their perceived or real treatment by others. Individuals may experience profound happiness and gratitude for perceived kindness, yet feel intense sadness or anger towards perceived criticism or harm.<ref name="cogemo">{{cite journal | vauthors = Arntz A | title = Introduction to special issue: cognition and emotion in borderline personality disorder | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 36 | issue = 3 | pages = 167–72 | date = September 2005 | pmid = 16018875 | doi = 10.1016/j.jbtep.2005.06.001 }}</ref> A notable feature of BPD is the tendency to engage in [[idealization and devaluation]] of others – that is to idealize and subsequently devalue others – oscillating between extreme admiration and profound mistrust or dislike.<ref>{{harvnb|Linehan|1993|page=146}}</ref> This pattern, often referred to as '[[Splitting (psychology)|splitting]]', can significantly influence the dynamics of interpersonal relationships.<ref>{{cite web |title=What Is BPD: Symptoms |url=http://www.borderlinepersonalitydisorder.com/understading-bpd/ |access-date=31 January 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130210110927/http://www.borderlinepersonalitydisorder.com/understading-bpd/ |archive-date=10 February 2013 }}</ref><ref name="Robinson">{{cite book | vauthors = Robinson DJ | title = Disordered Personalities| publisher = Rapid Psychler Press| year = 2005| pages =255–310| isbn = 978-1-894328-09-8}}</ref> In addition to this external "[[Splitting (psychology)|splitting]],” patients with BPD typically have internal splitting (i.e., vacillation between considering oneself a good person who has been mistreated, in which case anger predominates, and a bad person whose life has no value, in which case self-destructive or even suicidal behavior may occur. This splitting is also evident in black-and-white or all-or-nothing [[dichotomous thinking]].<ref name="Gund2011" />', 77 => '', 78 => 'Despite a strong desire for intimacy, individuals with BPD may exhibit insecure, avoidant, ambivalent, or fearfully preoccupied [[Attachment theory#Attachment patterns|attachment styles]] in relationships, complicating their interactions and connections with others.<ref>{{cite journal | vauthors = Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF | title = Attachment and borderline personality disorder: implications for psychotherapy | journal = Psychopathology | volume = 38 | issue = 2 | pages = 64–74 | year = 2005 | pmid = 15802944 | doi = 10.1159/000084813 | s2cid = 10203453 }}</ref> Family members, including parents of adults with BPD, may find themselves in a cycle of being overly involved in the individual’s life at times and, at other times, significantly detached,<ref name="parents">{{cite journal | vauthors = Allen DM, Farmer RG | title = Family relationships of adults with borderline personality disorder | journal = Comprehensive Psychiatry | volume = 37 | issue = 1 | pages = 43–51 | year = 1996 | pmid = 8770526 | doi = 10.1016/S0010-440X(96)90050-4 }}</ref> contributing to a sense of alienation within the family unit.<ref name="Gund2011">{{cite journal | vauthors = Gunderson JG | title = Clinical practice. Borderline personality disorder | journal = The New England Journal of Medicine | volume = 364 | issue = 21 | pages = 2037–2042 | date = May 2011 | pmid = 21612472 | doi = 10.1056/NEJMcp1007358 | hdl = 10150/631040 | hdl-access = free }}</ref>', 79 => '', 80 => '[[Personality disorders]], including BPD, are associated with an increased incidence of [[chronic stress]] and conflict, reduced satisfaction in romantic partnerships, [[domestic abuse]], and [[unintended pregnancies]].<ref name="Daley SE, Burge D, Hammen C 2000 451–60">{{cite journal | vauthors = Daley SE, Burge D, Hammen C | title = Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity | journal = Journal of Abnormal Psychology | volume = 109 | issue = 3 | pages = 451–460 | date = August 2000 | pmid = 11016115 | doi = 10.1037/0021-843X.109.3.451 | citeseerx = 10.1.1.588.6902 }}</ref> Research indicates variability in relationship patterns among individuals with BPD. A portion of these individuals may transition rapidly between relationships, a pattern metaphorically described as "butterfly-like", characterized by fleeting and transient interactions and "fluttering" in and out of relationships.<ref name="Ryan_2007">{{Cite journal | vauthors = Ryan K, Shean G |date=2007-01-01 |title=Patterns of interpersonal behaviors and borderline personality characteristics |journal=Personality and Individual Differences |volume=42 |issue=2 |pages=193–200 |doi=10.1016/j.paid.2006.06.010 |issn=0191-8869}}</ref> Conversely, a subgroup, referred to as "attached", tends to establish fewer but more intense and dependent relationships. These connections often form rapidly, evolving into deeply intertwined and tumultuous bonds,<ref name="Ryan_2007" /> indicating a more pronounced dependence on these interpersonal ties compared to those without BPD.<ref>{{cite book | vauthors = Jackson MH, Westbrook LF |title=Borderline Personality Disorder: New Research |publisher=Nova Science Publishers, Incorporated |year=2009 |isbn=978-1-60876-540-9 |pages=137–146 |language=en}}</ref>', 81 => '', 82 => '===Behavior===', 83 => 'Behavioral patterns associated with BPD frequently involve impulsive actions, which may manifest as substance use disorders, binge eating, unprotected sexual encounters, self-injury among other self-harming practices.<ref name=Manning_18/> These behaviors are often a response to the intense emotional distress experienced by individuals with BPD, serving as an immediate but temporary alleviation of their [[emotional pain]].<ref name=Manning_18/> However, such actions typically result in feelings of shame and guilt, contributing to a recurrent cycle.<ref name=Manning_18>{{harvnb|Manning|2011|page=18}}</ref> This cycle typically begins with emotional discomfort, followed by impulsive behavior aimed at mitigating this discomfort, only to lead to shame and guilt, which in turn exacerbates the emotional pain.<ref name=Manning_18/> This escalation of emotional pain then intensifies the [[Compulsive behavior|compulsion]] towards impulsive behavior as a form of relief, creating a vicious cycle. Over time, these impulsive responses can become an automatic mechanism for coping with emotional pain.<ref name=Manning_18/>', 84 => '', 85 => '===Self-harm and suicide===<!-- Self harm -->', 86 => '', 87 => 'Self-harm and suicidal behaviors are core diagnostic criteria for BPD as outlined in the DSM-5.<ref name="DSM53" /> Between 50% to 80% of individuals diagnosed with BPD<!--<ref name=Ou2008/> --> engage in self-harm, with [[cutting]] being the most common method.<ref name="Ou2008">{{cite journal | vauthors = Oumaya M, Friedman S, Pham A, Abou Abdallah T, Guelfi JD, Rouillon F | title = [Borderline personality disorder, self-mutilation and suicide: literature review] | language = fr | journal = L'Encéphale | volume = 34 | issue = 5 | pages = 452–8 | date = October 2008 | pmid = 19068333 | doi = 10.1016/j.encep.2007.10.007 }}</ref> Other methods, such as bruising, burning, head banging, or biting, are also prevalent.<ref name="Ou2008" /> It is hypothesized that individuals with BPD might experience a sense of emotional relief following acts of self-harm.<ref name="DucasseCourtet2014">{{cite journal | vauthors = Ducasse D, Courtet P, Olié E | title = Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review | journal = Current Psychiatry Reports | volume = 16 | issue = 5 | pages = 443 | date = May 2014 | pmid = 24633938 | doi = 10.1007/s11920-014-0443-2 | s2cid = 25918270 }}</ref><!-- Suicide -->', 88 => '', 89 => 'Estimates of the lifetime risk of death by suicide among individuals with BPD range between 3% and 10%, varying with the method of investigation.<ref name="pmid31142033">{{cite journal |vauthors=Paris J |year=2019 |title=Suicidality in Borderline Personality Disorder. |journal=Medicina (Kaunas) |volume=55 |issue=6 |page=223 |doi=10.3390/medicina55060223 |pmc=6632023 |pmid=31142033 |doi-access=free}}</ref><ref name="Gund2011" /><ref>{{cite book |title=Borderline Personality Disorder: A Clinical Guide |vauthors=Gunderson JG, Links PS |publisher=American Psychiatric Publishing, Inc |year=2008 |isbn=978-1-58562-335-8 |edition=2nd |page=9}}</ref> There is evidence that a significant proportion of males who die by suicide may have undiagnosed BPD.<ref name="Paris J 2008 21–22">{{cite book | vauthors = Paris J |title=Treatment of Borderline Personality Disorder. A Guide to Evidence-Based Practice | year=2008 | publisher=The Guilford Press | pages=21–22}}</ref><!-- Reasons -->', 90 => '', 91 => 'The motivations behind self-harm and [[suicide attempts]] among individuals with BPD are reported to differ.<ref name="reasons_NSSI">{{cite journal | vauthors = Brown MZ, Comtois KA, Linehan MM | s2cid = 4649933 | title = Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder | journal = Journal of Abnormal Psychology | volume = 111 | issue = 1 | pages = 198–202 | date = February 2002 | pmid = 11866174 | doi = 10.1037/0021-843X.111.1.198 }}</ref> Nearly 70% of individuals with BPD engage in self-harm without the intention of ending their lives. Motivations for self-harm include expressing anger, self-punishment, inducing normal feelings or feelings of normality (often in response to dissociative episodes), and distraction from emotional distress or challenging situations.<ref name="reasons_NSSI" /> Conversely, true suicide attempts by individuals with BPD frequently are motivated by the notion that others will be better off in their absence.<ref name="reasons_NSSI" /> [[Sexual abuse]] has been identified as a specific trigger for suicidal behaviors among adolescents with BPD.<ref>{{cite journal | vauthors = Horesh N, Sever J, Apter A | title = A comparison of life events between suicidal adolescents with major depression and borderline personality disorder | journal = Comprehensive Psychiatry | volume = 44 | issue = 4 | pages = 277–83 | date = July–August 2003 | pmid = 12923705 | doi = 10.1016/S0010-440X(03)00091-9 | s2cid = 22004538 }}</ref>', 92 => '', 93 => '===Sense of self and self-concept===', 94 => 'Individuals diagnosed with BPD frequently experience significant difficulties in maintaining a stable [[self-concept]]. This instability manifests as uncertainty in personal [[values]], [[Belief|beliefs]], [[Preference|preferences]], and interests.<ref name=Manning_23/> They may also express confusion regarding their aspirations and objectives in terms of relationships and career paths. Such indeterminacy often leads to feelings of emptiness and a profound sense of disorientation regarding their own [[Identity (social science)|identity]].<ref name=Manning_23/> Moreover, their [[Self-perception theory|self-perception]] can fluctuate dramatically over short periods, oscillating between positive and negative evaluations. Consequently, individuals with BPD might adopt their sense of self based on their surroundings or the people they interact with, resulting in a chameleon-like adaptation of identity.<ref>{{cite journal | vauthors = Biskin RS, Paris J | title = Diagnosing borderline personality disorder | journal = CMAJ | volume = 184 | issue = 16 | pages = 1789–1794 | date = November 2012 | pmid = 22988153 | pmc = 3494330 | doi = 10.1503/cmaj.090618 }}</ref>', 95 => '', 96 => '===Dissociation and cognitive challenges===', 97 => 'The often heightened emotional states experienced by individuals with BPD can impede their ability to concentrate and cognitive functions.<ref name=Manning_23>{{harvnb|Manning|2011|page=23}}</ref> Additionally, individuals with BPD may frequently [[Dissociation (psychology)|dissociate]], which can be regarded as a mild to severe disconnection from physical and emotional experiences.<ref name=Manning_24>{{harvnb|Manning|2011|page=24}}</ref> Observers may notice signs of dissociation in individuals with BPD through diminished expressiveness in their face or voice, or through an apparent disconnection and insensitivity to emotional cues or stimuli.<ref name=Manning_24/>', 98 => '', 99 => 'Dissociation typically arises in response to distressing occurrences or reminders of past trauma, acting as a psychological [[Defence mechanism|defense mechanism]] by diverting attention from the current stressor or by blocking it out entirely. This process, believed to shield the individual from the anticipated overwhelming negative emotions and undesired impulses that the current emotional situation might provoke, is rooted in avoidance of intense emotional pain based on past experiences. While this mechanism may offer temporary emotional respite, it can foster unhealthy coping strategies and inadvertently dull positive emotions, thereby obstructing the individual's access to crucial emotional insights. These insights are essential for informed, healthy decision-making in everyday life.<ref name=Manning_24/>', 100 => '', 101 => '=== Psychotic symptoms ===', 102 => 'BPD is predominantly characterized as a disorder involving emotional dysregulation, yet psychotic symptoms frequently occur in individuals with BPD, with prevalence estimates ranging between 21% and 54%.<ref name="Schroeder_2013">{{cite journal | vauthors = Schroeder K, Fisher HL, Schäfer I | title = Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management | journal = Current Opinion in Psychiatry | volume = 26 | issue = 1 | pages = 113–9 | date = January 2013 | pmid = 23168909 | doi = 10.1097/YCO.0b013e32835a2ae7 | s2cid = 25546693 | doi-access = free }}</ref> These manifestations have historically been labeled as "pseudo-psychotic" or "psychotic-like", implying a differentiation from symptoms observed in primary [[psychotic disorders]]. However, recent studies suggest a closer similarity between psychotic symptoms in BPD and those in recognized psychotic disorders than previously understood.<ref name="Schroeder_2013" /><ref name="Niemantsverdriet_2017">{{cite journal | vauthors = Niemantsverdriet MB, Slotema CW, Blom JD, Franken IH, Hoek HW, Sommer IE, van der Gaag M | title = Hallucinations in borderline personality disorder: Prevalence, characteristics and associations with comorbid symptoms and disorders | journal = Scientific Reports | volume = 7 | issue = 1 | pages = 13920 | date = October 2017 | pmid = 29066713 | pmc = 5654997 | doi = 10.1038/s41598-017-13108-6 | bibcode = 2017NatSR...713920N }}</ref> The distinction of pseudo-psychosis has faced criticism for its weak [[construct validity]] and the potential to diminish the perceived severity of these symptoms, potentially hindering accurate diagnosis and effective treatment. Consequently, there are suggestions from some in the research community to categorize these symptoms as genuine psychosis, advocating for the abolishment of the distinction between pseudo-psychosis and true psychosis.<ref name="Schroeder_2013" /><ref name="Slotema_2018">{{cite journal | vauthors = Slotema CW, Blom JD, Niemantsverdriet MB, Sommer IE | title = Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review | journal = Frontiers in Psychiatry | volume = 9 | pages = 347 | date = 31 July 2018 | pmid = 30108529 | pmc = 6079212 | doi = 10.3389/fpsyt.2018.00347 | doi-access = free }}</ref>', 103 => '', 104 => 'The DSM-5 identifies transient paranoia, exacerbated by stress, as a symptom of BPD.<ref name="DSM53"/> Research has identified the presence of both [[Hallucination|hallucinations]] and [[delusions]] in individuals with BPD who do not possess an alternate diagnosis that would better explain these symptoms.<ref name="Niemantsverdriet_2017" /> Further, [[Interpretative phenomenological analysis|phenomenological analysis]] indicates that [[auditory verbal hallucinations]] in BPD patients are indistinguishable from those observed in [[schizophrenia]].<ref name="Niemantsverdriet_2017" /><ref name="Slotema_2018" /> This has led to suggestions of a potential shared [[etiological]] basis for hallucinations across BPD and other disorders, including psychotic and [[Affective disorder|affective disorders]].<ref name="Niemantsverdriet_2017" />', 105 => '', 106 => '===Disability and employment===', 107 => 'Individuals diagnosed with BPD often possess the capability to engage in employment, provided they secure positions that align with their skill sets and the severity of their condition remains manageable. In certain cases, BPD may be recognized as a [[disability]] within the workplace, particularly if the condition's severity results in behaviors that undermine relationships, involve engagement in risky activities, or manifest as intense anger, thereby inhibiting the individual's ability to perform their job role effectively.<ref>{{cite journal | vauthors = Arvig TJ | title = Borderline personality disorder and disability | journal = AAOHN Journal | volume = 59 | issue = 4 | pages = 158–60 | date = April 2011 | pmid = 21462898 | doi = 10.1177/216507991105900401| doi-access = free }}</ref> The [[United States Social Security Administration]] officially recognizes BPD as a form of disability, enabling those significantly affected to apply for [[disability benefits]].<ref>{{cite web |title=Disability Evaluation Under Social Security. 12.00 Mental Disorders - Adult |url=https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm |url-status=live |archive-url=https://web.archive.org/web/20230723101142/https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm |archive-date=July 23, 2023 |access-date=July 23, 2023 |website=[[Social Security Administration]]}}</ref>', 108 => '', 109 => '==Causes==<!-- This section needs its sub-headers redone and re-imagined. -->', 110 => '', 111 => 'The [[etiology]], or causes, of BPD is multifaceted, with no consensus on a singular cause.<ref name="mayo">{{cite web| url = http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=3| title = Borderline personality disorder| publisher = Mayo Clinic| access-date = 15 May 2008| url-status=live| archive-url = https://web.archive.org/web/20080430112844/http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION%3D3| archive-date = 30 April 2008| df = dmy-all}}</ref> It is posited that BPD may share a connection with [[post-traumatic stress disorder]] (PTSD),<ref name="BPD & PTSD">{{cite journal | vauthors = Gunderson JG, Sabo AN | title = The phenomenological and conceptual interface between borderline personality disorder and PTSD | journal = The American Journal of Psychiatry | volume = 150 | issue = 1 | pages = 19–27 | date = January 1993 | pmid = 8417576 | doi = 10.1176/ajp.150.1.19 }}</ref> given the commonality of [[childhood trauma]] among individuals with BPD.<ref name="kluft">{{cite book|title=Incest-Related Syndromes of Adult Psychopathology | vauthors = Kluft RP |year=1990 |publisher=American Psychiatric Pub, Inc.|pages=83, 89 |isbn=978-0-88048-160-1}}</ref> While childhood trauma is a recognized contributing factor, the roles of congenital brain abnormalities, genetics, [[neurobiology]], and non-traumatic environmental factors remain subjects of ongoing investigation.<ref name="mayo" /><ref>{{cite journal |vauthors=Zanarini MC, Frankenburg FR |year=1997 |title=Pathways to the development of borderline personality disorder |journal=Journal of Personality Disorders |volume=11 |issue=1 |pages=93–104 |doi=10.1521/pedi.1997.11.1.93 |pmid=9113824 |s2cid=20669909}}</ref>', 112 => '', 113 => '===Genetics and heritability===', 114 => 'Compared to other major psychiatric conditions, the exploration of genetic underpinnings in BPD remains novel.