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Borderline Personality Disorder

Updated : February 16, 2024





Background

Borderline Personality Disorder is a psychiatric condition with characteristic patterns of impulse thinking, emotional dysregulation, risk-taking behavior, paranoia, self-harm, and fear of abandonment.

These emotions and behavior patterns could be precipitated by substance abuse or co-morbidities. It is also characterized by vulnerability to rejection and unstable personal relationships. It causes significant impairment and is often associated with other psychiatric disorders.

Epidemiology

The estimated prevalence of borderline personality disorder in the general population is 1.6%, with a lifetime prevalence of 5.9%. No considerable significance rate was observed in males and females in the general population. While in the inpatient, females have a higher prevalence rate than males, with a ratio of 3:1.

Studies comparing ethnicity and borderline personality disorder also demonstrate that females are more prevalent than males. Thus, ethnicity is a non-significant factor. Twin studies indicate a 50% chance of heritability.

Anatomy

Pathophysiology

The pathology of this disorder is combined with genetic predisposition with childhood-onset and neurologic dysfunction. Oxytocin plays a role in the control of the social reward and empathy networks. The oxytocin receptor (OXTR) is linked with environmental factors such as childhood adversity and emotional dysregulation.

Serotonin fluctuations reduce the sensitivity of the 5HT-1A receptor, which contributes to personality disorder. With the dysregulation of serotonin, patients have lower performance with learning, memory, attention, cognitive flexibility, speed processing, and visuospatial activities. Neuroimaging research has indicated abnormalities in the amygdala, hippocampus, and medial temporal lobes in patients with this disorder.

Etiology

There is a genetic and environmental predisposition. Environmental factors contributing to this disorder’s development includes childhood trauma such as neglect and physical or sexual abuse. In most patients, this disorder is linked to less maternal attachment, maternal neglect, maternal separation, substance abuse by parents, parental psychopathology, and inappropriate family boundaries.

Childhood abuse is correlated with decreased volume of limbic areas and the corpus callosum, while impulsivity is related to changes in blood flow in frontal cortical regions. Borderline personality results from a lack of resilience to psychological stressors; it develops from the inability to regulate stress and form healthy coping mechanisms.

This contraindication causes intense anxiety and leads to the development of splitting. Splitting is a defense mechanism where the patient cannot construct an actual perspective of the other person and considers the person positive or negative; it may affect interpersonal relationships.

Genetics

Family history, particularly psychiatric disorders, has a higher chance of transmission to future generations.

There is about a 40% risk of heritability of borderline personality disorder from parents and close relatives.

Twin studies suggest a 50% chance of being affected or being the carrier of this disorder.

Prognostic Factors

Patients with borderline personality disorder have good prognosis. There is a 35% chance of remission after two years and 91% remission after ten years. The onset of remission depends on several factors such as avoidance of personal relationships instead of developing communication skills, no history of childhood abuse, substance abuse, and no genetic predisposition.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782519/

https://www.ncbi.nlm.nih.gov/books/NBK430883/

Borderline Personality Disorder

Updated : February 16, 2024




Borderline Personality Disorder is a psychiatric condition with characteristic patterns of impulse thinking, emotional dysregulation, risk-taking behavior, paranoia, self-harm, and fear of abandonment.

These emotions and behavior patterns could be precipitated by substance abuse or co-morbidities. It is also characterized by vulnerability to rejection and unstable personal relationships. It causes significant impairment and is often associated with other psychiatric disorders.

The estimated prevalence of borderline personality disorder in the general population is 1.6%, with a lifetime prevalence of 5.9%. No considerable significance rate was observed in males and females in the general population. While in the inpatient, females have a higher prevalence rate than males, with a ratio of 3:1.

Studies comparing ethnicity and borderline personality disorder also demonstrate that females are more prevalent than males. Thus, ethnicity is a non-significant factor. Twin studies indicate a 50% chance of heritability.

The pathology of this disorder is combined with genetic predisposition with childhood-onset and neurologic dysfunction. Oxytocin plays a role in the control of the social reward and empathy networks. The oxytocin receptor (OXTR) is linked with environmental factors such as childhood adversity and emotional dysregulation.

Serotonin fluctuations reduce the sensitivity of the 5HT-1A receptor, which contributes to personality disorder. With the dysregulation of serotonin, patients have lower performance with learning, memory, attention, cognitive flexibility, speed processing, and visuospatial activities. Neuroimaging research has indicated abnormalities in the amygdala, hippocampus, and medial temporal lobes in patients with this disorder.

There is a genetic and environmental predisposition. Environmental factors contributing to this disorder’s development includes childhood trauma such as neglect and physical or sexual abuse. In most patients, this disorder is linked to less maternal attachment, maternal neglect, maternal separation, substance abuse by parents, parental psychopathology, and inappropriate family boundaries.

Childhood abuse is correlated with decreased volume of limbic areas and the corpus callosum, while impulsivity is related to changes in blood flow in frontal cortical regions. Borderline personality results from a lack of resilience to psychological stressors; it develops from the inability to regulate stress and form healthy coping mechanisms.

This contraindication causes intense anxiety and leads to the development of splitting. Splitting is a defense mechanism where the patient cannot construct an actual perspective of the other person and considers the person positive or negative; it may affect interpersonal relationships.

Family history, particularly psychiatric disorders, has a higher chance of transmission to future generations.

There is about a 40% risk of heritability of borderline personality disorder from parents and close relatives.

Twin studies suggest a 50% chance of being affected or being the carrier of this disorder.

Patients with borderline personality disorder have good prognosis. There is a 35% chance of remission after two years and 91% remission after ten years. The onset of remission depends on several factors such as avoidance of personal relationships instead of developing communication skills, no history of childhood abuse, substance abuse, and no genetic predisposition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782519/

https://www.ncbi.nlm.nih.gov/books/NBK430883/