Borderline Personality Disorder

While Borderline Personality Disorder may present in just 1% of the general population – and 10-25% of patients in the mental health community – the severity of its symptoms is far more concerning than most other disorders. Borderline Personality Disorder is characterized by inescapable feelings of instability in affect regulation, impulsivity, destructive interpersonal relationships and low self-image[1]. The development of this disease largely varies, sometimes caused by environmental factors, sometimes due to brain topological abnormalities, and sometimes caused largely by genetic predispositions. In several cases, this disorder presents as a result of childhood development largely due to the influence of both environmental factors, like creating an environment where the child is constantly criticized or punished for their actions, and biological factors, such as emotional vulnerability[2]. The neurological and genetic abnormalities present within these individuals unfortunately makes it likely that even with treatment, the patients will continue to present with symptoms throughout adulthood. Ultimately, Borderline Personality Disorder presents with many severe symptoms which are all taken into consideration during diagnosis according to DSM criteria in order to determine the best course of treatment, such as pharmacotherapy or psychotherapy.

1. Lieb, K., Zanarini, M., Schmahl, C., Linehan, M., & Bohus, M. (2004). Borderline Personality Disorder. The Lancet, 364(9432): 453-461.
2. Sauer, S. E., & Baer, R. A. (2009). Relationships Between Thought Suppression and Symptoms of Borderline Personality Disorder. Journal of Personality Disorders, 23(1): 48-61.

Borderline Personality Disorder Diagnosis

main article: Borderline Personality Disorder Diagnosis
author: Andrew Belli

DSM-IV Criteria for Borderline Personality Disorder
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Diagnostic Criteria for BPD. Image Source: Durham, Grube and Fuller, 2007[5]

Borderline Personality Disorder (BPD) is a dangerous mental disability that is often misdiagnosed or found to be comorbid with many other mental illnesses of similar attributes and symptoms. In order to correctly diagnose and eventually properly treat this mental disease, psychologists must take extra precautions to identify the symptoms associated with BPD and to make sure the symptoms involved are only present with the particular disorder in order to avoid a misdiagnosis. This is done using various questionnaires and tests in order to assess patients and correctly compare them to the symptoms associated with BDP. The symptoms that psychologists are looking for are outlined in DSM. The psychologists match the symptoms up to those presented in the DSM and make sure that a certain number of criteria are met in order to conclude that an individual has BDP as opposed to another mental disorder with slightly different, but very similar, symptoms. In order to properly observe this a number of studies were investigated in order to show examples of how patients are diagnosed with BDP using the criteria shown in DSM-IV. Although DSM-IV is now outdated since the release of the new DSM-5, the changes presented in the newly revised edition are very minimal. Diagnosing patients with a mental disease is never easy, but steps do exist in order to properly assess individuals and treat them for the correct disorders. [1] [2]

After a brief comparison of the two types of DSM, various studies were examined and focused on in order to get a better idea of how Borderline Personality Disorder is diagnosed in different scenarios, concentrating on its different pillars that make up the proper diagnostic criteria for the disease. Many cognitive symptoms exist with BPD and make up the main focus of this examination. One of the studies focused on in this category is that of Marion Robin and colleagues and their studies on adolescents and BPD. By examining a child’s response to identifying a person’s facial expression, adolescents diagnosed with BPD according to DSM IV criteria were found to be less sensitive to facial emotions (such as anger and happiness) and required far more intense facial expressions and cues.[3] Those suffering from BPD have also been found to exhibit irregular behavioural symptoms, such as self-harm and suicide.[4] The comorbidity of BPD and the problems of misdiagnosing it with other mental illnesses are also examined. Dangers such as those found in these studies must be examined immediately using DSM criteria in order to properly diagnose BPD and then to correctly treat it, so those suffering from this mental disease may live rich, fulfilling lives.