<ref name="pmid29032046">{{cite journal | vauthors = Bassir Nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM | title = Past, present, and future of genetic research in borderline personality disorder | journal = Current Opinion in Psychology | volume = 21 | issue = | pages = 60–68 | date = June 2018 | pmid = 29032046 | pmc = 5847441 | doi = 10.1016/j.copsyc.2017.09.002 }}</ref> Estimates suggest the [[heritability]] of BPD ranges from 37% to 69%,<ref name="Her2014">{{cite journal |vauthors=Gunderson JG, Zanarini MC, Choi-Kain LW, Mitchell KS, Jang KL, Hudson JI|date=August 2011|title=Family Study of Borderline Personality Disorder and Its Sectors of Psychopathology|journal=JAMA: The Journal of the American Medical Association|volume=68|issue=7|pages=753–762|doi=10.1001/archgenpsychiatry.2011.65|pmid=3150490|pmc=3150490}}</ref> indicating that [[Human genetic variation|human genetic variations]] account for a substantial portion of the risk for BPD within the population. However, [[Twin study|twin studies]], which often form the basis of these estimates, may overestimate the perceived influence of genetics due to the shared environment of twins, potentially skewing results.<ref>{{cite journal | vauthors = Torgersen S | title = Genetics of patients with borderline personality disorder | journal = The Psychiatric Clinics of North America | volume = 23 | issue = 1 | pages = 1–9 | date = March 2000 | pmid = 10729927 | doi = 10.1016/S0193-953X(05)70139-8 }}</ref>', 115 => '', 116 => 'Despite these methodological considerations, certain studies propose that personality disorders are significantly shaped by genetics, more so than many [[Axis I disorders]], such as depression and eating disorders, and even surpassing the genetic impact on broad [[personality traits]].<ref name="ReferenceA">{{cite journal | vauthors = Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, Tambs K, Kringlen E | title = A twin study of personality disorders | journal = Comprehensive Psychiatry | volume = 41 | issue = 6 | pages = 416–425 | year = 2000 | pmid = 11086146 | doi = 10.1053/comp.2000.16560 }}</ref> Notably, BPD ranks as the third most heritable among ten surveyed personality disorders.<ref name="ReferenceA" />', 117 => '', 118 => 'Research involving twin and sibling studies has shown a genetic component to traits associated with BPD, such as impulsive aggression. However, the genetic contribution to behavior from [[serotonin]]-related genes appears to be modest.<ref name="neurotrauma">{{cite journal | vauthors = Goodman M, New A, Siever L | title = Trauma, genes, and the neurobiology of personality disorders | journal = Annals of the New York Academy of Sciences | volume = 1032 | issue = 1 | pages = 104–116 | date = December 2004 | pmid = 15677398 | doi = 10.1196/annals.1314.008 | bibcode = 2004NYASA1032..104G | s2cid = 26270818 }}</ref>', 119 => '', 120 => 'A notable study conducted by Trull et al. in the Netherlands, which included 711 sibling pairs and 561 parents, aimed to identify [[Genetic marker|genetic markers]] associated with BPD.<ref name="Possible Genetic Causes">{{cite web|url=https://www.sciencedaily.com/releases/2008/12/081216114100.htm|title=Possible Genetic Causes Of Borderline Personality Disorder Identified|publisher=sciencedaily.com|date=20 December 2008|url-status=live|archive-url=https://web.archive.org/web/20140501161311/https://www.sciencedaily.com/releases/2008/12/081216114100.htm|archive-date=1 May 2014}}</ref> This research identified a linkage to genetic markers on [[chromosome 9]] as relevant to BPD characteristics,<ref name="Possible Genetic Causes" /> underscoring a significant genetic contribution to the [[Variability (statistics)|variability]] observed in BPD features.<ref name="Possible Genetic Causes" /> Prior findings from this group indicated that 42% of BPD feature variability could be attributed to genetics, with the remaining 58% owing to environmental factors.<ref name="Possible Genetic Causes" />', 121 => '', 122 => 'Among specific genetic variants under scrutiny {{as of|2012|lc=y}}, the [[DRD4 7-repeat polymorphism]] (of the [[Dopamine receptor D4|dopamine receptor D₄]]) located on [[chromosome 11]] has been linked to disorganized attachment, and in conjunction with the 10/10-repeat genotype of the [[dopamine transporter]] (DAT), it has been associated with issues with [[inhibitory control]], both of which are characteristic of BPD.<ref name="Brain Structure and Function">{{cite journal | vauthors = O'Neill A, Frodl T | title = Brain structure and function in borderline personality disorder | journal = Brain Structure & Function | volume = 217 | issue = 4 | pages = 767–782 | date = October 2012 | pmid = 22252376 | doi = 10.1007/s00429-012-0379-4 | s2cid = 17970001 }}</ref> Additionally, potential links to [[chromosome 5]] are being explored, further emphasizing the complex genetic landscape influencing BPD development and manifestation.<ref>{{cite journal | vauthors = Lubke GH, Laurin C, Amin N, Hottenga JJ, Willemsen G, van Grootheest G, Abdellaoui A, Karssen LC, Oostra BA, van Duijn CM, Penninx BW, Boomsma DI | title = Genome-wide analyses of borderline personality features | journal = Molecular Psychiatry | volume = 19 | issue = 8 | pages = 923–929 | date = August 2014 | pmid = 23979607 | pmc = 3872258 | doi = 10.1038/mp.2013.109 }}</ref>', 123 => '', 124 => '===Environmental factors===', 125 => '', 126 => '====Adverse childhood experiences<!-- and childhood trauma. **This one is BEAUTIFULLY WRITTEN!** -->====', 127 => 'Studies based on [[empiricism]] have established a strong [[correlation]] between [[adverse childhood experiences]] such as [[child abuse]], particularly [[child sexual abuse]], and the onset of BPD later in life.<ref>{{cite journal |vauthors=Cohen P |date=September 2008 |title=Child development and personality disorder |journal=The Psychiatric Clinics of North America |volume=31 |issue=3 |pages=477–493, vii |doi=10.1016/j.psc.2008.03.005 |pmid=18638647}}</ref><ref name="Herman91">{{cite book |url=https://archive.org/details/traumarecovery00herm_0 |title=Trauma and recovery |vauthors=Herman JL |publisher=Basic Books |year=1992 |isbn=978-0-465-08730-3 |location=New York}}</ref><ref name="AxisOne/AxisTwo" /> Reports from individuals diagnosed with BPD frequently include narratives of extensive abuse and neglect during early childhood, though [[causality]] remains a subject of ongoing investigation.<ref>{{cite journal | vauthors = Ball JS, Links PS | title = Borderline personality disorder and childhood trauma: evidence for a causal relationship | journal = Current Psychiatry Reports | volume = 11 | issue = 1 | pages = 63–68 | date = February 2009 | pmid = 19187711 | doi = 10.1007/s11920-009-0010-4 | s2cid = 20566309 }}</ref> These individuals are significantly more prone to recount experiences of verbal, emotional, physical, or sexual abuse by caregivers,<ref>{{cite news|url=http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/risk-factors/con-20023204|title=Borderline personality disorder: Understanding this challenging mental illness|work=Mayo Clinic|access-date=5 September 2017|url-status=live|archive-url=https://web.archive.org/web/20170830054834/http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/risk-factors/con-20023204|archive-date=30 August 2017}}</ref> alongside a notable frequency of [[incest]] and loss of caregivers in early childhood.<ref name="failchild">{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Lewis RE, Williams AA, Khera GS | title = Biparental failure in the childhood experiences of borderline patients | journal = Journal of Personality Disorders | volume = 14 | issue = 3 | pages = 264–273 | year = 2000 | pmid = 11019749 | doi = 10.1521/pedi.2000.14.3.264 }}</ref>', 128 => '', 129 => 'Moreover, there have been consistent accounts of caregivers [[Emotional validation|invalidating]] the individuals' emotions and thoughts, neglecting physical care, failing to provide necessary protection, and exhibiting emotional withdrawal and inconsistency.<ref name="failchild" /> Specifically, female individuals with BPD reporting past neglect or abuse by caregivers have a heightened likelihood of encountering sexual abuse from individuals outside their immediate family circle.<ref name="failchild" />', 130 => '', 131 => 'The enduring impact of chronic maltreatment and difficulties in forming [[Secure attachment|secure attachments]] during childhood has been hypothesized to potentially contribute to the development of BPD.<ref name="Dozier-1999">{{cite book | vauthors = Dozier M, Stovall-McClough KC, Albus KE |year=1999 |chapter=Attachment and psychopathology in adulthood | veditors = Cassidy J, Shaver PR |title=Handbook of attachment |pages=497–519 |location=New York |publisher=[[Guilford Press]]}}</ref> From a [[Psychoanalysis|psychoanalytic]] perspective, [[Otto Kernberg]] has posited that the child's failure to navigate the developmental challenge of differentiating self from others, or as Kernberg terms it achieve the developmental task of [[Otto F. Kernberg#First developmental task: psychic clarification of self and other|psychic clarification of self and other]], and failure to overcome the internal divisions caused by [[Splitting (psychology)|splitting]] may predispose that child to BPD.<ref>{{cite book | vauthors = Kernberg OF |title=Borderline conditions and pathological narcissism |publisher=J. Aronson |location=Northvale, New Jersey |isbn=978-0-87668-762-8 |year=1985 }}{{Page needed|date=July 2013}}</ref>', 132 => '', 133 => '==== Invalidating environment ====', 134 => '[[Marsha Linehan]]'s biosocial developmental theory posits that BPD arises from the interaction between a child's inherent emotional vulnerability and an invalidating environment. Emotional vulnerability is thought to be influenced by biological and genetic factors that shape the child's temperament. Invalidating environments are characterized by the neglect, ridicule, dismissal, or discouragement of a child's emotions and needs, and may also encompass experiences of trauma and abuse.<ref>{{cite journal | vauthors = Crowell SE, Beauchaine TP, Linehan MM | title = A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory | journal = Psychological Bulletin | volume = 135 | issue = 3 | pages = 495–510 | date = May 2009 | pmid = 19379027 | pmc = 2696274 | doi = 10.1037/a0015616 }}</ref>', 135 => '', 136 => 'Sheila Crowell further expanded on Linehan's theory by highlighting the significant role of impulsivity in the development of BPD. According to Crowell, emotionally vulnerable children who are subjected to invalidating environments are at a heightened risk of developing BPD, particularly if they exhibit high levels of impulsivity.<ref>{{cite journal |vauthors=Crowell SE, Beauchaine TP, Linehan MM |date=May 2009 |title=A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory |journal=Psychological Bulletin |volume=135 |issue=3 |pages=495–510 |doi=10.1037/a0015616 |pmc=2696274 |pmid=19379027}}</ref> Both theories underscore the dynamic interplay between a child's innate personality traits and their environmental context. For instance, children who are emotionally sensitive or prone to impulsivity may pose challenges in parenting, potentially worsening the invalidating nature of their environment. Conversely, experiences of invalidation may intensify the emotional sensitivity and distress of such children.{{Original research inline|date=March 2024}}', 137 => '', 138 => '===Brain structure and function===<!-- Structural brain changes', 139 => ' -->', 140 => '', 141 => 'Research employing [[structural neuroimaging]] techniques, such as [[voxel-based morphometry]], has reported variations in individuals diagnosed with BPD in specific [[brain regions]] that have been associated with the [[psychopathology]] of BPD. Notably, reductions in volume enclosed have been observed in the [[hippocampus]], [[orbitofrontal cortex]], [[anterior cingulate cortex]], and [[amygdala]], among others, which are crucial for [[emotional self-regulation]] and [[stress management]].<ref name="Brain Structure and Function" /><!-- Biochemical alterations', 142 => ' --><!-- Alterations in glucose metabolism and brain oxygenation', 143 => ' --><!-- Neurometabolites', 144 => ' -->', 145 => '', 146 => 'In addition to structural imaging, a subset of studies utilizing [[magnetic resonance spectroscopy]] has investigated the neurometabolic profile within these affected regions. These investigations have focused on the concentrations of various neurometabolites, including [[N-acetylaspartate|''N''-acetylaspartate]], [[creatine]], compounds related to [[glutamate]], and compounds containing [[choline]]. These studies aim to clarify the biochemical alterations that may underlie the symptomatology observed in BPD, offering insights into BPD's neurobiological basis.<ref name="Brain Structure and Function" />', 147 => '', 148 => '==== Neurological patterns ====', 149 => 'Research into BPD has identified that the propensity for experiencing intense negative emotions, a trait known as [[negative affectivity]], serves as a more potent predictor of BPD symptoms than the history of childhood sexual abuse alone.<ref name="Rosenthal"/> This correlation, alongside observed variations in brain structure and the presence of BPD in individuals without traumatic histories,<ref name="Gratz2007">{{harvnb|Chapman|Gratz|2007|page=52}}</ref> delineates BPD from disorders such as PTSD that are frequently co-morbid. Consequently, investigations into BPD encompass both developmental and traumatic origins.', 150 => '', 151 => 'Research has shown changes in two [[brain circuits]] implicated in the emotional dysregulation characteristic of BPD: firstly, an escalation in activity within brain circuits associated with experiencing severe emotional pain, and secondly, a decreased activation within circuits tasked with the regulation or suppression of these intense emotions. These dysfunctional activations predominantly occur within the [[limbic system]], though individual variances necessitate further neuroimaging research to explore these patterns in detail.<ref name="Ruocco, Anthony C.; Amirthavasagam, Sathya, Choi-Kain, Lois W.; McMain, Shelley F. 2013 153–160">{{cite journal | vauthors = Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF | title = Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis | journal = Biological Psychiatry | volume = 73 | issue = 2 | pages = 153–160 | date = January 2013 | pmid = 22906520 | doi = 10.1016/j.biopsych.2012.07.014 | s2cid = 8381799 }}</ref><!-- Seems this was inserted by someone related to study possibly for self-gain? -->', 152 => '', 153 => 'Contrary to earlier findings, individuals with BPD exhibit decreased amygdala activation in response to heightened negative emotional stimuli compared to control groups. John Krystal, the editor of ''[[Biological Psychiatry (journal)|Biological Psychiatry]]'', commented on these findings, suggesting they contribute to understanding the innate neurological predisposition of individuals with BPD to lead emotionally turbulent lives, which are not inherently negative or unproductive.<ref name="Ruocco, Anthony C.; Amirthavasagam, Sathya, Choi-Kain, Lois W.; McMain, Shelley F. 2013 153–160" /> This emotional volatility is consistently linked to disparities in several brain regions, emphasizing the neurobiological underpinnings of BPD.<ref name="Koenigsberg">{{cite journal | vauthors = Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, Cheng H, Flory J, Prohovnik I | title = Neural correlates of emotion processing in borderline personality disorder | journal = Psychiatry Research | volume = 172 | issue = 3 | pages = 192–199 | date = June 2009 | pmid = 19394205 | pmc = 4153735 | doi = 10.1016/j.pscychresns.2008.07.010 | quote = BPD patients demonstrated greater differences in activation than controls, when viewing negative pictures compared with rest, in the amygdala, fusiform gyrus, primary visual areas, superior temporal gyrus (STG), and premotor areas, while healthy controls showed greater differences than BPD patients in the insula, middle temporal gyrus and dorsolateral prefrontal cortex. }}</ref>', 154 => '', 155 => '===Mediating and moderating factors<!-- These 'factors' are all causes anyway? Why not be part of causes, why their own 'mediating and moderating factors'? -->===', 156 => '', 157 => '==== Executive function and social rejection sensitivity<!-- Should likely be under Brain function -->====', 158 => 'High sensitivity to [[social rejection]] is linked to more severe symptoms of BPD, with [[executive function]] playing a mediating role.<ref name="Executive_function">{{cite journal | vauthors = Ayduk O, Zayas V, Downey G, Cole AB, Shoda Y, Mischel W|author-link6=Walter Mischel | title = Rejection Sensitivity and Executive Control: Joint predictors of Borderline Personality features | journal = Journal of Research in Personality | volume = 42 | issue = 1 | pages = 151–168 | date = February 2008 | pmid = 18496604 | pmc = 2390893 | doi = 10.1016/j.jrp.2007.04.002 }}</ref> Executive function—encompassing [[planning]], [[working memory]], [[attentional control]], and [[problem-solving]]—moderates how rejection sensitivity influences BPD symptoms. Studies demonstrate that individuals with lower executive function exhibit a stronger correlation between rejection sensitivity and BPD symptoms.<ref name="Executive_function"/> Conversely, higher executive function may mitigate the impact of rejection sensitivity, potentially offering protection against BPD symptoms.<ref name="Executive_function"/> Additionally, deficiencies in working memory are associated with increased impulsivity in individuals with BPD.<ref>{{cite journal | vauthors = Lazzaretti M, Morandotti N, Sala M, Isola M, Frangou S, De Vidovich G, Marraffini E, Gambini F, Barale F, Zappoli F, Caverzasi E, Brambilla P | title = Impaired working memory and normal sustained attention in borderline personality disorder | journal = Acta Neuropsychiatrica | volume = 24 | issue = 6 | pages = 349–355 | date = December 2012 | pmid = 25287177 | doi = 10.1111/j.1601-5215.2011.00630.x | s2cid = 34486508 }}</ref>', 159 => '', 160 => '==== Family environment<!-- Should likely be under Environmental factors and merged with it -->====', 161 => 'The family environment significantly influences the development of BPD, acting as a mediator for the effects of child sexual abuse. An unstable family environment increases the risk of developing BPD, while a stable environment can provide a protective buffer against the disorder. This dynamic suggests the critical role of familial stability in mitigating or exacerbating the risk of BPD.<ref name="Bradley">{{cite journal | vauthors = Bradley R, Jenei J, Westen D | title = Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents | journal = The Journal of Nervous and Mental Disease | volume = 193 | issue = 1 | pages = 24–31 | date = January 2005 | pmid = 15674131 | doi = 10.1097/01.nmd.0000149215.88020.7c | s2cid = 21168862 }}</ref>', 162 => '', 163 => '==== Self-complexity<!-- Gives _no_ mention of how this relates to BPD, so we must find one. -->====', 164 => '{{Main|Self-complexity}}', 165 => 'Self-complexity refers to the extent to which individuals perceive themselves as having a wide range of distinct cognitive structures, encompassing various psychological attributes, physical characteristics, abilities, skills, and social roles. This concept plays a significant role in shaping one's [[self-perception]] and can mitigate conflicts between the actual self and the ideal [[self-image]]. Individuals with higher self-complexity tend to seek a diversity of traits, rather than focusing solely on enhancing certain superior qualities. This broader desire for varied traits influences how individuals perceive and value their own characteristics. Self-complexity challenges traditional views of normative attributes by prioritizing a relational rather than a categorical approach to understanding personal identity.