Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness characterized by a long-term pattern of unstable relationships, a distorted sense of self, and strong emotional reactions. There is often self-harm and other dangerous behavior. People may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms may be triggered by seemingly normal events or actions by others. The behavior typically begins by early adulthood and occurs across a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. Up to 10% of people affected die by suicide.
BPD's causes are unclear but seem to involve genetic, neurological, environmental, and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events also appear to play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders. Diagnosis is based on the symptoms, while a medical examination may be done to rule out other problems. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.
BPD is typically treated with therapy, such as cognitive behavioral therapy (CBT). Another type, dialectical behavior therapy (DBT), may reduce the risk of suicide. Therapy may occur one-on-one or in a group. While medications do not cure BPD, they may be used to help with the associated symptoms. Some people require care in hospital.
About 1.6% of people have BPD in a given year, with some estimates as high as 6%. Women are diagnosed about three times as often as men. It appears to become less common among older people. Up to half of people improve over a ten-year period. People affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline. The disorder is often stigmatized in both the media and the psychiatric field.