Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health syndrome of behavioral and emotional dysregulation. The term “borderline” was coined by American psychoanalyst Adolph Stern in the early 20th century to describe behavior that was neither clearly neurotic nor psychotic but bordered between the two categories. The person meeting the BPD criteria in the Diagnostic and Statistical Manual of Mental Disorders demonstrates patterns of:

  • Greater reactivity to both real and perceived stress
  • High intensity levels of emotional reactivity
  • Greater difficulty in showing age-appropriate, healthy management of emotion
  • Unstable self-image/sense of self-identity
  • Chronic suicidal ideation

BPD is frequently confused with bipolar disorder (a mood disorder) because of mood swings, suicidality, comorbid substance use and impulsivity (such as hypersexuality, risky behavior and exorbitant spending). Major distinctions between the two syndromes are that a person with BPD has impairment in their identity, self-direction and empathy. While some people can have both syndromes, compared to bipolar disorder, people with BPD distinctively have behavior patterns of:

  • Focusing on avoiding perceived or actual abandonment
  • Hypersensitivity to rejection
  • Inability to have healthy order and fairness in relationships (they are controlling)
  • Alternating between extremes of idealization and devaluation of other people
  • Paranoia that others are angry at them
  • Difficulty engaging in problem-solving
  • Chronic emptiness
  • Self-harm or self-sabotage (to include eating disorders and physical self-harm)

In terms of prevalence, the National Institutes of Health estimates 1.6 percent of the general population and between 11 and 20 percent of inpatient hospital populations are estimated to have BPD. Regarding biological gender, on a 3:1 ratio, females are more likely to be diagnosed with BPD than males.

There are multiple causes of BPD. While there is research suggesting a genetic predisposition to BPD, there are multiple developmental/environmental factors that include parental psychopathology, parental substance use, maternal separation, inappropriate family boundaries and childhood maltreatment (physical abuse, sexual abuse or neglect).


BPD is usually diagnosed in patients in their late teens or early adult years. Treatment options for BPD primarily are psychotherapy interventions, but some patients can benefit from psychiatric medications.

With proper treatment, many people with BPD may have their symptoms and functioning improve and live better lives. UofL Health – Peace Hospital can be reached at 502-451-3333 for a no-cost level-of-care assessment and assistance with treatment options.

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David Houvenagle, Ph.D., LCSW

David Houvenagle, Ph.D., LCSW, is the lead adult mental health therapist at UofL Health – Peace Hospital, where he has worked in various clinical capacities since 2002. He is the author of “Clinician’s Guide to Partial Hospitalization and Intensive Outpatient Practice” (Springer Publishing 2015) that has a chapter on working with borderline personality disorder patients. He earned his master’s degree in social work from the Southern Baptist Theological Seminary and his Ph.D. in urban and public affairs from University of Louisville.

All posts by David Houvenagle, Ph.D., LCSW
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