<ref name="Parker">{{cite journal | vauthors = Parker AG, Boldero JM, Bell RC | title = Borderline personality disorder features: the role of self-discrepancies and self-complexity | journal = Psychology and Psychotherapy | volume = 79 | issue = Pt 3 | pages = 309–321 | date = September 2006 | pmid = 16945194 | doi = 10.1348/147608305X70072 }}</ref>', 166 => '', 167 => '==== Thought suppression ====', 168 => 'The practice of [[thought suppression]], or deliberate efforts to avoid certain thoughts, has been found to mediate the relationship between emotional vulnerability and BPD symptoms.<ref name="Rosenthal">{{cite journal | vauthors = Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR | title = Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms | journal = Behaviour Research and Therapy | volume = 43 | issue = 9 | pages = 1173–1185 | date = September 2005 | pmid = 16005704 | doi = 10.1016/j.brat.2004.08.006 }}</ref> Although a direct link between emotional vulnerability and BPD symptoms is not always mediated by thought suppression, it does play a significant role in the context of an invalidating environment. This suggests that thought suppression can both contribute to and alleviate symptoms of BPD, depending on the surrounding environmental factors.<ref>{{cite journal | vauthors = Sauer SE, Baer RA | title = Relationships between thought suppression and symptoms of borderline personality disorder | journal = Journal of Personality Disorders | volume = 23 | issue = 1 | pages = 48–61 | date = February 2009 | pmid = 19267661 | doi = 10.1521/pedi.2009.23.1.48 }}</ref>', 169 => '', 170 => '==Diagnosis==', 171 => 'The clinical diagnosis of BPD can be made through a thorough [[psychiatric assessment]] conducted by a [[mental health professional]], ideally a [[psychiatrist]]. This comprehensive assessment integrates various sources of information to confirm the diagnosis, encompassing the patient's self-reported [[clinical history]], observations made by the clinician during interviews, and corroborative details obtained from family members, friends, and medical records. It is crucial to thoroughly assess patients for co-morbid mental health conditions, substance use disorders, suicidal ideation, and any self-harming behaviors.<ref>{{Cite book |url=https://www.uptodate.com/ |title=UpToDate |publisher=[[Wolters Kluwer]] |veditors=Post TW |chapter=Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis |access-date=11 March 2023 |chapter-url=https://www.uptodate.com/contents/borderline-personality-disorder-epidemiology-pathogenesis-clinical-features-course-assessment-and-diagnosis |url-access=subscription |archive-date=6 January 2009 |archive-url=https://web.archive.org/web/20090106134307/http://uptodate.com/ |url-status=live }}</ref>', 172 => '', 173 => 'An effective approach involves presenting the criteria of the disorder to the individual and inquiring if they perceive these criteria as reflective of their experiences. Involving individuals in the diagnostic process may enhance their acceptance of the diagnosis. Despite the stigma associated with BPD and previous notions of its untreatability, disclosing the diagnosis to individuals is generally beneficial. It provides them with validation and directs them to appropriate treatment options.<ref name="Gund2011" />', 174 => '', 175 => 'The [[psychological evaluation]] for BPD typically explores the onset and intensity of symptoms and their impact on the individual's [[quality of life]]. Critical areas of focus include suicidal thoughts, self-harm behaviors, and any thoughts of harming others.<ref name="Mayo_Clinic_Diagnosis">{{cite web|title=Personality Disorders: Tests and Diagnosis|url=http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=tests-and-diagnosis|publisher=Mayo Clinic|access-date=13 June 2013|url-status=live|archive-url=https://web.archive.org/web/20130606185940/http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION%3Dtests-and-diagnosis|archive-date=6 June 2013}}</ref> The diagnosis relies on both the individual's self-reported symptoms and the clinician's observations.<ref name="Mayo_Clinic_Diagnosis" /> To exclude other potential causes of the symptoms, additional assessments may include a [[physical examination]] and [[Blood test|blood tests]], to exclude thyroid disorders or substance use disorders.<ref name="Mayo_Clinic_Diagnosis" /> The [[International Classification of Diseases]] (ICD-10) categorizes the condition as ''emotionally unstable personality disorder'', with diagnostic criteria similar to those in the [[Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition|''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'']] (DSM-5), where the disorder's name remains unchanged from previous editions.<ref name="DSM53" />', 176 => '', 177 => '=== ''DSM-5'' diagnostic criteria ===', 178 => '<!-- Please do not add diagnosis criteria as this constitutes a copyright violation. APA has forbidden us.-->', 179 => 'The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5) has eliminated the multiaxial diagnostic system, integrating all disorders, including personality disorders, into Section II of the manual. For a diagnosis of BPD, an individual must meet five out of nine specified diagnostic criteria.<ref name="DSM-5-borderine personality disorders" /> The DSM-5 characterizes BPD as a pervasive pattern of instability in interpersonal relationships, self-image, affect, and a significant propensity towards impulsive behavior.<ref name="DSM-5-borderine personality disorders">{{harvnb|American Psychiatric Association|2013|pages=663–8}}</ref> Moreover, the DSM-5 introduces alternative diagnostic criteria for BPD in Section III, titled "Alternative DSM-5 Model for Personality Disorders". These criteria are rooted in trait research and necessitate the identification of at least four out of seven maladaptive traits.<ref name="DSM-5-borderline-alternative">{{harvnb|American Psychiatric Association|2013|pages=766–7}}</ref> Marsha Linehan highlights the diagnostic challenges faced by mental health professionals in using the DSM criteria due to the broad range of behaviors they encompass.<ref name="Manning_13">{{harvnb|Manning|2011|page=13}}</ref> To mitigate these challenges, Linehan categorizes BPD symptoms into five principal areas of dysregulation: emotions, behavior, interpersonal relationships, sense of self, and cognition.<ref name="Manning_13" />', 180 => '', 181 => '===International Classification of Disease (ICD) diagnostic criteria===', 182 => '', 183 => '==== ICD-11 diagnostic criteria ====', 184 => 'The [[World Health Organization]]'s [[ICD-11]] completely restructured its personality disorder section. It classifies BPD as ''Personality disorder, severity unspecified,'' ''Borderline pattern'', ({{ICD11|6D10.X/6D11.5}}) coded as the following:<ref>{{Cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse/2024-01/mms/en#2006821354 |access-date=2024-03-11 |website=icd.who.int |archive-date=14 March 2024 |archive-url=https://web.archive.org/web/20240314103223/https://icd.who.int/browse/2024-01/mms/en#2006821354 |url-status=live }}</ref>', 185 => '{{quote ', 186 => '|text = The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by five (or more) of the following: ', 187 => '* Frantic efforts to avoid real or imagined abandonment.', 188 => '* A pattern of unstable and intense interpersonal relationships, which may be characterized by vacillations between idealization and devaluation, typically associated with both strong desire for and fear of closeness and intimacy.', 189 => '* Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.', 190 => '* A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours (e.g., risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating).', 191 => '* Recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation).', 192 => '* Emotional instability due to marked reactivity of mood. Fluctuations of mood may be triggered either internally (e.g., by one’s own thoughts) or by external events. As a consequence, the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days.', 193 => '* Chronic feelings of emptiness.', 194 => '* Inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights).', 195 => '* Transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.', 196 => '', 197 => 'Other manifestations of Borderline pattern, not all of which may be present in a given individual at a given time, include the following:', 198 => '*A view of the self as inadequate, bad, guilty, disgusting, and contemptible. ', 199 => '*An experience of the self as profoundly different and isolated from other people; a painful sense of alienation and pervasive loneliness. ', 200 => '*Proneness to rejection hypersensitivity; problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships; frequent misinterpretation of social signals.', 201 => '}}', 202 => '', 203 => '==== ICD-10 diagnostic criteria ====', 204 => 'The [[ICD-10]] (version 2019) identified a condition akin to BPD it termed ''Emotionally unstable personality disorder'' (EUPD) ({{ICD10|F|60|3|f|60}}). This classification described EUPD as a personality disorder with a marked propensity for impulsive behavior without considering potential consequences. Individual with EUPD had noticeably erratic and fluctuating moods and are prone to sudden emotional outbursts, struggling to regulate these rapid shifts in emotion. Conflict and confrontational behavior are common, especially in situations where impulsive actions are criticized or hindered.', 205 => '', 206 => 'The ICD-10 recognizes two subtypes of this disorder: the ''impulsive type'', characterized mainly by emotional dysregulation and impulsivity, and the ''borderline type'', which additionally includes disturbances in self-perception, goals, and personal preferences. Those with the ''borderline subtype'' also experience a persistent feeling of emptiness, unstable and chaotic interpersonal relationships, and a predisposition towards self-harming behaviors, encompassing both suicidal ideations and suicide attempts.<ref>{{Cite web |title=ICD-10 Version:2019 |url=https://icd.who.int/browse10/2019/en#F60.3 |access-date=2024-03-11 |website=icd.who.int |archive-date=31 March 2020 |archive-url=https://archive.today/20200331004754/https://icd.who.int/browse10/2019/en%23/U07.1#F60.3 |url-status=live }}</ref>', 207 => '', 208 => '===Millon's subtypes<!-- relevance ? -->===', 209 => 'Psychologist [[Theodore Millon]] proposed four subtypes of BPD, where individuals with BPD would exhibit none, one, or multiple of the following:<ref name="Millon">{{cite book | vauthors = Millon T |year=2004 |title=Personality Disorders in Modern Life |page=4 |publisher=John Wiley & Sons |location=Hoboken, New Jersey |isbn=978-0-471-23734-1}}</ref>', 210 => '{| class="wikitable"', 211 => '|-', 212 => '! Subtype', 213 => '! Features', 214 => '|-', 215 => '| '''Discouraged'''', 216 => '| Characterized by avoidant, dependent features, and unexpressed anger. More likely to internalize and less likely to community their feelings or be impulsive.<ref>{{cite journal | vauthors = Duică L, Antonescu E, Totan M, Boța G, Silișteanu SC | title = Borderline Personality Disorder "Discouraged Type": A Case Report | journal = Medicina | volume = 58 | issue = 2 | pages = 162 | date = January 2022 | pmid = 35208485 | pmc = 8874928 | doi = 10.3390/medicina58020162 | doi-access = free }}</ref> Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.', 217 => '|-', 218 => '| '''Petulant''' (including [[Passive-aggressive personality disorder|negativistic]] features)', 219 => '| Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily feels "slighted" and quickly disillusioned.', 220 => '|-', 221 => '| '''Impulsive''' (including histrionic and antisocial features)', 222 => '| Captivating, capricious, superficial, flighty, distractable, frenetic, and seductive; fearing loss, the individual becomes agitated; gloomy and irritable; and potentially suicidal.', 223 => '|-', 224 => '| '''Self-destructive''' (including depressive or [[Self-defeating personality disorder|masochistic]] features)', 225 => '| Inward-turning, intropunitive (self-punishing), angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.', 226 => '|}', 227 => '', 228 => '===Misdiagnosis===', 229 => '{{Main|Misdiagnosis of borderline personality disorder}}', 230 => 'Individuals with BPD are subject to [[misdiagnosis]] due to various factors, notably the overlap (comorbidity) of BPD symptoms with those of other disorders such as depression, PTSD, and bipolar disorder.<ref name="Chanen">{{cite journal | vauthors = Chanen AM, Thompson KN | title = Prescribing and borderline personality disorder | journal = Australian Prescriber | volume = 39 | issue = 2 | pages = 49–53 | date = April 2016 | pmid = 27340322 | pmc = 4917638 | doi = 10.18773/austprescr.2016.019 }}</ref><ref>{{cite journal | vauthors = Meaney R, Hasking P, Reupert A | title = Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination | journal = PLOS ONE | volume = 11 | issue = 6 | pages = e0157294 |year = 2016 | pmid = 27348858 | pmc = 4922551 | doi = 10.1371/journal.pone.0157294 | bibcode = 2016PLoSO..1157294M | doi-access = free }}</ref> Misdiagnosis of BPD can lead to a range of adverse consequences. Diagnosis plays a crucial role in informing healthcare professionals about the patient's mental health status, guiding treatment strategies, and facilitating accurate reporting of successful interventions.<ref>{{Cite journal |last=Sartorius |first=Norman |date=2015 |title=Why do we need a diagnosis? Maybe a syndrome is enough? |journal=Dialogues in Clinical Neuroscience |volume=17 |issue=1 |pages=6–7 |doi=10.31887/DCNS.2015.17.1/nsartorius |pmc=4421902 |pmid=25987858}}</ref> Consequently, misdiagnosis may deprive individuals of access to suitable psychiatric medications or evidence-based psychological interventions tailored to their specific disorders.<ref name=":5">{{Cite journal |last1=Paris |first1=Joel |last2=Black |first2=Donald W. |date=2015 |title=Borderline Personality Disorder and Bipolar Disorder |url=http://dx.doi.org/10.1097/nmd.0000000000000225 |journal=The Journal of Nervous and Mental Disease |volume=203 |issue=1 |pages=3–7 |doi=10.1097/nmd.0000000000000225 |issn=0022-3018 |pmid=25536097 |s2cid=2825326|url-access=subscription }}</ref>', 231 => '', 232 => 'Critics of the BPD diagnosis contend that it is indistinguishable from negative affectivity upon undergoing regression and factor analyses. They maintain that the diagnosis of BPD does not provide additional insight beyond what is captured by other diagnoses, positing that it may be redundant or potentially misleading.<ref name=FG>{{cite journal | vauthors = Gutiérrez F, Aluja A, Ruiz Rodríguez J, Peri JM, Gárriz M, Garcia LF, Sorrel MA, Sureda B, Vall G, Ferrer M, Calvo N | title = Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11) | journal = Personality Disorders | date = June 2022 | volume = 14 | issue = 3 | pages = 355–359 | pmid = 35737563 | doi = 10.1037/per0000592 | s2cid = 249805748 }}</ref>', 233 => '', 234 => '===Adolescence===', 235 => 'The onset of BPD symptoms typically occurs during adolescence or early adulthood, with possible early signs in childhood.<ref>{{harvnb|Linehan|1993|page=49}}</ref> Predictive symptoms in adolescents include [[body image]] issues, extreme sensitivity to rejection, behavioral challenges, [[non-suicidal self-injury]], seeking exclusive relationships, and profound shame.<ref name="Gund2011" /> Although many adolescents exhibit these symptoms without developing BPD, those who do are significantly more likely to develop the disorder and potentially face long-term social challenges.<ref name="Gund2011" />', 236 => '', 237 => 'BPD is recognized as a stable and valid diagnosis during adolescence, supported by the DSM-5 and ICD-11.<ref name="Miller_2008">{{cite journal |vauthors=Miller AL, Muehlenkamp JJ, Jacobson CM |date=July 2008 |title=Fact or fiction: diagnosing borderline personality disorder in adolescents |url=http://dx.doi.org/10.1016/j.cpr.2008.02.004 |url-status=live |journal=Clinical Psychology Review |volume=28 |issue=6 |pages=969–81 |doi=10.1016/j.cpr.2008.02.004 |pmid=18358579 |archive-url=https://web.archive.org/web/20201204232033/https://www.sciencedirect.com/science/article/abs/pii/S0272735808000299?via%3Dihub |archive-date=4 December 2020 |access-date=23 September 2020|url-access=subscription }}</ref><ref name="National Collaborating Centre for Mental Health (UK)_2009">{{cite book |author=National Collaborating Centre for Mental Health (UK) |url=https://www.ncbi.nlm.nih.gov/books/NBK55399/ |title=Young People With Borderline Personality Disorder |date=2009 |publisher=British Psychological Society |access-date=23 September 2020 |archive-url=https://web.archive.org/web/20201204232017/https://www.ncbi.nlm.nih.gov/books/NBK55399/ |archive-date=4 December 2020 |url-status=live}}</ref><ref name="Kaess_2014">{{cite journal |vauthors=Kaess M, Brunner R, Chanen A |date=October 2014 |title=Borderline personality disorder in adolescence |url=https://publications.aap.org/pediatrics/article-pdf/134/4/782/1098814/peds_2013-3677.pdf |url-status= |journal=Pediatrics |volume=134 |issue=4 |pages=782–93 |doi=10.1542/peds.2013-3677 |pmid=25246626 |s2cid=8274933 |archive-url= |archive-date= |access-date=23 September 2020}}</ref><ref name="Biskin_2015">{{cite journal |vauthors=Biskin RS |date=July 2015 |title=The Lifetime Course of Borderline Personality Disorder |journal=Canadian Journal of Psychiatry |volume=60 |issue=7 |pages=303–8 |doi=10.1177/070674371506000702 |pmc=4500179 |pmid=26175388}}</ref> Early detection and treatment of BPD in young individuals are emphasized in national guidelines across various countries, including the US, Australia, the UK, Spain, and Switzerland, highlighting the importance of early intervention.<ref name="Kaess_2014" /><ref>{{cite book |last=National Health and Medical Research Council (Australia) |url=http://worldcat.org/oclc/948783298 |title=Clinical practice guideline for the management of borderline personality disorder |date=2013 |publisher=National Health and Medical Research Council |isbn=978-1-86496-564-3 |oclc=948783298 |access-date=23 September 2020 |archive-url=https://web.archive.org/web/20201204232022/https://www.worldcat.org/title/clinical-practice-guideline-for-the-management-of-borderline-personality-disorder/oclc/948783298 |archive-date=4 December 2020 |url-status=live}}</ref><ref>{{cite web |date=28 January 2009 |title=Overview {{!