Developments in Diagnosis and Treatment of People With Borderline Personality Disorder

Sathya Rao; Parvaneh Heidari; Jillian H. Broadbear


Curr Opin Psychiatry. 2020;33(5):441-446. 

In This Article

Recent Developments in the Understanding of the Diagnosis of Borderline Personality Disorder

The community prevalence of BPD in Western countries is similar in men and women,[1] impacting at least 1% of the population;[2] the prevalence of BPD in non-Western populations is uncertain. Interest in the detection and treatment of BPD is gathering momentum in Eastern countries as the impact of untreated BPD becomes clearer.[3] Most clinical studies are representative of outcomes in women aged 18–64, reflecting their greater likelihood of being diagnosed with BPD in Western clinical settings to which women present three to four times more often than men do.[4] The clinical profile of BPD in men therefore remains unclear. Gender studies in people with BPD show equivalent suicide attempts but higher lethality in men, who are also more impulsive and aggressive.[5] With respect to age, BPD symptoms may persist beyond 65 years of age or manifest for the first time in later life.[6] Despite guidance for diagnosing from 12 years of age,[7] reluctance remains for diagnosing people under 18 or over 65.

This is compounded by a lack of clinically appropriate screening tools that enable clinicians to clearly differentiate BPD from other psychiatric disorders. This contributes to the underrecognition of BPD, its underdiagnosis and inappropriate and delayed treatment. The widely used McLean Screening Instrument for BPD is validated in people aged 18–59.[8] Although BPD screening in older people is being investigated,[9] there remains a need for validated screening tools suitable for psychiatric and primary health settings across the life span.