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

The Evolving Approach to Borderline Personality Disorder Diagnosis

Important psychopathologies of BPD include a lack of mentalizing capacity and emotion dysregulation with consequent skills deficits; however significant gaps exist in our understanding of its core psychopathology. One recent explanation proposes a general personality disorder factor ('g' factor) that is common to all personality disorders.[10] This appears to complement the way in which personality disorder is conceptualized in international classification of diseases 11th revision (ICD-11).

The ICD-11 represents a paradigm shift, describing a unified diagnosis of personality disorder that describes traits and a borderline subtype, with emphasis on severity. This entails the most significant change in the nosology of BPD since its introduction as a diagnostic category. BPD is no longer a unique diagnosis; it has become a Personality Disorder with a 'borderline pattern' qualifier that can be specified as 'mild', 'moderate' or 'severe' according to the prominence and impact of traits and symptoms on the individual's social and occupational functioning.[11,12] The borderline qualifier, unlike other trait qualifiers, still requires the presence of five of the nine BPD criteria adapted from DSM-5 (which defines BPD as a distinct diagnostic category despite the fact that its clinical features overlap with other psychiatric disorders). It remains to be seen whether classifying all personality disorders under a unitary diagnosis, according to the severity and dimensions of the symptoms, will help clinicians to better conceptualize and treat BPD patients.