}} Borderline personality disorder: recognition and management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg78 |url-status=live |archive-url=https://web.archive.org/web/20191011171334/https://www.nice.org.uk/guidance/CG78 |archive-date=11 October 2019 |access-date=23 September 2020 |website=www.nice.org.uk}}</ref><ref>{{cite journal |author=Grupo de Trabajo de la Guía de Práctica Clínica sobre Trastorno Límite de la Personalidad |date=June 2011 |title=Guía de práctica clínica sobre trastorno límite de la personalidad |url=https://scientiasalut.gencat.cat/handle/11351/810 |url-status=live |journal=Scientia |archive-url=https://web.archive.org/web/20201204232022/https://scientiasalut.gencat.cat/handle/11351/810 |archive-date=4 December 2020 |access-date=23 September 2020}}</ref>', 238 => '', 239 => 'Historically, diagnosing BPD during adolescence was met with caution,<ref name="Kaess_2014" /><ref>{{cite book |title=Treatment of Personality Disorders |vauthors=de Vito E, Ladame F, Orlandini A |date=1999 |publisher=Springer US |isbn=978-1-4419-3326-3 |veditors=Derksen J, Maffei C, Groen H |place=Boston, MA |pages=77–95 |chapter=Adolescence and Personality Disorders |doi=10.1007/978-1-4757-6876-3_7 |access-date=23 September 2020 |chapter-url=http://link.springer.com/10.1007/978-1-4757-6876-3_7 |archive-url=https://web.archive.org/web/20201204232040/https://link.springer.com/chapter/10.1007%2F978-1-4757-6876-3_7 |archive-date=4 December 2020 |url-status=live}}</ref><ref>{{cite journal |vauthors=Guilé JM, Boissel L, Alaux-Cantin S, de La Rivière SG |date=23 November 2018 |title=Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies |journal=Adolescent Health, Medicine and Therapeutics |volume=9 |pages=199–210 |doi=10.2147/ahmt.s156565 |pmc=6257363 |pmid=30538595 |doi-access=free}}</ref> due to concerns about the accuracy of diagnosing young individuals,<ref>{{cite book |last=American Psychiatric Association. Work Group on Borderline Personality Disorder. |url=http://worldcat.org/oclc/606593046 |title=Practice guideline for the treatment of patients with borderline personality disorder |date=2001 |publisher=American Psychiatric Association |oclc=606593046 |access-date=23 September 2020 |archive-url=https://web.archive.org/web/20201204232020/https://www.worldcat.org/title/practice-guideline-for-the-treatment-of-patients-with-borderline-personality-disorder/oclc/606593046 |archive-date=4 December 2020 |url-status=live}}</ref><ref>{{cite book |author=World Health Organization |url=http://worldcat.org/oclc/476159430 |title=The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines. |date=1992 |publisher=World Health Organization |isbn=978-92-4-068283-2 |oclc=476159430 |access-date=23 September 2020 |archive-url=https://web.archive.org/web/20201204232022/https://www.worldcat.org/title/icd-10-classification-of-mental-and-behavioural-disorders-clinical-descriptions-and-diagnostic-guidelines/oclc/476159430 |archive-date=4 December 2020 |url-status=live}}</ref> the potential misinterpretation of normal adolescent behaviors, stigma, and the stability of personality during this developmental stage.<ref name="Kaess_2014" /> Despite these challenges, research has confirmed the validity and clinical utility of the BPD diagnosis in adolescents,<ref name="Miller_2008" /><ref name="National Collaborating Centre for Mental Health (UK)_2009" /><ref name="Kaess_2014" /><ref name="Biskin_2015" /> though misconceptions persist among mental health care professionals,<ref name="Baltzersen_2020">{{cite journal |vauthors=Baltzersen ÅL |date=August 2020 |title=Moving forward: closing the gap between research and practice for young people with BPD |journal=Current Opinion in Psychology |volume=37 |pages=77–81 |doi=10.1016/j.copsyc.2020.08.008 |pmid=32916475 |s2cid=221636857 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Boylan K |date=August 2018 |title=Diagnosing BPD in Adolescents: More good than harm |journal=Journal of the Canadian Academy of Child and Adolescent Psychiatry |volume=27 |issue=3 |pages=155–156 |pmc=6054283 |pmid=30038651}}</ref><ref>{{cite journal |vauthors=Laurenssen EM, Hutsebaut J, Feenstra DJ, Van Busschbach JJ, Luyten P |date=February 2013 |title=Diagnosis of personality disorders in adolescents: a study among psychologists |journal=Child and Adolescent Psychiatry and Mental Health |volume=7 |issue=1 |pages=3 |doi=10.1186/1753-2000-7-3 |pmc=3583803 |pmid=23398887 |doi-access=free}}</ref> contributing to clinical reluctance in diagnosing and a key barrier to the provision of effective treatment BPD in this population.<ref name="Baltzersen_2020" /><ref>{{cite journal |vauthors=Chanen AM |date=August 2015 |title=Borderline Personality Disorder in Young People: Are We There Yet? |url=http://doi.wiley.com/10.1002/jclp.22205 |url-status=live |journal=Journal of Clinical Psychology |volume=71 |issue=8 |pages=778–91 |doi=10.1002/jclp.22205 |pmid=26192914 |archive-url=https://web.archive.org/web/20201204232036/https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22205 |archive-date=4 December 2020 |access-date=23 September 2020|url-access=subscription }}</ref><ref>{{cite journal |vauthors=Koehne K, Hamilton B, Sands N, Humphreys C |date=January 2013 |title=Working around a contested diagnosis: borderline personality disorder in adolescence |journal=Health |volume=17 |issue=1 |pages=37–56 |doi=10.1177/1363459312447253 |pmid=22674745 |s2cid=1674596}}</ref>', 240 => '', 241 => 'A diagnosis of BPD in adolescence can indicate the persistence of the disorder into adulthood,<ref name="DSM-IV-TR">{{harvnb|American Psychiatric Association|2000}}{{Page needed|date=July 2013}}</ref><ref name="Netherton">{{cite book | vauthors = Netherton SD, Holmes D, Walker CE |year=1999 |title=Child and Adolescent Psychological Disorders: Comprehensive Textbook |location=New York |publisher=Oxford University Press}}{{Page needed|date=July 2013}}</ref> with outcomes varying among individuals. Some maintain a stable diagnosis over time, while others may not consistently meet the diagnostic criteria.<ref name="Fact_or_Fiction">{{cite journal | vauthors = Miller AL, Muehlenkamp JJ, Jacobson CM | title = Fact or fiction: diagnosing borderline personality disorder in adolescents | journal = Clinical Psychology Review | volume = 28 | issue = 6 | pages = 969–981 | date = July 2008 | pmid = 18358579 | doi = 10.1016/j.cpr.2008.02.004 }}</ref> Early diagnosis facilitates the development of effective treatment plans,<ref name="DSM-IV-TR" /><ref name="Netherton" /> including family therapy, to support adolescents with BPD.<ref>{{harvnb|Linehan|1993|page=98}}</ref>', 242 => '', 243 => '===Differential diagnosis and comorbidity===', 244 => 'Lifetime co-occurring ([[Comorbidity|comorbid]]) conditions are prevalent among individuals diagnosed with BPD. Individuals with BPD exhibit higher rates of comorbidity compared to those diagnosed with other personality disorders, including [[mood disorders]] (such as major depressive disorder and bipolar disorder), [[Anxiety disorder|anxiety disorders]] (including [[panic disorder]], [[social anxiety disorder]], and PTSD), other personality disorders (notably [[Schizotypal personality disorder|schizotypal]], [[Antisocial personality disorder|antisocial]], and [[dependent personality disorder]]), substance use disorder, [[eating disorders]] ([[anorexia nervosa]] and [[bulimia nervosa]]), [[attention deficit hyperactivity disorder]] (ADHD),<ref name="PM">{{cite journal | vauthors = Ferrer M, Andión O, Matalí J, Valero S, Navarro JA, Ramos-Quiroga JA, Torrubia R, Casas M | title = Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder | journal = Journal of Personality Disorders | volume = 24 | issue = 6 | pages = 812–822 | date = December 2010 | pmid = 21158602 | doi = 10.1521/pedi.2010.24.6.812 }}{{primary source inline|date=May 2013}}</ref> [[somatic symptom disorder]], and the [[dissociative disorders]].<ref name="comorbidity">{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V | title = Axis I comorbidity of borderline personality disorder | journal = The American Journal of Psychiatry | volume = 155 | issue = 12 | pages = 1733–1739 | date = December 1998 | pmid = 9842784 | doi = 10.1176/ajp.155.12.1733 }}</ref> It is advised that a personality disorder diagnosis should be made cautiously during untreated mood episodes or disorders unless a comprehensive lifetime history supports the existence of a personality disorder.<ref>{{cite journal | vauthors = Vieta E | title = Bipolar II Disorder: Frequent, Valid, and Reliable | journal = Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie | volume = 64 | issue = 8 | pages = 541–543 | date = August 2019 | pmid = 31340672 | pmc = 6681515 | doi = 10.1177/0706743719855040 }}</ref>', 245 => '', 246 => '====Comorbid Axis I disorders====', 247 => '{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"', 248 => '|-', 249 => '|+Gender variations in lifetime prevalence of comorbid Axis I disorders among individuals diagnosed with BPD: A comparative study between 2008<ref name="Grant_2008" /> and 1998<ref name="comorbidity2">{{cite journal |vauthors=Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V |date=December 1998 |title=Axis I comorbidity of borderline personality disorder |journal=The American Journal of Psychiatry |volume=155 |issue=12 |pages=1733–1739 |doi=10.1176/ajp.155.12.1733 |pmid=9842784}}</ref>', 250 => '|-', 251 => '! Axis I diagnosis !! Overall (%) !! Male (%) !! Female (%)', 252 => '|-', 253 => '! Mood disorders !! 75.0 !! 68.7 !! 80.2', 254 => '|-', 255 => '|[[Major depressive disorder]] || 32.1 || 27.2 || 36.1', 256 => '|-', 257 => '|[[Dysthymia]] || {{0}}9.7 || {{0}}7.1 || 11.9', 258 => '|-', 259 => '|[[Bipolar I disorder]] || 31.8 || 30.6 || 32.7', 260 => '|-', 261 => '|[[Bipolar II disorder]] || {{0}}7.7 || {{0}}6.7 || {{0}}8.5', 262 => '|-', 263 => '! Anxiety disorders !! 74.2 !! 66.1 !! 81.1', 264 => '|-', 265 => '|[[Panic disorder]] with [[agoraphobia]] || 11.5 || {{0}}7.7 || 14.6', 266 => '|-', 267 => '|Panic disorder without agoraphobia || 18.8 || 16.2 || 20.9', 268 => '|-', 269 => '|[[Social phobia]] || 29.3 || 25.2 || 32.7', 270 => '|-', 271 => '|[[Specific phobia]] || 37.5 || 26.6 || 46.6', 272 => '|-', 273 => '|[[post-traumatic stress disorder|PTSD]] || 39.2 || 29.5 || 47.2', 274 => '|-', 275 => '|[[Generalized anxiety disorder]] || 35.1 || 27.3 || 41.6', 276 => '|-', 277 => '|[[Obsessive–compulsive disorder]]** || 15.6 || – || –', 278 => '|-', 279 => '! Substance use disorders !! 72.9 !! 80.9 !! 66.2', 280 => '|-', 281 => '|Any [[alcohol use disorder]] || 57.3 || 71.2 || 45.6', 282 => '|-', 283 => '|Any non-alcohol [[substance use disorder]] || 36.2 || 44.0 || 29.8', 284 => '|-', 285 => '! Eating disorders** !! 53.0 !! 20.5 !! 62.2', 286 => '|-', 287 => '|[[Anorexia nervosa]]** || 20.8 || {{0}}7 * || 25 *', 288 => '|-', 289 => '|[[Bulimia nervosa]]** || 25.6 || 10 * || 30 *', 290 => '|-', 291 => '|[[Eating disorder not otherwise specified]]** || 26.1 || 10.8 || 30.4', 292 => '|-', 293 => '! Somatoform disorders** !! 10.3 !! 10 * !! 10 *', 294 => '|-', 295 => '|[[Somatization disorder]]** || {{0}}4.2 || – || –', 296 => '|-', 297 => '|[[Hypochondriasis]]** || {{0}}4.7 || – || –', 298 => '|-', 299 => '|[[psychogenic pain|Somatoform pain disorder]]** || {{0}}4.2 || – || –', 300 => '|-', 301 => '! [[Psychotic disorders]]** !! {{0}}1.3 !! {{0}}1 * !! {{0}}1 *', 302 => '|-', 303 => '| Colspan="4" | * Approximate values <br />** Values from 1998 study<ref name = comorbidity /><br>– Value not provided by from both studies', 304 => '|}', 305 => 'A 2008 study revealed that 75% of individuals with BPD at some point meet criteria for mood disorders, notably major depression and bipolar I, with a similar percentage for anxiety disorders.<ref name="Grant_2008" /> Furthermore, nearly 73% of individuals with BPD meet criteria for substance use disorders, and about 40% for PTSD.<ref name="Grant_2008"/> This challenges the notion that BPD and PTSD are identical, as less than half of those with BPD exhibit PTSD symptoms in their lifetime.<ref name=comorbidity /> The study also noted significant gender differences in comorbidity among individuals with BPD: a higher proportion of males meet criteria for substance use disorders, whereas females are more likely to have PTSD and eating disorders.<ref name="comorbidity" /><ref name="Grant_2008" /><ref>{{cite journal | vauthors = Gregory RJ | date = November 2006 |url=http://www.psychiatrictimes.com/articles/clinical-challenges-co-occurring-borderline-personality-and-substance-use-disorders |title=Clinical Challenges in Co-occurring Borderline Personality and Substance Use Disorders |journal=Psychiatric Times | series = Psychiatric Times Vol 23 No 13 | volume = 23 | issue = 13 |url-status=live |archive-url=https://web.archive.org/web/20130921063228/http://www.psychiatrictimes.com/articles/clinical-challenges-co-occurring-borderline-personality-and-substance-use-disorders |archive-date=21 September 2013 }}</ref> Additionally, 38% of individuals with BPD were found to meet criteria for ADHD,<ref name="PM" /> and 15% for [[autism spectrum disorder]] (ASD) in separate studies,<ref name="Ryden2008">{{cite journal| volume = 5| issue = 1| pages = 22–30| vauthors = Rydén G, Rydén E, Hetta J | title = Borderline personality disorder and autism spectrum disorder in females: A cross-sectional study| journal = Clinical Neuropsychiatry| access-date = 7 February 2013| year = 2008| url = http://www.clinicalneuropsychiatry.org/pdf/04_ryden_hetta.pdf| url-status = dead| archive-url = https://web.archive.org/web/20130921055225/http://www.clinicalneuropsychiatry.org/pdf/04_ryden_hetta.pdf| archive-date = 21 September 2013| df = dmy-all}}</ref> highlighting the risk of misdiagnosis due to "lower expressions" of BPD or a complex pattern of comorbidity that might obscure the underlying personality disorder. This complexity in diagnosis underscores the importance of comprehensive assessment in identifying BPD.<ref name="comorbidity" />', 306 => '', 307 => '====Mood disorders====', 308 => 'Individuals with BPD often concurrently experience mood disorders, notably major depressive disorder (MDD) or bipolar disorder (BD),<ref name="Robinson"/> complicating diagnostic clarity due to overlapping symptoms.<ref name=":16">{{cite journal |vauthors=Bolton S, Gunderson JG |date=September 1996 |title=Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications |journal=The American Journal of Psychiatry |volume=153 |issue=9 |pages=1202–1207 |doi=10.1176/ajp.153.9.1202 |pmid=8780426}}</ref><ref name="APAguide">{{cite journal |author=American Psychiatric Association Practice Guidelines |date=October 2001 |title=Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association |journal=The American Journal of Psychiatry |volume=158 |issue=10 Suppl |pages=1–52 |doi=10.1176/appi.ajp.158.1.1 |pmid=11665545 |s2cid=20392111}}</ref><ref>{{cite web |title=Differential Diagnosis of Borderline Personality Disorder |url=http://www.borderlinepersonalitytoday.com/main/diffdx.htm |url-status=dead |archive-url=https://web.archive.org/web/20040509181831/http://www.borderlinepersonalitytoday.com/main/diffdx.htm |archive-date=9 May 2004 |work=BPD Today}}</ref> Distinguishing BPD from BD is particularly challenging, as behaviors part of diagnostic criteria for both BPD and BD may emerge during depressive or [[manic episodes]] in BD. However, these behaviours are likely subside as mood normalises in BD to [[Euthymia (medicine)|euthymia]], but typically are pervasive in BPD.<ref name="Chapman_87">{{harvnb|Chapman|Gratz|2007|page=87}}</ref> Thus, diagnosis should ideally be deferred until after the mood has stabilised.<ref name="BPD_vs_BD">{{cite book |url=https://archive.org/details/manicdepressivei00good/page/108 |title=Manic-depressive illness |vauthors=Jamison KR, Goodwin FJ |publisher=Oxford University Press |year=1990 |isbn=978-0-19-503934-4 |location=Oxford |page=[https://archive.org/details/manicdepressivei00good/page/108 108]}}</ref> ', 309 => '', 310 => 'Differences between BPD and BD mood swings include their duration, with BD episodes typically lasting for at least two weeks at a time, in contrast to the rapid and transient mood shifts seen in BPD.<ref name="Chapman_87" /><ref name="BPD_vs_BD" /><ref name="Chapman_88" /> Additionally, BD mood changes are generally unresponsive to environmental stimuli, whereas BPD moods are. For example, a positive event might alleviate a depressive mood in BPD, responsiveness not observed in BD.<ref name="BPD_vs_BD" /> Furthermore, the [[euphoria]] in BPD lacks the [[racing thoughts]] and reduced need for sleep characteristic of BD,<ref name="BPD_vs_BD" /> though sleep disturbances have been noted in BPD.<ref>{{cite journal | vauthors = Selby EA | title = Chronic sleep disturbances and borderline personality disorder symptoms | journal = Journal of Consulting and Clinical Psychology | volume = 81 | issue = 5 | pages = 941–947 | date = October 2013 | pmid = 23731205 | pmc = 4129646 | doi = 10.1037/a0033201 }}</ref>', 311 => '', 312 => 'An exception would be individuals with rapid-cycling BD, who can be a challenge to differentiate from the affective liability of individuals with BPD.<ref>{{cite journal | vauthors = Mackinnon DF, Pies R | title = Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders | journal = Bipolar Disorders | volume = 8 | issue = 1 | pages = 1–14 | date = February 2006 | pmid = 16411976 | doi = 10.1111/j.1399-5618.2006.00283.x | doi-access = free }}</ref><ref name="Chapman_88">{{harvnb|Chapman|Gratz|2007|page=88}}</ref><ref name="Chapman_87" />', 313 => '', 314 => 'Historically, BPD was considered a milder form of BD,<ref>{{cite journal | vauthors = Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H | title = The nosologic status of borderline personality: clinical and polysomnographic study | journal = The American Journal of Psychiatry | volume = 142 | issue = 2 | pages = 192–198 | date = February 1985 | pmid = 3970243 | doi = 10.1176/ajp.142.2.192 }}</ref><ref>{{cite journal | vauthors = Gunderson JG, Elliott GR | title = The interface between borderline personality disorder and affective disorder | journal = The American Journal of Psychiatry | volume = 142 | issue = 3 | pages = 277–788 | date = March 1985 | pmid = 2857532 | doi = 10.1176/ajp.142.3.277 }}</ref> or part of the bipolar spectrum. However, distinctions in phenomenology, family history, disease progression, and treatment responses refute a singular underlying mechanism for both conditions.<ref>{{cite journal | vauthors = Paris J | title = Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders | journal = Harvard Review of Psychiatry | volume = 12 | issue = 3 | pages = 140–145 | year = 2004 | pmid = 15371068 | doi = 10.1080/10673220490472373 | s2cid = 39354034 }}</ref> Research indicates only a modest association between BPD and BD, challenging the notion of a close spectrum relationship.<ref>{{cite book | vauthors = Jamison KR, Goodwin FJ |title=Manic-depressive illness |publisher=Oxford University Press |location=Oxford |year=1990 |page=[https://archive.org/details/manicdepressivei00good/page/336 336] |isbn=978-0-19-503934-4 |url=https://archive.org/details/manicdepressivei00good/page/336 }}</ref><ref>{{cite journal | vauthors = Benazzi F | title = Borderline personality-bipolar spectrum relationship | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 30 | issue = 1 | pages = 68–74 | date = January 2006 | pmid = 16019119 | doi = 10.1016/j.pnpbp.2005.06.010 | s2cid = 1358610 }}</ref>', 315 => '', 316 => '====Premenstrual dysphoric disorder====', 317 => 'BPD is a psychiatric condition distinguishable from [[premenstrual dysphoric disorder]] (PMDD), despite some symptom overlap. BPD affects individuals persistently across all stages of the menstrual cycle, unlike PMDD, which is confined to the [[luteal phase]] and ends with [[menstruation]].<ref>{{cite journal | vauthors = Rapkin AJ, Berman SM, London ED | title = The Cerebellum and Premenstrual Dysphoric Disorder | journal = AIMS Neuroscience | volume = 1 | issue = 2 | pages = 120–141 |year = 2014 | pmid = 28275721 | pmc = 5338637 | doi = 10.3934/Neuroscience.2014.2.120 }}</ref><ref name="Grady-Weliky">{{cite journal |vauthors=Grady-Weliky TA |date=January 2003 |title=Clinical practice. Premenstrual dysphoric disorder |journal=The New England Journal of Medicine |volume=348 |issue=5 |pages=433–8 |doi=10.1056/NEJMcp012067 |pmid=12556546}}</ref> While PMDD, affecting 3–8% of women,<ref name="Rapkin">{{cite journal | vauthors = Rapkin AJ, Lewis EI | title = Treatment of premenstrual dysphoric disorder | journal = Women's Health | volume = 9 | issue = 6 | pages = 537–56 | date = November 2013 | pmid = 24161307 | doi = 10.2217/whe.13.62 | doi-access = free }}</ref> includes mood swings, irritability, and anxiety tied to the [[menstrual cycle]], BPD presents a broader, constant emotional and behavioral challenge irrespective of hormonal changes.', 318 => '', 319 => '====Comorbid Axis II disorders====', 320 => '{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"', 321 => '|-', 322 => '|+Lifetime percentage prevalence of comorbid Axis II disorders among individuals with BPD in 2008<ref name="Grant_2008"/>', 323 => '|-', 324 => '! Axis II diagnosis !! Overall (%) !! Male (%) !! Female (%)', 325 => '|-', 326 => '! Any cluster A !! 