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington , VA: American Psychiatric Publishing.
2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
3. M. Robin et al. Decreased sensitivity to facial emotions in adolescents with Borderline Personality Disorder. Psychiatry Res. 2012; 200 (2-3): 417-21.
4. B. Stringer et al. Recurrent suicide attempts in patients with depressive and anxiety disorders: the role of borderline personality traits. J Affect Disord. 2013; 151 (1): 23-30.
5. Durham, J., Grube, R., and Fuller., S. (2007). Borderline Personality Disorder. US Pharm. 32(11): 52-58.

Developmental Profile of Borderline Personality Disorder

main article: Developmental Profile of Borderline Personality Disorder
author: Sonya Varma

Bivariate Analysis of Risk Factors influential to BPD
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This chart displays a few of the significant risk factors to developing BPD to be further discussed within![4]

As depicted throughout the previous sections of this Neurowiki, Borderline Personality Disorder presents with extreme intensities in emotional states. These patients have challenges with interpersonal relationships, react impulsively, and demonstrate behaviors that are detrimental to themselves, and often times to their loved ones[1]. Crucial to finding a way to best help these patients, however, is first considering the development of this disorder. To the extent that they can, researchers have been studying adolescents who present with symptomatic resemblance to BPD, or those who have actually been recently diagnosed with BPD. Due to a wide array of conflicting evidence, a true developmental profile for the disease is difficult to depict, particularly in terms of the neuroanatomical background of this disorder. In today’s research, brain imaging techniques such as MRIs and fMRIs (fMRIs only really completed on adults)[2] among several other techniques have been extremely popular in understanding of this disorder, and have identified various volume abnormalities, several of which seem to be somewhat contradictory of one another[1]. Hyper and hypoactivity of various limbic – as well as a number of other neuroanatomical structures – structures, volume variations within structures, and much more will be discussed to depict the neuro-development of this disorder. Further, current research additionally indicates that the development of this disorder does not cease at a neurological cause. Genetic associations and environmental influences perhaps occurring throughout childhood largely contribute to the onset of this disorder[3]. The first step to finding the ideal cause, and ultimately treatment, of this disorder is to understand its development, and here will be presented a wide array of research completed to provide an accurate and detailed account of said development of BPD as recognized by researchers today.

1. E. Lis, B. Greenfield, M. Henry, J. Guile, G. Dougherty. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci. 2007. 32(3): 162-173.
2. Goodman, M., Mascitelli, K., Triebwasser J. The neurobiological basis of adolescent-onset borderline personality. J Can Acad Child Adolesc Psychiatry. 2013; 22(3): 212-219
3. Karan E, Niesten IJ, Frankenburg FR, Fitzmaurice GM, Zanarini MC. The 16-year course of shame and its risk factors in patients with borderline personality disorder. Personal Ment Health. 2014 Mar 6. Doi: 10.1002/pmh.1258.
4. Stepp SD, Whalen DJ, Scott LN, Zalewski M, Loeber R, Hipwell AE. Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. Dev Psychopathol. 2014; 1-18.

Genes Associated with Borderline Personality Disorder

main article: Genes Associated with Borderline Personality Disorder
author: Madeleine M
Borderline Personality Disorder (BPD) is thought to arise from both environmental and genetic factors. From twin studies, the concordance rate for having BPD for monozygotic twins has been found to be 35-69%[1] while the concordance rate for dizygotic twins is only 7%[2]. This indicates that there is a genetic contribution to the development of BPD. Although a causative gene has not yet been found, certain polymorphisms in several genes in the serotonergic and dopaminergic pathways have been found to be associated with having BPD. Genes that have been found in the serotonergic pathway include the serotonin transporter 5HTT[3], the Monamine Oxidase A gene MAOA[4], and the Serotonin 1A receptor HTR1A[1]. Genes that have been found in the dopaminergic pathway include the dopamine transporter DAT1[1],[5], and the dopamine receptors DRD2 and DRD4[6]. Epigenetic differences, such as the aberrant methylation of genes, have been examined as well[7]. There has additionally been some research beginning to look at genes that regulate the circadian rhythm as being implicated in patients with BPD[8]. Further research must certainly be undertaken to fully understand the genetics of BPD.

