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


Although significant progress is being made, we are yet to fully appreciate the broad impact of BPD and allocate appropriate funding despite BPD having comparable prevalence (1%) and rate of suicide (10%)[53,54] to schizophrenia and bipolar disorders.[55] Our present challenge is to develop and increase timely access to a greater range of evidence-based psychosocial interventions for BPD, with a goal of achieving recovery beyond remission.

More research on BPD diagnosis and management is required amongst men and people below 18 and over 64 years of age. Clear guidance is needed to confidently delineate BPD from overlapping disorders such as PTSD, psychosis, mood disorders, ADHD and autism spectrum disorders. Evidence is urgently required to inform the treatment of BPD when it cooccurs with other psychiatric disorders; the application of stepped-care approaches; effective interventions for different levels of severity and trait combinations, and an evidence-base for the application of nonpsychotherapeutic interventions. The treatment implications of the unitary personality disorder diagnosis articulated in ICD-11 on BPD treatments remain to be seen.

Clarity is needed regarding the prevalence of BPD in non-Western settings. Do current diagnostic constructs and psychotherapeutic approaches apply across cultural contexts? Treatment of BPD will pose a considerable challenge in countries where mental healthcare is not widely accessible. It is not clear whether treatments developed for Western cultures with individualistic societies are optimal for non-Western cultures.

Psychological interventions that actively include family members and have been adapted to local cultural contexts will need to be developed and tested. It is critical that future work in the BPD field encompasses a global, population-based approach to maximize its relevance and benefits.