50.4 !! 49.5 !! 51.1', 327 => '|-', 328 => '| [[Paranoid personality disorder|Paranoid]] || 21.3 || 16.5 || 25.4', 329 => '|-', 330 => '| [[Schizoid personality disorder|Schizoid]] || 12.4 || 11.1 || 13.5', 331 => '|-', 332 => '| [[Schizotypal personality disorder|Schizotypal]] || 36.7 || 38.9 || 34.9', 333 => '|-', 334 => '! Any other cluster B !! 49.2 !! 57.8 !! 42.1', 335 => '|-', 336 => '| [[Antisocial personality disorder|Antisocial]] || 13.7 || 19.4 || 9.0', 337 => '|-', 338 => '| [[Histrionic personality disorder|Histrionic]] || 10.3 || 10.3 || 10.3', 339 => '|-', 340 => '| [[Narcissistic personality disorder|Narcissistic]] || 38.9 || 47.0 || 32.2', 341 => '|-', 342 => '! Any cluster C !! 29.9 !! 27.0 !! 32.3', 343 => '|-', 344 => '| [[Avoidant personality disorder|Avoidant]] || 13.4 || 10.8 || 15.6', 345 => '|-', 346 => '| [[Dependent personality disorder|Dependent]] || 3.1 || 2.6 || 3.5', 347 => '|-', 348 => '| [[Obsessive–compulsive personality disorder|Obsessive–compulsive]] || 22.7 || 21.7 || 23.6', 349 => '|-', 350 => '|}', 351 => 'Approximately 74% of individuals with BPD also fulfill criteria for another [[Axis II (psychiatry)|Axis II]] personality disorder during their lifetime, according to research conducted in 2008.<ref name="Grant_2008" /> The most prevalent co-occurring disorders are from Cluster A (paranoid, schizoid, and schizotypal personality disorders), affecting about half of those with BPD, with schizotypal personality disorder alone impacting one-third of individuals. Being part of Cluster B, BPD patients also commonly share characteristics with other Cluster B disorders (antisocial, histrionic, and narcissistic personality disorders), with nearly half of individuals with BPD showing signs of these conditions, and narcissistic personality disorder affecting roughly one-third.<ref name="Grant_2008" /> Cluster C disorders (avoidant, dependent, and obsessive-compulsive personality disorders) have the least comorbidity with BPD, with just under a third of individuals with BPD meeting the criteria for a Cluster C disorder.<ref name="Grant_2008" />', 352 => '', 353 => '==Management==', 354 => '{{Main|Management of borderline personality disorder}}', 355 => 'The main approach to managing BPD is through [[psychotherapy]], tailored to the individual's specific needs rather than applying a one-size-fits-all model based on the diagnosis alone.<ref name =Lei2011/> While medications do not directly treat BPD, they are beneficial in managing comorbid conditions like depression and anxiety.<ref>{{cite web |url=http://www.nice.org.uk/Guidance/CG78/NiceGuidance/pdf/English |title=CG78 Borderline personality disorder (BPD): NICE guideline |publisher=Nice.org.uk |date=28 January 2009 |access-date=12 August 2009 |url-status=live |archive-url=https://web.archive.org/web/20090411104754/http://www.nice.org.uk/Guidance/CG78/NiceGuidance/pdf/English |archive-date=11 April 2009 }}</ref> Furthermore, evidence suggests that short-term hospitalization does not offer advantages over community care in terms of enhancing outcomes or in the long-term prevention of suicidal behavior among individuals with BPD.<ref>{{cite journal | vauthors = Paris J | s2cid = 28921269 | title = Is hospitalization useful for suicidal patients with borderline personality disorder? | journal = Journal of Personality Disorders | volume = 18 | issue = 3 | pages = 240–247 | date = June 2004 | pmid = 15237044 | doi = 10.1521/pedi.18.3.240.35443 }}</ref>', 356 => '', 357 => '===Psychotherapy===', 358 => '[[File:Dialectical Behavior Therapy Cycle EN.jpg|thumb|right|The stages used in [[dialectical behavior therapy]]]]Long-term, consistent psychotherapy stands as the preferred method for treating BPD and engagement in any therapeutic approach tends to surpass the absence of treatment, particularly in diminishing self-harm impulses.<ref name="BPD_therapies">{{cite journal | vauthors = Zanarini MC | title = Psychotherapy of borderline personality disorder | journal = Acta Psychiatrica Scandinavica | volume = 120 | issue = 5 | pages = 373–377 | date = November 2009 | pmid = 19807718 | pmc = 3876885 | doi = 10.1111/j.1600-0447.2009.01448.x }}</ref> Among the effective psychotherapeutic approaches, dialectical behavior therapy (DBT) and [[psychodynamic]] therapies have shown efficacy, although improvements may require extensive time, often years of dedicated effort.<ref>{{cite journal | vauthors = Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P | title = Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis | journal = JAMA Psychiatry | volume = 74 | issue = 4 | pages = 319–328 | date = April 2017 | pmid = 28249086 | doi = 10.1001/jamapsychiatry.2016.4287 | hdl = 1871.1/845f5460-273e-4150-b79d-159f37aa36a0 | s2cid = 30118081 | url = https://research.vu.nl/en/publications/845f5460-273e-4150-b79d-159f37aa36a0 | access-date = 12 December 2019 | archive-date = 4 December 2020 | archive-url = https://web.archive.org/web/20201204232025/https://research.vu.nl/en/publications/efficacy-of-psychotherapy-for-borderline-personality-disorder-a-s | url-status = live | hdl-access = free }}</ref>', 359 => '', 360 => 'Available treatments for BPD include [[dynamic deconstructive psychotherapy]] (DDP),<ref>{{cite book | vauthors = Gabbard GO | date = 2014 | title = Psychodynamic psychiatry in clinical practice | edition = 5th | publisher = American Psychiatric Publishing | location = Washington, D.C. | pages = 445–448 }}</ref> [[mentalization-based treatment]] (MBT), transference-focused psychotherapy, dialectical behavior therapy (DBT), general psychiatric management, and schema-focused therapy.<ref name="Gund2011" /><ref name="Choi-Kain_2017">{{cite journal | vauthors = Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT | title = What Works in the Treatment of Borderline Personality Disorder | journal = Current Behavioral Neuroscience Reports | volume = 4 | issue = 1 | pages = 21–30 |year = 2017 | pmid = 28331780 | pmc = 5340835 | doi = 10.1007/s40473-017-0103-z }}</ref> The effectiveness of these therapies does not significantly vary between more intensive and less intensive approaches.<ref name="LinksShah2017">{{cite journal | vauthors = Links PS, Shah R, Eynan R | title = Psychotherapy for Borderline Personality Disorder: Progress and Remaining Challenges | journal = Current Psychiatry Reports | volume = 19 | issue = 3 | page = 16 | date = March 2017 | pmid = 28271272 | doi = 10.1007/s11920-017-0766-x | s2cid = 1076175 }}</ref>', 361 => '', 362 => '[[Transference focused psychotherapy|Transference-focused psychotherapy]] is designed to mitigate absolutist thinking by encouraging individuals to express their interpretations of social interactions and their emotions, thereby fostering more nuanced and flexible categorizations.<ref name="Bliss_2014">{{cite journal| vauthors = Bliss S, McCardle M |date=1 March 2014|title=An Exploration of Common Elements in Dialectical Behavior Therapy, Mentalization Based Treatment and Transference Focused Psychotherapy in the Treatment of Borderline Personality Disorder|journal=Clinical Social Work Journal|volume=42|issue=1|pages=61–69|doi=10.1007/s10615-013-0456-z|s2cid=145079695|issn=0091-1674}}</ref> [[Dialectical behavior therapy]] (DBT), on the other hand, focuses on developing skills in four main areas: interpersonal communication, distress tolerance, emotional regulation, and mindfulness, aiming to equip individuals with BPD with tools to manage intense emotions and improve interpersonal relationships.<ref name="Bliss_2014" /><ref>{{cite book|vauthors=Livesay WJ|chapter=Understanding Borderline Personality Disorder|title=Integrated Modular Treatment for Borderline Personality Disorder|year=2017|pages=29–38|place=Cambridge, England|publisher=[[Cambridge University Press]]|doi=10.1017/9781107298613.004|isbn=978-1-107-29861-3|url=https://zenodo.org/record/4384573|access-date=14 March 2024|archive-date=25 December 2020|archive-url=https://web.archive.org/web/20201225055919/https://zenodo.org/record/4384573|url-status=live}}</ref><ref name="Choi-Kain_2017" />', 363 => '', 364 => '[[Cognitive behavioral therapy]] (CBT) targets the modification of behaviors and beliefs through problem identification related to BPD, showing efficacy in reducing anxiety, mood symptoms, suicidal ideation, and self-harming actions.<ref name="NIH2016" />', 365 => '', 366 => '[[Mentalization-based treatment|Mentalization-based therapy]] and transference-focused psychotherapy draw from [[psychodynamic]] principles, while DBT is rooted in cognitive-behavioral principles and [[mindfulness]].<ref name="BPD_therapies" /> General psychiatric management integrates key aspects from these treatments and is seen as more accessible and less resource-intensive.<ref name="Gund2011" /> Studies suggest DBT and MBT may be particularly effective, with ongoing research into developing abbreviated forms of these therapies to enhance accessibility and reduce both financial and resource burdens on patients and providers.<ref name="DBT_vs_therapyByExperts">{{cite journal | vauthors = Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N | title = Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder | journal = Archives of General Psychiatry | volume = 63 | issue = 7 | pages = 757–766 | date = July 2006 | pmid = 16818865 | doi = 10.1001/archpsyc.63.7.757 | doi-access = free }}</ref><ref name="DBT_and_Mentalization">{{cite journal | vauthors = Paris J | title = Effectiveness of different psychotherapy approaches in the treatment of borderline personality disorder | journal = Current Psychiatry Reports | volume = 12 | issue = 1 | pages = 56–60 | date = February 2010 | pmid = 20425311 | doi = 10.1007/s11920-009-0083-0 | s2cid = 19038884 }}</ref><ref name="BPD_therapies" />', 367 => '', 368 => 'Additionally, [[mindfulness meditation]] has been associated with positive structural changes in the brain and improvements in BPD symptoms, with some participants in mindfulness-based interventions no longer meeting the diagnostic criteria for BPD after treatment.<ref name="Mindfulness_neuroscience">{{cite journal | vauthors = Tang YY, Posner MI | title = Special issue on mindfulness neuroscience | journal = Social Cognitive and Affective Neuroscience | volume = 8 | issue = 1 | pages = 1–3 | date = January 2013 | pmid = 22956677 | pmc = 3541496 | doi = 10.1093/scan/nss104 }}</ref><ref name="Mindfulness_mechanisms">{{cite journal | vauthors = Posner MI, Tang YY, Lynch G | title = Mechanisms of white matter change induced by meditation training | journal = Frontiers in Psychology | volume = 5 | issue = 1220 | page = 1220 |year = 2014 | pmid = 25386155 | pmc = 4209813 | doi = 10.3389/fpsyg.2014.01220 | doi-access = free }}</ref><ref name="Mindfulness_therapies">{{cite journal |vauthors=Chafos VH, Economou P |date=October 2014 |title=Beyond borderline personality disorder: the mindful brain |journal=Social Work |volume=59 |issue=4 |pages=297–302 |doi=10.1093/sw/swu030 |pmid=25365830 |s2cid=14256504}}</ref><ref name="Mindfulness_BPD">{{cite journal |vauthors=Sachse S, Keville S, Feigenbaum J |date=June 2011 |title=A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder |journal=Psychology and Psychotherapy |volume=84 |issue=2 |pages=184–200 |doi=10.1348/147608310X516387 |pmid=22903856}}</ref>', 369 => '', 370 => '===Medications===', 371 => 'A 2010 review by the [[Cochrane collaboration]] found no medications effective for the core symptoms of BPD, such as chronic feelings of emptiness, identity disturbances, and fears of abandonment. Some medications might impact isolated symptoms of BPD or those of comorbid conditions.<ref name="Stoffers">{{cite journal | vauthors = Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K | title = Pharmacological interventions for borderline personality disorder | journal = The Cochrane Database of Systematic Reviews | issue = 6 | page = CD005653 | date = June 2010 | pmid = 20556762 | pmc = 4169794 | doi = 10.1002/14651858.CD005653.pub2 }}</ref> Later reviews in 2017 and 2020 confirmed these findings, with the latter noting a decline in research into medications for BPD treatment and mostly negative results.<ref name="Drugs2017rev">{{cite journal | vauthors = Hancock-Johnson E, Griffiths C, Picchioni M | title = A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder | journal = CNS Drugs | volume = 31 | issue = 5 | pages = 345–356 | date = May 2017 | pmid = 28353141 | doi = 10.1007/s40263-017-0425-0 | s2cid = 207486732 }}</ref> However, [[quetiapine]] showed some benefits for BPD severity, psychosocial impairment, aggression, and manic symptoms at doses of 150 mg/day to 300 mg/day. Despite the lack of evidence, [[SSRIs]] are still frequently prescribed for BPD.<ref name="stofferswinterling20">{{cite journal |vauthors=Stoffers-Winterling J, Storebø OJ, Lieb K |year=2020 |title=Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies |url=https://link.springer.com/content/pdf/10.1007/s11920-020-01164-1.pdf |journal=Current Psychiatry Reports |volume=22 |issue=37 |page=37 |doi=10.1007/s11920-020-01164-1 |pmc=7275094 |pmid=32504127 |doi-access=free |access-date=30 May 2021 |archive-date=4 May 2022 |archive-url=https://web.archive.org/web/20220504162542/https://link.springer.com/content/pdf/10.1007/s11920-020-01164-1.pdf |url-status=live }}</ref>', 372 => '', 373 => 'Specific medications have shown varied effectiveness on BPD symptoms: [[haloperidol]] and [[flupenthixol]] for anger and suicidal behavior reduction; [[aripiprazole]] for decreased impulsivity and interpersonal problems;<ref name=Stoffers/> and [[olanzapine]] and quetiapine for reducing affective instability, anger, and anxiety, though olanzapine showed less benefit for suicidal ideation than a placebo.<ref name="Stoffers" /><ref name="Drugs2017rev" /> Mood stabilizers like [[valproate]] and [[topiramate]] showed some improvements in depression, impulsivity, and anger, but the effect of [[carbamazepine]] was not significant. Of the [[antidepressant]]s, [[amitriptyline]] may reduce depression, but [[mianserin]], [[fluoxetine]], [[fluvoxamine]], and [[phenelzine]] sulfate showed no effect. [[Omega-3 fatty acid]] may ameliorate suicidality and improve depression. {{as of|2017}}, trials with these medications had not been replicated and the effect of long-term use had not been assessed.<ref name="Stoffers" /><ref name="Drugs2017rev" /> [[Lamotrigine]]<ref name="stofferswinterling20" /> and other medications like IV ketamine<ref>{{cite journal | vauthors = Purohith AN, Chatorikar SA, Nagaraj AK, Soman S |date = December 2021 |title=Ketamine for non-suicidal self-harm in borderline personality disorder with co-morbid recurrent depression: A case report |journal=Journal of Affective Disorders Reports |volume=6 |pages=100280 |doi=10.1016/j.jadr.2021.100280 |issn=2666-9153|doi-access=free }}</ref><ref>{{cite journal |vauthors=Chen KS, Dwivedi Y, Shelton RC |date=October 2022 |title=The effect of IV ketamine in patients with major depressive disorder and elevated features of borderline personality disorder |journal=Journal of Affective Disorders |volume=315 |pages=13–16 |doi=10.1016/j.jad.2022.07.054 |pmid=35905793 |s2cid=251117957 |doi-access=free}}</ref> for unresponsive depression require further research for their effects on BPD.', 374 => '', 375 => 'Given the weak evidence and potential for serious side effects, the UK [[National Institute for Health and Clinical Excellence]] (NICE) recommends against using drugs specifically for BPD or its associated behaviors and symptoms. Medications may be considered for treating comorbid conditions within a broader treatment plan.<ref>{{cite web|url=http://www.nice.org.uk/nicemedia/live/12125/42900/42900.pdf|publisher=UK National Institute for Health and Clinical Excellence (NICE) |title=2009 clinical guideline for the treatment and management of BPD|access-date=6 September 2011|url-status=dead|archive-url=https://web.archive.org/web/20120618094650/http://www.nice.org.uk/nicemedia/live/12125/42900/42900.pdf|archive-date=18 June 2012}}</ref> Reviews suggest minimizing the use of medications for BPD to very low doses and short durations, emphasizing the need for careful evaluation and management of drug treatment in BPD.<ref>{{cite journal | vauthors = Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, Lawrence-Smith G, Leeson V, Lemonsky F, Lykomitrou G, Montgomery AA, Morriss R, Munjiza J, Paton C, Skorodzien I, Singh V, Tan W, Tyrer P, Reilly JG | title = The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial | journal = The American Journal of Psychiatry | volume = 175 | issue = 8 | pages = 756–764 | date = August 2018 | pmid = 29621901 | doi = 10.1176/appi.ajp.2018.17091006 | s2cid = 4588378 | doi-access = free | hdl = 10044/1/57265 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Cattarinussi G, Delvecchio G, Prunas C, Moltrasio C, Brambilla P | title = Effects of pharmacological treatments on emotional tasks in borderline personality disorder: A review of functional magnetic resonance imaging studies | journal = Journal of Affective Disorders | volume = 288 | pages = 50–57 | date = June 2021 | pmid = 33839558 | doi = 10.1016/j.jad.2021.03.088 | s2cid = 233211413 }}</ref>', 376 => '', 377 => '===Health care services===', 378 => 'The disparity between those benefiting from treatment and those receiving it, known as the "treatment gap," arises from several factors. These include reluctance to seek treatment, healthcare providers' underdiagnosis, and limited availability and accessibility to advanced treatments.<ref name="BPD Article">{{cite news| vauthors = Johnson RS |title=Treatment of Borderline Personality Disorder|url=http://bpdfamily.com/content/treatment-borderline-personality-disorder|publisher=[[BPDFamily.com]]|date=26 July 2014|access-date=5 August 2014|url-status=live|archive-url=https://web.archive.org/web/20140714183908/http://bpdfamily.com/content/treatment-borderline-personality-disorder|archive-date=14 July 2014}}</ref> Furthermore, establishing clear pathways to services and medical care remains a challenge, complicating access to treatment for individuals with BPD. Despite efforts, many healthcare providers lack the training or resources to address severe BPD effectively, an issue acknowledged by both affected individuals and medical professionals.<ref>{{cite journal | vauthors = Friesen L, Gaine G, Klaver E, Burback L, Agyapong V | title = Key stakeholders' experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care | journal = PLOS ONE | volume = 17 | issue = 9 | pages = e0274197 | date = 2022-09-22 | pmid = 36137103 | pmc = 9499299 | doi = 10.1371/journal.pone.0274197 | bibcode = 2022PLoSO..1774197F | doi-access = free }}</ref>', 379 => '', 380 => 'In the context of psychiatric hospitalizations, individuals with BPD constitute approximately 20% of admissions.<ref>{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J | title = Treatment histories of borderline inpatients | journal = Comprehensive Psychiatry | volume = 42 | issue = 2 | pages = 144–150 | year = 2001 | pmid = 11244151 | doi = 10.1053/comp.2001.19749 }}</ref> While many engage in outpatient treatment consistently over several years, reliance on more restrictive and expensive treatment options, such as inpatient admission, tends to decrease over time.