What is borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself. When they are exhibited in a wide range of important social and personal contexts and cause serious functional impairment or subjective distress, they constitute a personality disorder. The manifestations of personality disorders are often recognized by adolescence and continue throughout most of adult life.

Personality disorders are not formally diagnosed in patients younger than 18 years, because of the ongoing developmental changes. However, if the disturbance is pervasive and if the criteria are fully and persistently met and are not limited to a developmental stage, diagnosing borderline personality disorder (BPD) in children and adolescents is appropriate.

Historically, BPD has been seen as lying on the border between psychosis and neurosis. It is characterized by marked instability in functioning, affect, mood, interpersonal relationships, and, at times, reality testing. Of patients with BPD about 20-50% report psychotic symptoms. [9]

In 1942, Deutsch described a group of patients who lacked a consistent sense of identity and source of inner direction. [10] She created the term “as-if personalities” because the patients completely identified with those upon whom they were dependent, changing their identifications and sense of self as their relationships changed. In 1975, Kernberg conceptualized BPD to describe a group of patients with particular primitive defense mechanisms and pathologic internalized object relations (splitting and projective identification). [11]

Borderline pathology in children refers to a syndrome characterized by a combination of externalizing symptoms (disruptive behavioral problems), internalizing symptoms (mood and anxiety symptoms), and cognitive symptoms. Follow-up studies of these children show that they have a tendency to develop a wide range of personality disorders, with no strong specific tendency toward BPD. Further research in this area is needed to elucidate the etiology and facilitate early intervention.

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