1. Joyce, P.R., Stephenson, J., Kennedy, M., Mulder, R.T. & McHugh, P.C. The presence of both serotonin 1A receptor (HTR1A) and dopamine transporter (DAT1) gene variants increase the risk of borderline personality disorder. Frontiers in Genetics. 4, 1-7 (2014)
2. Lis, E., Greenfield, B., Henry, M., Guile, J.M. & Dougherty, G. Neuroimaging and genetics of borderline personality disorder: a review. Rev Psychiatr Neurosci. 32, 162-73 (2007)
4. Ni, X. et al. Monoamine oxidase A gene is associated with borderline personality disorder. Psychiat Genet. 17, 153-157 (2007)
8. Fleischer, M., Schafer, M., Coogan, A., Habler, F. & Thome, J. Sleep disturbances and circadian CLOCK genes in borderline personality disorder. J Neural Transm. 119, 1105-1110 (2012)

Symptoms of Borderline Personality Disorder

main article: Symptoms of Borderline Personality Disorder
author: Patricia Saad
Borderline personality disorder is distinguished by a range of pathological symptoms which include unstable affective states that affect interpersonal relationships as well as their behaviour[1]. These symptoms make their first appearance sometime in adolescence, and continue to appear chronically throughout adult life if left untreated[2]. People suffering from this mental disease set unrealistic expectations for relationships by idealizing the person they admire and offsetting overwhelming fears of rejection and abandonment[3]. Therefore when actual or imagined neglect is perceived, the ego of the patient undergoes self-depletion which causes them to view themselves as worthless[3]. Patients also display signs of impulsive and reckless behaviour, which includes, but is not limited to, gambling, substance abuse, binge eating and sex[3]. This may lead to engaging in recurring self-harming behaviours, possibly resulting in suicide[3]. Altogether, these symptoms make it challenging for borderline personality disorder patients to maintain a relationship with any other person.

Borderline Personality Disorder
A quick introduction to borderline personality disorder and its symptoms.
Adapted from (Ofir Sasson, 2013)[4].
1. Sansone, R. A., & Sansone, L. A.(2013). Responses of Mental Health Clinicians to Patients with Borderline Personality Disorder. Innov Clin Neurosci, 10(5-6):39-43.
2. Stepp, S. (2012). Development of Borderline Personality Disorder in Adolescence and Young Adulthood: Introduction to the Special Section. J Abnorm Child Psychol, 40(1):doi:10.1007/s10802-011-9594-3.
3. Gunderson, J. G. (2011). Borderline Personality Disorder. New England Journal of Medicine, 364(21):2037-2042.
4. Ofir Sasson. (2010). Borderline Personality Disorder.

Treatments of Borderline Personality Disorder

main article: Treatments of Borderline Personality Disorder
author: Pauline Gaprielian

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Adapted from

Borderline Personality Disorder, which affects about two percent of the general population, is a mental disorder that is characterized by pervasive patterns of instability in affect regulation, impulse control, interpersonal relationships and self-image[1]. Symptoms are accompanied by suicidal thoughts and attempts to inflict self-harm[2]. The management of borderline personality disorder poses a challenge to mental-health professionals due to the lack of effective treatments available. In the past two decades, new treatment options, like specialized psychotherapies, have emerged, but their availability remains limited[2]. These newly developed specialized psychotherapies have been proven to largely reduce the symptoms experienced by borderline personality disorder patients and can maintain their reduction over time[2]. Apart from the implementation of psychotherapies in the management of this disorder, pharmacotherapies have also been introduced. Some medications show promise, but overall, treating patients with drugs is limited and not as beneficial as the use of specialized psychotherapies[2].

1. Lieb, K., M. C. Zanarini, C. Schmahl, M. M. Linehan, and M. Bohus. (2004) Borderline Personality Disorder. The Lancet, 364.(9432): 453-461.
2. Biskin, R. S., & Paris, J. (2012). Management of borderline personality disorder. Canadian Medical Association Journa, 184(17): 1897-1902.

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