<ref>{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Hennen J, Silk KR | title = Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years | journal = The Journal of Clinical Psychiatry | volume = 65 | issue = 1 | pages = 28–36 | date = January 2004 | pmid = 14744165 | doi = 10.4088/JCP.v65n0105 }}</ref>', 381 => '', 382 => 'Service experiences vary among individuals with BPD.<ref>{{cite journal | vauthors = Fallon P | title = Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services | journal = Journal of Psychiatric and Mental Health Nursing | volume = 10 | issue = 4 | pages = 393–401 | date = August 2003 | pmid = 12887630 | doi = 10.1046/j.1365-2850.2003.00617.x }}</ref> Assessing suicide risk poses a challenge for clinicians, with patients often underestimating the lethality of self-harm behaviors. The suicide risk among people with BPD is significantly higher than that of the general population, characterized by a history of multiple suicide attempts during crises.<ref>{{cite journal | vauthors = Links PS, Bergmans Y, Warwar SH |date=1 July 2004 |url=http://www.psychiatrictimes.com/articles/assessing-suicide-risk-patients-borderline-personality-disorder |title=Assessing Suicide Risk in Patients With Borderline Personality Disorder |journal=Psychiatric Times |series=Psychiatric Times Vol 21 No 8 |volume=21 |issue=8 |url-status=live |archive-url=https://web.archive.org/web/20130821210809/http://www.psychiatrictimes.com/articles/assessing-suicide-risk-patients-borderline-personality-disorder |archive-date=21 August 2013 }}</ref> Notably, about half of all individuals who commit suicide are diagnosed with a personality disorder, with BPD being the most common association.<ref>{{cite journal | vauthors = Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M | title = Borderline personality disorder | journal = Lancet | volume = 364 | issue = 9432 | pages = 453–461 | year = 2004 | pmid = 15288745 | doi = 10.1016/S0140-6736(04)16770-6 | s2cid = 54280127 }}</ref>', 383 => '', 384 => 'In 2014, following the death by suicide of a patient with BPD, the [[National Health Service]] (NHS) in England faced criticism from a coroner for the lack of commissioned services to support individuals with BPD. It was revealed that 45% of female patients were diagnosed with BPD, yet there was no provision or prioritization for therapeutic psychological services. At that time, England had only 60 specialized inpatient beds for BPD patients, all located in London or the northeast region.<ref>{{cite news|title=National leaders warned over lack of services for personality disorders|url=https://www.hsj.co.uk/mersey-care-nhs-trust/national-leaders-warned-over-lack-of-services-for-personality-disorders/7020669.article|access-date=22 December 2017|work=Health Service Journal|date=29 September 2017|archive-date=23 December 2017|archive-url=https://web.archive.org/web/20171223102152/https://www.hsj.co.uk/mersey-care-nhs-trust/national-leaders-warned-over-lack-of-services-for-personality-disorders/7020669.article|url-status=live}}{{subscription required|s}}</ref>', 385 => '', 386 => '==Prognosis==', 387 => 'With treatment, the majority of people with BPD can find relief from distressing symptoms and achieve [[Remission (medicine)|remission]], defined as a consistent relief from symptoms for at least two years.<ref name="longitudinal_remission">{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Hennen J, Silk KR | title = The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder | journal = The American Journal of Psychiatry | volume = 160 | issue = 2 | pages = 274–283 | date = February 2003 | pmid = 12562573 | doi = 10.1176/appi.ajp.160.2.274 }}</ref><ref name=PToverview/> A [[longitudinal study]] tracking the symptoms of people with BPD found that 34.5% achieved remission within two years from the beginning of the study. Within four years, 49.4% had achieved remission, and within six years, 68.6% had achieved remission. By the end of the study, 73.5% of participants were found to be in remission.<ref name=longitudinal_remission /> Moreover, of those who achieved recovery from symptoms, only 5.9% experienced recurrences. A later study found that ten years from baseline (during a hospitalization), 86% of patients had sustained a stable recovery from symptoms.<ref name="Treatment">{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G | title = Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study | journal = The American Journal of Psychiatry | volume = 167 | issue = 6 | pages = 663–667 | date = June 2010 | pmid = 20395399 | pmc = 3203735 | doi = 10.1176/appi.ajp.2009.09081130}}</ref><ref>{{cite press release|title=Long-Term Study of Borderline Personality Disorder Shows Importance of Measuring Real-World Outcomes |url= http://www.mclean.harvard.edu/news/press/current.php?kw=long-term-study-borderline-personality-disorder-shows-importance-measuring&id=153 |date=15 April 2010 |location=Arlington, Virginia |publisher=[[McLean Hospital]] |access-date=5 February 2013 |archive-date=8 June 2013 |archive-url=https://web.archive.org/web/20130608092738/http://www.mclean.harvard.edu/news/press/current.php?kw=long-term-study-borderline-personality-disorder-shows-importance-measuring&id=153 |url-status=dead}}</ref>', 388 => '', 389 => 'Patient personality can play an important role during the therapeutic process, leading to better clinical outcomes. Recent research has shown that BPD patients undergoing dialectical behavior therapy (DBT) exhibit better clinical outcomes correlated with higher levels of the trait of agreeableness in the patient, compared to patients either low in agreeableness or not being treated with DBT. This association was mediated through the strength of a working alliance between patient and therapist; that is, more agreeable patients developed stronger working alliances with their therapists, which in turn, led to better clinical outcomes.<ref>{{cite journal | vauthors = Hirsh JB, Quilty LC, Bagby RM, McMain SF | s2cid = 33621688 | title = The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder | journal = Journal of Personality Disorders | volume = 26 | issue = 4 | pages = 616–627 | date = August 2012 | pmid = 22867511 | doi = 10.1521/pedi.2012.26.4.616 }}</ref>', 390 => '', 391 => 'In addition to recovering from distressing symptoms, people with BPD can also achieve high levels of [[psychosocial]] functioning. A longitudinal study tracking the social and work abilities of participants with BPD found that six years after diagnosis, 56% of participants had good function in work and social environments, compared to 26% of participants when they were first diagnosed. Vocational achievement was generally more limited, even compared to those with other personality disorders. However, those whose symptoms had remitted were significantly more likely to have good relationships with a romantic partner and at least one parent, good performance at work and school, a sustained work and school history, and good psychosocial functioning overall.<ref>{{cite journal | vauthors = Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR | title = Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years | journal = Journal of Personality Disorders | volume = 19 | issue = 1 | pages = 19–29 | date = February 2005 | pmid = 15899718 | doi = 10.1521/pedi.19.1.19.62178 }}</ref>', 392 => '', 393 => '==Epidemiology==', 394 => 'BPD has a [[point prevalence]] of 1.6%<ref name="PToverview" /> and a [[lifetime prevalence]] of 5.9% of the global population.<ref name="Grant_2008" /><ref name="DSM53" /><ref name="NIH2016" /><ref name="Wolters Kluwer" /><!-- Quote (in archived version): 'According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.' --><ref name="nimh.nih.gov" /> Within clinical settings, the occurrence of BPD is 6.4% among urban primary care patients,<ref>{{cite journal | vauthors = Gross R, Olfson M, Gameroff M, Shea S, Feder A, Fuentes M, Lantigua R, Weissman MM | title = Borderline personality disorder in primary care | journal = Archives of Internal Medicine | volume = 162 | issue = 1 | pages = 53–60 | date = January 2002 | pmid = 11784220 | doi = 10.1001/archinte.162.1.53 }}</ref> 9.3% among psychiatric [[outpatients]],<ref>{{cite journal | vauthors = Zimmerman M, Rothschild L, Chelminski I | title = The prevalence of DSM-IV personality disorders in psychiatric outpatients | journal = The American Journal of Psychiatry | volume = 162 | issue = 10 | pages = 1911–1918 | date = October 2005 | pmid = 16199838 | doi = 10.1176/appi.ajp.162.10.1911 }}</ref> and approximately 20% among psychiatric [[inpatients]].<ref>{{Cite book |title=American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) }}</ref> Despite the high utilization of healthcare resources by individuals with BPD,<ref name="Bourke_2018" /> up to half may show significant improvement over a ten-year period with appropriate treatment.<ref name="DSM53" />', 395 => '', 396 => 'Regarding gender distribution, women are diagnosed with BPD three times more frequently than men in clinical environments.<ref name="DSM53" /><ref name="Wolters Kluwer" /> Nonetheless, [[epidemiological research]] in the United States indicates no significant gender difference in the lifetime prevalence of BPD within the general population.<ref name="Lenzenweger_2007" /><ref name="Grant_2008" /> This finding implies that women with BPD may be more inclined to seek treatment compared to men. Studies examining BPD patients have found no significant differences in the rates of childhood trauma and levels of current psychosocial functioning between genders.<ref>{{cite journal | vauthors = Johnson DM, Shea MT, Yen S, Battle CL, Zlotnick C, Sanislow CA, Grilo CM, Skodol AE, Bender DS, McGlashan TH, Gunderson JG, Zanarini MC | title = Gender differences in borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study | journal = Comprehensive Psychiatry | volume = 44 | issue = 4 | pages = 284–292 | date = July 2003 | pmid = 12923706 | doi = 10.1016/S0010-440X(03)00090-7 | url = https://works.bepress.com/cgi/viewcontent.cgi?article=1033&context=charles_sanislow | citeseerx = 10.1.1.644.9832 }}</ref> The relationship between BPD and ethnicity continues to be ambiguous, with divergent findings reported in the United States.<ref name="Wolters Kluwer" /> The overall prevalence of BPD in the U.S. prison population is thought to be 17%.<ref name="BPD_fact_sheet">{{cite web |year=2013 |title=BPD Fact Sheet |url=http://www.borderlinepersonalitydisorder.com/understading-bpd/bpd-fact-sheet/ |url-status=live |archive-url=https://web.archive.org/web/20130104231941/http://www.borderlinepersonalitydisorder.com/understading-bpd/bpd-fact-sheet/ |archive-date=4 January 2013 |publisher=National Educational Alliance for Borderline Personality Disorder}}</ref> These high numbers may be related to the high frequency of substance use and [[substance use disorders]] among people with BPD, which is estimated at 38%.<ref name="BPD_fact_sheet" />', 397 => '', 398 => '==History==', 399 => '[[File:Edvard Munch - Salomé.jpg|thumb|Devaluation in [[Edvard Munch]]'s ''Salome'' (1903). Idealization and devaluation of others in personal relations is a common trait in BPD. The painter Edvard Munch depicted his new friend, the violinist [[Eva Mudocci]], in both ways within days. First as "a woman seen by a man in love", then as "a bloodthirsty and [[Human cannibalism|cannibalistic]] [[Salome]]".<ref name="Ed1990">{{cite book|title=Edvard Munch : the life of a person with borderline personality as seen through his art|date=1990|publisher=Lundbeck Pharma A/S|location=[Danmark]|isbn=978-87-983524-1-9|pages=34–35}}</ref> In modern times, Munch has been diagnosed as having had BPD.<ref>{{cite book | author-link = James F. Masterson | vauthors = Masterson JF | title = Search for the Real Self. Unmasking The Personality Disorders Of Our Age | chapter = Chapter 12: The Creative Solution: Sartre, Munch, and Wolfe | pages = 208–230, especially 212–213 | publisher = Simon and Schuster | location = New York | date = 1988 | isbn = 978-1-4516-6891-9}}</ref><ref>{{cite book | vauthors = Aarkrog T | title = Edvard Munch: the life of a person with borderline personality as seen through his art | publisher = Lundbeck Pharma A/S | location = Denmark | year = 1990 | isbn = 978-87-983524-1-9 }}</ref>]]', 400 => 'The coexistence of intense, divergent moods within an individual was recognized by [[Homer]], [[Hippocrates]], and [[Aretaeus of Cappadocia|Aretaeus]], the latter describing the vacillating presence of impulsive anger, [[melancholia]], and [[mania]] within a single person. The concept was revived by Swiss physician Théophile Bonet in 1684 who, using the term ''folie maniaco-mélancolique'',<ref>{{Harvnb|Millon|Grossman|Meagher|2004|p=172}}</ref> described the phenomenon of unstable moods that followed an unpredictable course. Other writers noted the same pattern, including the American psychiatrist Charles H. Hughes in 1884 and J. C. Rosse in 1890, who called the disorder "borderline insanity".<ref>{{cite journal | vauthors = Hughes CH |year=1884 |title=Borderline psychiatric records – prodromal symptoms of psychical impairments |journal=Alienists & Neurology |volume=5 |pages=85–90 |oclc=773814725 }}</ref> In 1921, [[Emil Kraepelin|Kraepelin]] identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.<ref name="millon">{{Harvnb|Millon|1996|pp= 645–690}}</ref>', 401 => '', 402 => 'The idea that there were forms of disorder that were neither psychotic nor simply neurotic began to be discussed in psychoanalytic circles in the 1930s.<ref name="David W Jones history of borderline">{{cite journal |vauthors=Jones DW |title=A history of borderline: disorder at the heart of psychiatry |journal=Journal of Psychosocial Studies |date=1 August 2023 |volume=16 |issue=2 |pages=117–134 |doi=10.1332/147867323X16871713092130 |s2cid=259893398 |url=https://oro.open.ac.uk/90946/1/90946.pdf |access-date=25 September 2023 |doi-access=free |archive-date= |archive-url= |url-status= }}</ref> The first formal definition of borderline disorder is widely acknowledged to have been written by [[Adolph Stern]] in 1938.<ref name="stern">{{cite journal | vauthors = Stern A |year= 1938 |title= Psychoanalytic investigation of and therapy in the borderline group of neuroses |journal= Psychoanalytic Quarterly |volume= 7 |issue= 4 |pages= 467–489 |doi= 10.1080/21674086.1938.11925367 }}</ref><ref name="alberto">{{cite journal | vauthors = Stefana A |year= 2015 |title= Adolph Stern, father of term 'borderline personality' |journal= Minerva Psichiatrica |volume= 56 |issue=2 |pages= 95 }}</ref> He described a group of patients who he felt to be on the ''borderline'' between [[neurosis]] and [[psychosis]], who very often came from family backgrounds marked by trauma. He argued that such patients would often need more active support than that provided by classical psychoanalytic techniques.', 403 => '', 404 => 'The 1960s and 1970s saw a shift from thinking of the condition as [[Pseudoneurotic schizophrenia|borderline schizophrenia]] to thinking of it as a borderline affective disorder (mood disorder), on the fringes of bipolar disorder, [[cyclothymia]], and [[dysthymia]]. In the [[DSM-II]], stressing the intensity and variability of moods, it was called [[cyclothymic personality]] (affective personality).<ref name="DSM-IV-TR"/> While the term "borderline" was evolving to refer to a distinct category of disorder, psychoanalysts such as [[Otto Kernberg]] were using it to refer to a broad [[Spectrum disorder|spectrum]] of issues, describing an intermediate level of personality organization<ref name="millon"/> between neurosis and psychosis.<ref name="pmid3898174">{{cite journal | vauthors = Aronson TA | title = Historical perspectives on the borderline concept: a review and critique | journal = Psychiatry | volume = 48 | issue = 3 | pages = 209–222 | date = August 1985 | pmid = 3898174 | doi = 10.1080/00332747.1985.11024282 }}</ref>', 405 => '', 406 => 'After standardized criteria were developed<ref>{{cite journal | vauthors = Gunderson JG, Kolb JE, Austin V | title = The diagnostic interview for borderline patients | journal = The American Journal of Psychiatry | volume = 138 | issue = 7 | pages = 896–903 | date = July 1981 | pmid = 7258348 | doi = 10.1176/ajp.138.7.896 }}</ref> to distinguish it from mood disorders and other Axis I disorders, BPD became a personality disorder diagnosis in 1980 with the publication of the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-III]].<ref name="PToverview">{{cite web | vauthors = Oldham JM | date = July 2004 |url=http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0 |title=Borderline Personality Disorder: An Overview |work=Psychiatric Times |volume=XXI |issue=8 |url-status=live |archive-url=https://web.archive.org/web/20131021180803/http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0 |archive-date=21 October 2013 }}</ref> The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder".<ref name=pmid3898174/> The DSM-IV Axis II Work Group of the American Psychiatric Association finally decided on the name "borderline personality disorder", which is still in use by the DSM-5 today.<ref name="DSM53"/> However, the term "borderline" has been described as uniquely inadequate for describing the symptoms characteristic of this disorder.<ref>{{cite book | vauthors = Stone MH |year=2005 |chapter=Borderline Personality Disorder: History of the Concept | veditors = Zanarini MC |title=Borderline personality disorder |pages=1–18 |publisher=Taylor & Francis |location=Boca Raton, Florida |isbn=978-0-8247-2928-8}}</ref>', 407 => '', 408 => '===Etymology===', 409 => 'Earlier versions of the DSM—before the multiaxial diagnosis system—classified most people with mental health problems into two categories: the [[Psychosis|psychotics]] and the [[Neurosis|neurotics]]. Clinicians noted a certain class of neurotics who, when in crisis, appeared to straddle the borderline into psychosis.<ref>{{cite book | vauthors = Moll T |title=Mental Health Primer |isbn=978-1-7205-1057-4 |page=43|date=29 May 2018 |publisher=CreateSpace Independent Publishing Platform }}</ref> The term "borderline personality disorder" was coined in American psychiatry in the 1960s. It became the preferred term over a number of competing names, such as "emotionally unstable character disorder" and "borderline schizophrenia" during the 1970s.<ref>{{cite book |title=Psychopharmacology Bulletin |date=1966 |publisher=The Clearinghouse |page=555 |url=https://books.google.com/books?id=_kOnSecueiYC&pg=PA555 |access-date=5 June 2020 |archive-date=4 December 2020 |archive-url=https://web.archive.org/web/20201204232024/https://books.google.com/books?id=_kOnSecueiYC&pg=PA555 |url-status=live }}</ref><ref>{{cite journal | vauthors = Spitzer RL, Endicott J, Gibbon M | title = Crossing the border into borderline personality and borderline schizophrenia. The development of criteria | journal = Archives of General Psychiatry | volume = 36 | issue = 1 | pages = 17–24 | date = January 1979 | pmid = 760694 | doi = 10.1001/archpsyc.1979.01780010023001 }}</ref> Borderline personality disorder was included in DSM-III (1980) despite not being universally recognized as a valid diagnosis.<ref>Harold Merskey, ''Psychiatric Illness: Diagnosis, Management and Treatment for General Practitioners and Students'', Baillière Tindall (1980), p. 415. "Borderline personality disorder is a very controversial and confusing American term, best avoided.</ref>', 410 => '', 411 => '==Controversies==', 412 => '', 413 => '===Credibility and validity of testimony===', 414 => 'The credibility of individuals with personality disorders has been questioned at least since the 1960s.<ref name="Goodwin">{{cite book| vauthors = Goodwin J | veditors = Kluft RP |title=Childhood antecedents of multiple personality|date=1985|publisher=American Psychiatric Press|isbn=978-0-88048-082-6|chapter=Chapter 1: Credibility problems in multiple personality disorder patients and abused children|chapter-url=https://archive.org/details/childhoodanteced00kluf|url-access=registration|url=https://archive.org/details/childhoodanteced00kluf}}</ref>{{rp|2}} Two concerns are the incidence of [[dissociation (psychology)|dissociation episodes]] among people with BPD and the belief that lying is not uncommon in those diagnosed with the condition.<ref>{{cite journal | vauthors = Dike CC, Baranoski M, Griffith EE | title = Pathological lying revisited | journal = The Journal of the American Academy of Psychiatry and the Law | volume = 33 | issue = 3 | pages = 342–349 | year = 2005 | pmid = 16186198 | url = https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=43902f103c5ab7f664c1fdfe6b2bcb7743f9bcdb | access-date = 10 January 2023 | archive-date = 10 January 2023 | archive-url = https://web.archive.org/web/20230110160409/https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=43902f103c5ab7f664c1fdfe6b2bcb7743f9bcdb | url-status = live }}</ref>', 415 => '', 416 => '====Dissociation====', 417 => 'Researchers disagree about whether dissociation, or a sense of [[emotional detachment]] and physical experiences, impacts the ability of people with BPD to recall the specifics of past events. A 1999 study reported that the specificity of [[autobiographical memory]] was decreased in BPD patients.<ref name="Startup">{{cite journal | vauthors = Jones B, Heard H, Startup M, Swales M, Williams JM, Jones RS | title = Autobiographical memory and dissociation in borderline personality disorder | journal = Psychological Medicine | volume = 29 | issue = 6 | pages = 1397–1404 | date = November 1999 | pmid = 10616945 | doi = 10.1017/S0033291799001208 | s2cid = 19211244 | df = dmy-all }}</ref> The researchers found that decreased ability to recall specifics was correlated with patients' levels of dissociation, which 'may help them to avoid [[episodic memory|episodic]] information that would evoke acutely negative [[affect (psychology)|affect]]'.<ref name = "Startup" />', 418 => '', 419 => '====Lying as a feature====', 420 => 'Some theorists argue that patients with BPD often lie.<ref name="Linehan 1993, p.17">{{harvnb|Linehan|1993|page=17}}</ref> However, others write that they have rarely seen lying among patients with BPD in clinical practice.<ref name="Linehan 1993, p.17"/>', 421 => '', 422 => '===Gender===', 423 => 'Joel Paris states that "In the clinic ... Up to 80% of patients are women. That may not be true in the community."<ref>{{cite book | vauthors = Paris J |title=Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice | year=2008 | publisher=The Guilford Press | page=21}}</ref> He offers the following explanations regarding these sex discrepancies:', 424 => '', 425 => '{{blockquote|The most probable explanation for gender differences in clinical samples is that women are more likely to develop the kind of symptoms that bring patients in for treatment. Twice as many women as men in the community [have] depression (Weissman & Klerman, 1985). In contrast, there is a preponderance of men meeting the criteria for substance use disorder and psychopathy (Robins & Regier, 1991), and males with these disorders do not necessarily present in the mental health system. Men and women with similar psychological problems may express distress differently. Men tend to drink more and carry out more crimes. Women tend to turn their anger on themselves, leading to depression as well as the cutting and overdosing that characterize BPD. Thus, [[anti-social personality disorder]] (ASPD) and borderline personality disorders might derive from similar underlying pathology but present with symptoms strongly influenced by gender (Paris, 1997a; Looper & Paris, 2000).', 426 => '', 427 => 'We have even more specific evidence that men with BPD may not seek help. In a study of completed suicides among people aged 18 to 35 years (Lesage et al., 1994), 30% of the suicides involved individuals with BPD (as confirmed by psychological autopsy, in which symptoms were assessed by interviews with family members). Most of the suicide completers were men, and very few were in treatment. Similar findings emerged from a later study conducted by our own research group (McGirr, Paris, Lesage, Renaud, & Turecki, 2007).<ref name="Paris J 2008 21–22"/>}}', 428 => '', 429 => 'In short, men are less likely to seek or accept appropriate treatment, more likely to be treated for symptoms of BPD such as substance use rather than BPD itself (the symptoms of BPD and ASPD possibly deriving from a similar underlying etiology); more likely to wind up in the correctional system due to criminal behavior; and, more likely to commit suicide prior to diagnosis.', 430 => '', 431 => 'Among men diagnosed with BPD there is also evidence of a higher suicide rate: "men are more than twice as likely as women—18 percent versus 8 percent"—to die by suicide.<ref name="Kreisman J, Strauss H 2004 206"/>', 432 => '', 433 => 'There are also sex differences in borderline personality disorder.<ref name="Sansone_2011">{{cite journal | vauthors = Sansone RA, Sansone LA | title = Gender patterns in borderline personality disorder | journal = Innovations in Clinical Neuroscience | volume = 8 | issue = 5 | pages = 16–20 | date = May 2011 | pmid = 21686143 | pmc = 3115767 }}</ref> Men with BPD are more likely to recreationally use substances, have explosive temper, high levels of [[novelty seeking]] and have (especially) antisocial [[Narcissism|narcissistic]], passive-aggressive or sadistic personality traits (male BPD being characterised by antisocial overtones<ref name="Sansone_2011" />). Women with BPD are more likely to have eating disorders, mood disorders, anxiety and post-traumatic stress.<ref name="Sansone_2011" />', 434 => '', 435 => '===Manipulative behavior===', 436 => '{{undue weight section|date=June 2023|to=a single source's interpretation of manipulative behavior as unintentional, implying that this correctly describes all people with BPD}}', 437 => '', 438 => '[[Manipulation (psychology)|Manipulative behavior]] to obtain nurturance is considered by the [[diagnostic and statistical manual of mental disorders|DSM-IV-TR]] and many mental health professionals to be a defining characteristic of borderline personality disorder.<ref>{{harvnb|American Psychiatric Association|2000|page=705}}</ref> In one research study, 88% of therapists reported that they have experinced manipulation attempts from patient(s).<ref>{{cite journal |vauthors=Mandal E, Kocur D |date=2013 |title=Psychological masculinity, femininity and tactics of manipulation in patients with borderline personality disorder |url=https://www.researchgate.net/publication/259344581 |journal=Archives of Psychiatry and Psychotherapy |language=en |issue=1 |pages=45–53 |issn=2083-828X |access-date=14 March 2024 |archive-date=14 March 2024 |archive-url=https://web.archive.org/web/20240314152609/https://www.researchgate.net/publication/259344581_Psychological_masculinity_femininity_and_tactics_of_manipulation_in_patients_with_borderline_personality_disorder |url-status=live }}</ref> However, [[Marsha Linehan]] notes that doing so relies upon the assumption that people with BPD who communicate intense pain, or who engage in self-harm and suicidal behavior, do so with the intention of influencing the behavior of others.<ref name = Linehanp14>{{harvnb|Linehan|1993|page=14}}</ref> The impact of such behavior on others—often an intense emotional reaction in concerned friends, family members, and therapists—is thus assumed to have been the person's intention.<ref name = Linehanp14/>', 439 => '', 440 => 'According to Linehan, their frequent expressions of intense pain, self-harming, or suicidal behavior may instead represent a method of mood regulation or an escape mechanism from situations that feel unbearable, however, making their assumed manipulative behavior an involuntary and unintentional response.<ref>{{harvnb|Linehan|1993|page=15}}</ref>', 441 => '', 442 => 'One paper identified possible reasons for manipulation in BPD: identifying others feelings and reactions, a regulatory function due to insecurity, to communicate ones emotions and connect to others, or to feel as if one is in control, or to allow them to be "liberated" from relationships or commitments.<ref>{{cite journal |vauthors=Schmidt P |date=2021-12-01 |title=Crossing the Lines: Manipulation, Social Impairment, and a Challenging Emotional Life |url=https://journals.openedition.org/phenomenology/312#tocto2n1 |journal=Phenomenology and Mind |language=en |issue=21 |pages=62–72 |doi=10.17454/pam-2105 |issn=2280-7853 |access-date=14 March 2024 |archive-date=5 March 2024 |archive-url=https://web.archive.org/web/20240305210156/https://journals.openedition.org/phenomenology/312#tocto2n1 |url-status=live }}</ref>', 443 => '', 444 => '===Stigma===', 445 => 'The features of BPD include: emotional instability, intense and unstable interpersonal relationships, a need for intimacy, and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms to describe people with BPD, such as "difficult", "treatment resistant", "manipulative", "demanding", and "[[attention seeking]]", are often used and may become a [[self-fulfilling prophecy]], as negative treatment of these individuals may trigger further self-destructive behavior.<ref>{{cite journal | vauthors = Aviram RB, Brodsky BS, Stanley B | title = Borderline personality disorder, stigma, and treatment implications | journal = Harvard Review of Psychiatry | volume = 14 | issue = 5 | pages = 249–256 | year = 2006 | pmid = 16990170 | doi = 10.1080/10673220600975121 | s2cid = 23923078 }}</ref>', 446 => '', 447 => 'Since BPD can be a stigmatizing diagnosis even within the mental health community, some survivors of childhood abuse who are diagnosed with BPD are re-traumatized by the negative responses they receive from healthcare providers.<ref>{{cite journal | vauthors = Nehls N | title = Borderline personality disorder: gender stereotypes, stigma, and limited system of care | journal = Issues in Mental Health Nursing | volume = 19 | issue = 2 | pages = 97–112 | year = 1998 | pmid = 9601307 | doi = 10.1080/016128498249105 }}{{subscription required}}</ref> One camp{{Who|date=June 2023}} argues that it would be better to diagnose these men or women with post-traumatic stress disorder, as this would acknowledge the impact of abuse on their behavior.{{Citation needed|date=June 2023}} Critics of the PTSD diagnosis argue that it medicalizes abuse rather than addressing the root causes in society.<ref>{{cite journal | vauthors = Becker D | title = When she was bad: borderline personality disorder in a posttraumatic age | journal = The American Journal of Orthopsychiatry | volume = 70 | issue = 4 | pages = 422–432 | date = October 2000 | pmid = 11086521 | doi = 10.1037/h0087769 }}</ref> Regardless, a diagnosis of PTSD does not encompass all aspects of the disorder (see [[#Brain abnormalities|brain abnormalities]] and [[#Terminology|terminology]]).', 448 => '', 449 => '====Physical violence====', 450 => 'The stigma surrounding borderline personality disorder includes the belief that people with BPD are prone to violence toward others.<ref name=Chapman_31>{{harvnb|Chapman|Gratz|2007|page=31}}</ref> While movies and visual media often sensationalize people with BPD by portraying them as violent, the majority of researchers agree that people with BPD are unlikely to physically harm others.<ref name="Chapman_31"/> Although people with BPD often struggle with experiences of intense anger, a defining characteristic of BPD is that they direct it inward toward themselves.<ref name=Chapman_32>{{harvnb|Chapman|Gratz|2007|page=32}}</ref>', 451 => '', 452 => 'One 2020 study found that BPD is individually associated with psychological, physical and sexual forms of intimate partner violence (IPV), especially amongst men.<ref name=MunroMartin>{{cite journal | vauthors = Munro OE, Sellbom M | title = Elucidating the relationship between borderline personality disorder and intimate partner violence | journal = Personality and Mental Health | volume = 14 | issue = 3 | pages = 284–303 | date = August 2020 | pmid = 32162499 | doi = 10.1002/pmh.1480 | s2cid = 212677723 | hdl = 10523/10488 }}</ref> In terms of the AMPD trait facets, hostility (negative affectivity), suspiciousness (negative affectivity) and risk taking (disinhibition) were most strongly associated with IPV perpetration for the total sample.<ref name=MunroMartin/>', 453 => '', 454 => 'In addition, adults with BPD have often experienced abuse in childhood, so many people with BPD adopt a "no-tolerance" policy toward expressions of anger of any kind.<ref name=Chapman_32/> Their extreme aversion to violence can cause many people with BPD to overcompensate and experience difficulties being assertive and expressing their needs.<ref name=Chapman_32/> This is one reason why people with BPD often choose to harm themselves over potentially causing harm to others.<ref name=Chapman_32/><ref name=reasons_NSSI /><ref name="Chapman_31"/>', 455 => '', 456 => '====Mental health care providers====', 457 => '', 458 => 'People with BPD are considered to be among the most challenging groups of patients to work with in therapy, requiring a high level of skill and training for the psychiatrists, therapists, and nurses involved in their treatment.<ref>{{cite journal | vauthors = Hinshelwood RD | author-link=R. D. Hinshelwood | title = The difficult patient. The role of 'scientific psychiatry' in understanding patients with chronic schizophrenia or severe personality disorder | journal = The British Journal of Psychiatry | volume = 174 | issue = 3 | pages = 187–190 | date = March 1999 | pmid = 10448440 | doi = 10.1192/bjp.174.3.187 | doi-access = free }}</ref> A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with and more difficult than other client groups.<ref>{{cite journal | vauthors = Cleary M, Siegfried N, Walter G | title = Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder | journal = International Journal of Mental Health Nursing | volume = 11 | issue = 3 | pages = 186–191 | date = September 2002 | pmid = 12510596 | doi = 10.1046/j.1440-0979.2002.00246.x }}</ref> This largely negative view of BPD can result in people with BPD being terminated from treatment early, being provided harmful treatment, not being informed of their diagnosis of BPD, or being misdiagnosed.<ref name="Campbell_2020">{{cite journal| vauthors = Campbell K, Clarke KA, Massey D, Lakeman R |date=19 May 2020|title=Borderline Personality Disorder: To diagnose or not to diagnose? That is the question |journal=International Journal of Mental Health Nursing|volume=29|issue=5|pages=972–981|doi=10.1111/inm.12737|pmid=32426937|s2cid=218690798|issn=1445-8330}}</ref> With healthcare providers contributing to the stigma of a BPD diagnosis, seeking treatment can often result in the perpetuation of BPD features.<ref name="Campbell_2020" /> Efforts are ongoing to improve public and staff attitudes toward people with BPD.<ref>{{cite journal | vauthors = Deans C, Meocevic E | title = Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder | journal = Contemporary Nurse | volume = 21 | issue = 1 | pages = 43–49 | year = 2006 | pmid = 16594881 | doi = 10.5172/conu.2006.21.1.43 | s2cid = 20500743 | hdl = 1959.17/66356 | url = https://researchonline.federation.edu.au/vital/access/services/Download/vital:236/DS1 }}</ref><ref>{{cite journal | vauthors = Krawitz R | title = Borderline personality disorder: attitudinal change following training | journal = The Australian and New Zealand Journal of Psychiatry | volume = 38 | issue = 7 | pages = 554–559 | date = July 2004 | pmid = 15255829 | doi = 10.1111/j.1440-1614.2004.01409.x }}</ref>', 459 => '', 460 => 'In psychoanalytic theory, the [[Stigma (sociological theory)|stigmatization]] among mental health care providers may be thought to reflect [[countertransference]] (when a therapist projects his or her own feelings on to a client). This inadvertent countertransference can give rise to inappropriate clinical responses, including excessive use of medication, inappropriate mothering, and punitive use of limit setting and interpretation.<ref>{{cite journal | vauthors = Vaillant GE | title = The beginning of wisdom is never calling a patient a borderline; or, the clinical management of immature defenses in the treatment of individuals with personality disorders | journal = The Journal of Psychotherapy Practice and Research | volume = 1 | issue = 2 | pages = 117–134 | year = 1992 | pmid = 22700090 | pmc = 3330289 }}</ref>', 461 => '', 462 => 'Some clients feel the diagnosis is helpful, allowing them to understand that they are not alone and to connect with others with BPD who have developed helpful coping mechanisms. However, others experience the term "borderline personality disorder" as a [[pejorative]] [[labeling theory|label]] rather than an informative diagnosis. They report concerns that their self-destructive behavior is incorrectly perceived as manipulative and that the stigma surrounding this disorder limits their access to health care.<ref>{{cite journal | vauthors = Nehls N | title = Borderline personality disorder: the voice of patients | journal = Research in Nursing & Health | volume = 22 | issue = 4 | pages = 285–293 | date = August 1999 | pmid = 10435546 | doi = 10.1002/(SICI)1098-240X(199908)22:4<285::AID-NUR3>3.0.CO;2-R }}</ref> Indeed, mental health professionals frequently refuse to provide services to those who have received a BPD diagnosis.<ref name=Manning_ix>{{harvnb|Manning|2011|page=ix}}</ref>', 463 => '', 464 => '===Terminology===', 465 => 'Because of concerns around stigma, and because of a move away from the original theoretical basis for the term (see [[#History|history]]), there is ongoing debate about renaming borderline personality disorder. While some clinicians agree with the current name, others argue that it should be changed,<ref name="borderlinepersonalitytoday.com">{{cite news| vauthors = Bogod E |title=Borderline Personality Disorder Label Creates Stigma |url=http://www.borderlinepersonalitytoday.com/main/label.htm |url-status=dead |archive-url=https://web.archive.org/web/20150502181810/http://www.borderlinepersonalitytoday.com/main/label.htm |archive-date=2 May 2015 }}</ref> since many who are labelled with borderline personality disorder find the name unhelpful, stigmatizing, or inaccurate.<ref name="borderlinepersonalitytoday.com"/><ref>{{cite web |url=http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=12 |title=Understanding Borderline Personality Disorder |publisher=Treatment and Research Advancements Association for Personality Disorder |year=2004 |url-status=dead |archive-url=https://web.archive.org/web/20130526035257/http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=12 |archive-date=26 May 2013 }}</ref> Valerie Porr, president of Treatment and Research Advancement Association for Personality Disorders states that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma".<ref>{{cite web|url=http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=32&Itemid=35 |title=How Advocacy is Bringing Borderline Personality Disorder into the Light | vauthors = Porr V |year=2001 |url-status=dead |archive-url=https://web.archive.org/web/20141020191907/http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=32&Itemid=35 |archive-date=20 October 2014 }}</ref>', 466 => '', 467 => 'Alternative suggestions for names include ''emotional regulation disorder'' or ''[[emotional dysregulation]] disorder''. ''Impulse disorder'' and ''interpersonal regulatory disorder'' are other valid alternatives, according to [[John G. Gunderson]] of [[McLean Hospital]] in the United States.<ref>{{cite book | vauthors = Gunderson JG, Hoffman PD |title=Understanding and Treating Borderline Personality Disorder A Guide for Professionals and Families |url=https://archive.org/details/understandingtre00john |url-access=registration |location=Arlington, Virginia |publisher=American Psychiatric Publishing |year=2005|isbn=978-1-58562-135-4 }}{{Page needed|date=July 2013}}</ref> Another term suggested by psychiatrist Carolyn Quadrio is ''post traumatic personality disorganization'' (PTPD), reflecting the condition's status as (often) both a form of chronic post traumatic stress disorder (PTSD) as well as a personality disorder.<ref name="AxisOne/AxisTwo">{{cite journal |vauthors=Quadrio C |date=December 2005 |title=Axis One/Axis Two: A disordered borderline |journal=Australian and New Zealand Journal of Psychiatry |volume=39 |pages=A97–A153 |doi=10.1111/j.1440-1614.2005.01674_39_s1.x |url=http://med.unsw.edu.au/publication/axis-oneaxis-two-disordered-borderline |archive-url=https://archive.today/20130705153948/http://med.unsw.edu.au/publication/axis-oneaxis-two-disordered-borderline |url-status=dead |archive-date=5 July 2013 |access-date=5 July 2013 |url-access=subscription }}</ref> However, although many with BPD do have traumatic histories, some do not report any kind of traumatic event, which suggests that BPD is not necessarily a trauma spectrum disorder.<ref name="Gratz2007" />', 468 => '', 469 => 'The Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned unsuccessfully to change the name and designation of BPD in DSM-5, published in May 2013, in which the name "borderline personality disorder" remains unchanged and it is not considered a trauma- and stressor-related disorder.<ref name="DSM-5-borderline-663">{{harvnb|American Psychiatric Association|2013|pages=663–666}}</ref>', 470 => '', 471 => '==Society and culture==', 472 => '', 473 => '===Fiction===', 474 => '', 475 => '==== Literature ====', 476 => 'In literature, characters with behavior consistent with borderline personality disorder include Catherine in ''[[Wuthering Heights]]'' (1847), Smerdyakov in ''[[The Brothers Karamazov]]'' (1880), and Harry Haller in ''[[Steppenwolf (novel)|Steppenwolf]]'' (1927).<ref>{{cite journal| vauthors = Morris P |date=1 April 2013|title=The Depiction of Trauma and its Effect on Character Development in the Brontë Fiction |journal=Brontë Studies|volume=38|issue=2|pages=157–168 |doi=10.1179/1474893213Z.00000000062 |s2cid=192230439 }}</ref><ref>{{cite journal |vauthors=Ohi SI |date=26 October 2019 |title=Personality Disorder of Character Smerdyakov in Novel the Brother Karamazov Bu [sic&#93; Fyodor Dostovesky (Translated by Constance Clara Garnett) |url=https://repository.ung.ac.id/skripsi/show/321412044/personality-disorder-of-character-smerdyakov-in-novel-the-brother-karamazov-bu-fyodor-dostovesky-translated-by-constance-clara-garnett.html |journal=Skripsi |volume=1 |issue=321412044 |access-date=22 May 2022 |archive-date=13 February 2023 |archive-url=https://web.archive.org/web/20230213123501/https://repository.ung.ac.id/skripsi/show/321412044/personality-disorder-of-character-smerdyakov-in-novel-the-brother-karamazov-bu-fyodor-dostovesky-translated-by-constance-clara-garnett.html |url-status=live }}</ref><ref>{{cite book|vauthors=Wellings N, McCormick EW|url=https://books.google.com/books?id=RXa0uEkiNbQC&q=borderline+personality+disorder+%22steppenwolf%22&pg=PA74|title=Transpersonal Psychotherapy|date=1 January 2000|publisher=SAGE|isbn=978-1-4129-0802-3|access-date=22 May 2022|archive-date=14 March 2024|archive-url=https://web.archive.org/web/20240314152701/https://books.google.com/books?id=RXa0uEkiNbQC&q=borderline+personality+disorder+%22steppenwolf%22&pg=PA74#v=onepage&q=borderline%20personality%20disorder%20%22steppenwolf%22&f=false|url-status=live}}</ref>', 477 => '', 478 => '==== Film ====', 479 => 'Films attempting to depict characters with the disorder include ''[[Margot at the Wedding]]'' (2007), ''[[Mr. Nobody (film)|Mr. Nobody]]'' (2009), ''[[Cracks (film)|Cracks]]'' (2009),<ref name="RobinsonFG">{{cite book| vauthors = Robinson DJ |title=The Field Guide to Personality Disorders|publisher=Rapid Psychler Press|year=1999|isbn=978-0-9680324-6-6|page=113 }}</ref> ''[[Truth (2013 film)|Truth]]'' (2013), ''[[Wounded (2013 film)|Wounded]] (2013)'', ''[[Welcome to Me]]'' (2014),<ref>{{cite news| vauthors = O'Sullivan M | date=7 May 2015|title=Kristen Wiig earns awkward laughs and silence in 'Welcome to Me'|newspaper=The Washington Post|url=https://www.washingtonpost.com/goingoutguide/movies/kristen-wiig-earns-awkward-laughs-and-silence-in-welcome-to-me/2015/05/06/c26d9b78-ef6d-11e4-8abc-d6aa3bad79dd_story.html|url-status=live|access-date=3 June 2015|archive-url=https://web.archive.org/web/20150604082145/http://www.washingtonpost.com/goingoutguide/movies/kristen-wiig-earns-awkward-laughs-and-silence-in-welcome-to-me/2015/05/06/c26d9b78-ef6d-11e4-8abc-d6aa3bad79dd_story.html|archive-date=4 June 2015 }}</ref><ref>{{cite news|vauthors = Chang J |date=11 September 2014|title=Toronto Film Review: 'Welcome to Me': Kristen Wiig plays a woman with borderline personality disorder in this startlingly inspired comedy from Shira Piven|newspaper=Variety|url=https://variety.com/2014/film/festivals/toronto-film-review-welcome-to-me-1201304067/|url-status=live|access-date=3 June 2015|archive-url=https://web.archive.org/web/20150617215603/http://variety.com/2014/film/festivals/toronto-film-review-welcome-to-me-1201304067/|archive-date=17 June 2015 }}</ref> and ''[[Tamasha (2015 film)|Tamasha]]'' (2015).<ref>{{cite web|vauthors=Setia S|date=9 November 2021|title=Use Your Movie Time To Get Help With Mental Health Issues|url=https://www.femina.in/wellness/mental-health/use-your-movie-time-to-get-help-with-mental-health-issues-211072.html|access-date=21 January 2022|website=[[Femina (India)]]|archive-date=21 January 2022|archive-url=https://web.archive.org/web/20220121130338/https://www.femina.in/wellness/mental-health/use-your-movie-time-to-get-help-with-mental-health-issues-211072.html|url-status=live}}</ref>', 480 => '', 481 => 'Robert O. Friedel has suggested that the behavior of Theresa Dunn, the leading character of ''[[Looking for Mr. Goodbar (novel)|Looking for Mr. Goodbar]]'' (1975) is consistent with a diagnosis of borderline personality disorder.<ref>{{cite journal|title=Early Sea Changes in Borderline Personality Disorder |url=http://www.nami.org/Template.cfm?Section=By_Illness&template=%2FContentManagement%2FContentDisplay.cfm&ContentID=43145 |archive-url=https://web.archive.org/web/20090417050113/http://www.nami.org/Template.cfm?Section=By_Illness&template=%2FContentManagement%2FContentDisplay.cfm&ContentID=43145 |url-status=dead |archive-date=17 April 2009 |access-date=17 April 2009|journal=Current Psychiatry Reports|year= 2006|volume= 8|issue = 1|pages=1–4| vauthors = Friedel RO |doi = 10.1007/s11920-006-0071-6|pmid = 16513034|s2cid = 27719611|url-access=subscription}}</ref>', 482 => '', 483 => 'The films ''[[Play Misty for Me]]'' (1971)<ref name="Robinson_2003">{{cite book |title=Reel Psychiatry: Movie Portrayals of Psychiatric Conditions| vauthors = Robinson DJ | year= 2003|publisher=Rapid Psychler Press |location=Port Huron, Michigan |isbn=978-1-894328-07-4|page=234}}</ref> and ''[[Girl, Interrupted (film)|Girl, Interrupted]]'' (1999, based on the [[Girl, Interrupted|memoir of the same name]]) both suggest the emotional instability of the disorder.<ref>{{cite book |title=Movies and Mental Illness: Using Films to Understand Psychopathology |vauthors=Wedding D, Boyd MA, Niemiec RM |year=2005 |publisher=Hogrefe |location=Cambridge, Massachusetts |isbn=978-0-88937-292-4 |page=59}}</ref>', 484 => '', 485 => 'The film ''[[Single White Female]]'' (1992) suggests characteristics which are typical of the disorder: the character Hedy had markedly disturbed sense of identity and reacts drastically to abandonment.<ref name="Robinson_2003" />{{rp|235}}', 486 => '', 487 => 'Multiple commenters have noted that Clementine in ''[[Eternal Sunshine of the Spotless Mind]]'' (2004) shows classic borderline personality disorder behavior.<ref>{{cite journal| vauthors = Alberini CM |date=29 October 2010|title=Long-term Memories: The Good, the Bad, and the Ugly|journal=Cerebrum: The Dana Forum on Brain Science|volume=2010|page=21|issn=1524-6205|pmc=3574792|pmid=23447766}}</ref><ref>{{cite book| vauthors = Young SD |date=14 March 2012|title=Psychology at the Movies |doi=10.1002/9781119941149|isbn=978-1-119-94114-9}}</ref>', 488 => '', 489 => 'In a review of the film ''[[Shame (2011 film)|Shame]]'' (2011) for the British journal ''The Art of Psychiatry'', another psychiatrist, Abby Seltzer, praises [[Carey Mulligan]]'s portrayal of a character with the disorder even though it is never mentioned onscreen.<ref name="Art of Psychiatry Shame review">{{cite news | vauthors = Seltzer A |title=''Shame'' and ''A Dangerous Method'' reviews |url= http://www.artofpsychiatry.co.uk/shame-and-a-dangerous-method-reviews/ |newspaper=The Art of Psychiatry |date=16 April 2012 |access-date=13 January 2017 |url-status=live |archive-url=https://web.archive.org/web/20170116164632/http://www.artofpsychiatry.co.uk/shame-and-a-dangerous-method-reviews/ |archive-date=16 January 2017 }}</ref>', 490 => '', 491 => 'Psychiatrists Eric Bui and Rachel Rodgers argue that the [[Darth Vader|Anakin Skywalker/Darth Vader]] character in the ''[[Star Wars]]'' films meets six of the nine diagnostic criteria; Bui also found Anakin a useful example to explain BPD to medical students. In particular, Bui points to the character's abandonment issues, uncertainty over his identity, and dissociative episodes.<ref name="BPD paper">{{cite news| vauthors = Hsu J |title=The Psychology of Darth Vader Revealed|url=http://www.livescience.com/culture/psychology-darth-vader-revealed-100604.html|work=[[LiveScience]]|publisher=TopTenReviews|date=8 June 2010|access-date=8 June 2010|url-status=live|archive-url=https://web.archive.org/web/20100826000507/http://www.livescience.com/culture/psychology-darth-vader-revealed-100604.html|archive-date=26 August 2010}}</ref>', 492 => '', 493 => '==== Television ====', 494 => 'On television, [[The CW]] show ''[[Crazy Ex-Girlfriend (TV series)|Crazy Ex-Girlfriend]]'' portrays the main character, played by Rachel Bloom, with borderline personality disorder,<ref>{{cite web| vauthors = Kelly E |date=21 November 2017|title=Crazy Ex-Girlfriend is the best depiction of mental health on television today|url=http://metro.co.uk/2017/11/21/crazy-ex-girlfriend-is-the-best-depiction-of-mental-health-on-television-today-7097094/|url-status=live|archive-url=https://web.archive.org/web/20171201033347/http://metro.co.uk/2017/11/21/crazy-ex-girlfriend-is-the-best-depiction-of-mental-health-on-television-today-7097094/|archive-date=1 December 2017|access-date=30 January 2018|website=Metro}}</ref> and [[Emma Stone]]'s character in the [[Netflix]] miniseries ''[[Maniac (miniseries)|Maniac]]'' is diagnosed with the disorder.<ref>{{cite news|date=26 September 2018|title=Netflix's 'Maniac' Is A Trippy Ride with a Lot To Say About Mental Illness|website=Bustle|url=https://www.bustle.com/p/how-netflixs-maniac-uses-mental-illness-to-interrogate-what-it-means-to-be-normal-12019062|url-status=live|access-date=1 March 2019|archive-url=https://web.archive.org/web/20190302024650/https://www.bustle.com/p/how-netflixs-maniac-uses-mental-illness-to-interrogate-what-it-means-to-be-normal-12019062|archive-date=2 March 2019|vauthors=Patton R}}</ref> Additionally, incestuous twins [[Cersei Lannister|Cersei]] and [[Jaime Lannister]], in [[George R. R. Martin]]'s ''[[A Song of Ice and Fire]]'' series and its television adaptation, ''[[Game of Thrones]]'', have traits of borderline and narcissistic personality disorders.<ref>{{cite news|publisher=MTV News|title=A Therapist Explains Why Everyone on 'Game of Thrones' Has Serious Issues: Westeros is Basically A Living, Breathing Manual for Mental Illness|date=30 April 2015|vauthors=Rosenfield K|url=http://www.mtv.com/news/2146368/game-of-thrones-mental-illness/|access-date=13 May 2019|archive-date=13 May 2019|archive-url=https://web.archive.org/web/20190513175836/http://www.mtv.com/news/2146368/game-of-thrones-mental-illness/|url-status=live}}</ref> In ''[[The Sopranos]]'', the character of [[Dr. Melfi]] diagnoses [[Livia Soprano]] with BPD<ref>{{cite book | vauthors = Lavery D |title=This Thing of Ours: Investigating the Sopranos |date=2002 |publisher=Wallflower Press |page=118}}</ref> and the character of Bruce Wayne/Batman, as portrayed in the show ''[[Titans (2018 TV series)|Titans]]'', is said to have it too.<ref>{{cite web |title=Titans Gives Bruce Wayne a Psychological Diagnosis |date=26 August 2021 |url=https://www.cbr.com/titans-bruce-wayne-borderline-personality-disorder/ |access-date=9 August 2022 |archive-date=9 August 2022 |archive-url=https://web.archive.org/web/20220809095534/https://www.cbr.com/titans-bruce-wayne-borderline-personality-disorder/ |url-status=live }}</ref> The titular character in the adult animation series ''[[BoJack Horseman|Bojack Horseman]]'' also exhibits many symptoms of BPD.<ref>{{cite web |last=Alvernaz |first=Adam |date=2019-01-29 |title=The Depressing Themes Hiding in Bojack Horseman's Closet |url=https://www.highlandernews.org/34540/depressing-themes-hiding-bojack-horsemans-closet/ |access-date=2024-01-04 |website=Highlander |language=en-US |archive-date=4 January 2024 |archive-url=https://web.archive.org/web/20240104230452/https://www.highlandernews.org/34540/depressing-themes-hiding-bojack-horsemans-closet/ |url-status=live }}</ref>', 495 => '', 496 => '===Awareness===', 497 => 'In early 2008, the [[United States House of Representatives]] declared the month of May Borderline Personality Disorder Awareness Month.<ref>HR 1005, 4/1/08</ref><ref>{{cite news|url= http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml |title= BPD Awareness Month – Congressional History |work= BPD Today |publisher= Mental Health Today |access-date= 1 November 2010 |url-status=dead |archive-url= https://web.archive.org/web/20110708083602/http://www.borderlinepersonalitydisorder.com/awareness/awareness-files/background.shtml |archive-date= 8 July 2011 |df= dmy-all }}</ref>', 498 => '', 499 => 'In 2020, South Korean singer-songwriter [[Lee Sunmi]] spoke out about her struggle with borderline personality disorder on the show ''Running Mates'', having been diagnosed five years prior.<ref>{{cite web|vauthors=Kim E|date=16 December 2020|title=선미 고백한 '경계선 인격장애' 뭐길래?|trans-title=What is the 'borderline personality disorder' that Sunmi confessed to?|language=Korean|url=https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|publisher=[[Naver TV]]|access-date=16 December 2020|archive-date=6 February 2021|archive-url=https://web.archive.org/web/20210206162916/https://entertain.naver.com/ranking/read?oid=082&aid=0001052070|url-status=live}}</ref>', 500 => '', 501 => '{{clear}}', 502 => '', 503 => '== See also ==', 504 => '{{Portal|Psychology}}', 505 => '* [[Affective empathy]]', 506 => '* [[Hysteria]]', 507 => '* [[Pseudohallucination]]', 508 => '* [[Obsessive love]]', 509 => '', 510 => '== Citations ==', 511 => '{{reflist}}', 512 => '', 513 => '== General bibliography ==', 514 => '{{Refbegin}}', 515 => '* {{cite book |author=American Psychiatric Association |author-link=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders |title-link=Diagnostic and Statistical Manual of Mental Disorders |publisher=American Psychiatric Association |year=2000 |isbn=978-0-89042-025-6 |edition=4th}}', 516 => '* {{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders |title-link=Diagnostic and Statistical Manual of Mental Disorders |publisher=American Psychiatric Publishing |year=2013 |isbn=978-0-89042-555-8 |edition=5th}}', 517 => '* {{cite book |vauthors=Chapman AL, Gratz KL |year=2007 |title=The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD |location=Oakland, CA |publisher=[[New Harbinger Publications]] |isbn=978-1-57224-507-5}}', 518 => '* {{cite journal |vauthors=Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N |author-link1=Marsha M. Linehan |date=July 2006 |title=Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder |journal=Archives of General Psychiatry |volume=63 |issue=7 |pages=757–66 |pmid=16818865 |doi=10.1001/archpsyc.63.7.757 |doi-access=free }}', 519 => '* {{cite book |vauthors=Linehan M |author-link=Marsha M. Linehan |year=1993 |title=Cognitive-behavioral treatment of borderline personality disorder |location=New York |publisher=[[Guilford Press]] |isbn=978-0-89862-183-9}}', 520 => '* {{cite book |vauthors=Manning S |year=2011 |title=Loving Someone with Borderline Personality Disorder |publisher=The Guilford Press |isbn=978-1-59385-607-6}}', 521 => '* {{cite book |vauthors=Millon T |author-link=Theodore Millon |year=1996 |title=Disorders of Personality: DSM-IV-TM and Beyond |location=New York |publisher=[[John Wiley & Sons]] |isbn=978-0-471-01186-6}}', 522 => '* {{cite book |vauthors=Millon T |author-link=Theodore Millon |year=2004 |title=Personality Disorders in Modern Life |publisher=Wiley |isbn=978-0-471-32355-6}}', 523 => '* {{cite book |vauthors=Millon T, Grossman S, Meagher SE |author-link1=Theodore Millon |year=2004 |title=Masters of the mind: exploring the story of mental illness from ancient times to the new millennium |publisher=[[John Wiley & Sons]] |isbn=978-0-471-46985-8}}', 524 => '* {{cite web |vauthors=Millon T |author-link=Theodore Millon |year=2006 |title=Personality Subtypes |url=http://millon.net/taxonomy/summary.htm |access-date=1 November 2010 |archive-date=4 November 2010 |archive-url=https://web.archive.org/web/20101104162306/http://www.millon.net/taxonomy/summary.htm |url-status=dead |website=Institute for Advanced Studies in Personology and Psychopathology|publisher=Dicandrien, Inc. }}', 525 => '{{refend}}', 526 => '', 527 => '== External links ==', 528 => '{{Commons category|Borderline personality disorder}}', 529 => '* {{curlie|Health/Mental_Health/Disorders/Personality/Borderline/}}', 530 => '* {{cite web|url= http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml |publisher= [[National Institute of Mental Health]] |title= Borderline personality disorder}}', 531 => '* [https://www.bpdfamily.com/content/borderline-personality-disorder APA DSM 5 Definition of Borderline personality disorder]', 532 => '* [https://div12.org/psychological-treatments/disorders/borderline-personality-disorder/ APA Division 12 treatment page for Borderline personality disorder]', 533 => '* [https://icd.who.int/browse10/2016/en#/F60.3 ICD-10 definition of EUPD by the World Health Organization]', 534 => '* [https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/ NHS]', 535 => '* {{cite web |url=https://borderlinesupport.org.uk |title=Borderline Support UK}}', 536 => '', 537 => '{{Medical condition classification and resources', 538 => '| ICD10 = {{ICD10|F|60|3|f|60}}', 539 => '| ICD9 = {{ICD9|301.83}}', 540 => '| MeshID = D001883', 541 => '| ICDO =', 542 => '| OMIM =', 543 => '| OMIM_mult =', 544 => '| MedlinePlus = 000935', 545 => '| eMedicineSubj = article', 546 => '| eMedicineTopic = 913575', 547 => '| eMedicine_mult =', 548 => '| SNOMED CT = 20010003', 549 => '|ICD11={{ICD11|6D11.5}}}}', 550 => '{{Borderline personality disorder}}', 551 => '{{ICD-10 personality disorders}}', 552 => '{{Authority control}}', 553 => '', 554 => '{{DEFAULTSORT:Borderline personality disorder}}', 555 => '[[Category:Borderline personality disorder| ]]', 556 => '[[Category:Cluster B personality disorders]]', 557 => '[[Category:Wikipedia medicine articles ready to translate]]', 558 => '[[Category:Wikipedia neurology articles ready to translate]]', 559 => '[[Category:Women and psychology]]' ]