Borderline Personality Disorder

Part
01
of four
Part
01

Borderline Personality Disorder: United States

Borderline personality disorder or BPD is an often stigmatized and misunderstood condition that affects between 1.6% and 5.9% of the population in the United States. It is often seen in conjunction with other conditions and frequently stems from childhood trauma, although genetics and brain abnormalities may also be at fault. Below, is a comprehensive overview of BPD, along with 25 United States-based statistics about the condition.

Overview

Borderline Personality Disorder (BPD) is a mental disorder that is characterized by the inability to effectively manage emotions, which consequently leads to severe mood swings, unstable relationships, and poor self-image and esteem. BPD often has an onset of adolescence or early adulthood and typically manifests itself as intense episodes of anger, impulsive and dangerous behavior, depression, and anxiety. Unlike bipolar disorder, these episodes do not last weeks or months, but rather typically occur for much shorter time periods of between a few hours to a few days. Patients with BPD often view situations and people in extremes, either as all "good" or all "bad." Their opinions and values can also change quickly. For instance, "an individual who is seen as a friend one day may be considered an enemy or traitor the next." This black and white world view often leads to a "pattern of intense and unstable relationships with family, friends, and loved ones."

Causes of BPD are unclear; however, "personality theorists believe BPD to be a combination of inherited biological traits and environmental conditions." Child abuse and neglect tend to be linked to high rates of BPD. Moreover, some "studies of twins and families suggest that personality disorders may be inherited" and there are indications that there may be brain abnormalities in the "areas of the brain involved in emotion regulation, impulsivity and aggression" in some BPD sufferers.

People with BPD are often high functioning in many areas of their lives, but their private lives are frequently plagued with fears of abandonment, "chronic feelings of emptiness," thoughts of suicide or self-harm, trust issues, and "feelings of dissociation." In addition, other disorders, such as substance abuse, eating disorders, and alcoholism often co-exist with BPD. A recent study of 594 college students with BPD showed that alcohol and cannabis use were both found to be strongly associated coping motives for those with BPD diagnoses. For females with BPD, the study found that not only are alcohol and cannabis used for coping with BPD, but prescription opioids and pain (self harm) are used frequently as well.

BPD is often misdiagnosed as bipolar disorder, mood disorders, and other personality disorders, which "leads to misleading pharmacological interventions that rarely succeed." Moreover, the term "borderline" has a "history of misuse and prejudice" as the condition was initially considered on the "borderline between psychosis and neurosis." The NEA BPD states that the name does not "describe the condition very well" and has caused significant misunderstanding of the disorder. This, combined with the fact that "self-harming behaviors and proneness to crisis can decrease over time," make it an illness that is not well understood by the public. To be diagnosed with BPD, individuals have to meet a minimum of five of the following nine criteria for a year or longer:


Treatments for BPD include coginitive behavior therapy (including "dialectical behavior therapy (DBT)" and "schema-focused psychotherapy") and psychodynamic therapies (including "mentalization-based therapy" and "transference-focused psychotherapy"). The efficacy of one therapy over another is not known, however as "direct comparison of active treatments... are uncommon and show few reliable differences." Other specialty treatments show promise, such as "good psychiatric management, step-down treatment, Systems Training for Emotional Predictability and Problem Solving, and motive-oriented psychotherapy," but not enough studies have been conducted to measure their impact.

U.S. Statistics

  • While the prevalence of BPD is estimated to be about 1.6% of the U.S. population, it may be as high as 5.9%.
  • About 50% more people are affected by BPD than by Alzheimer's disease.
  • Around 20% of patients admitted to mental health facilities suffer from BPD.
  • BPD has been diagnosed in approximately 10% of people seeking treatment from outpatient mental health facilities.
  • In clinical settings, women represent about 75% of BPD diagnoses in the United States, suggesting that women may seek treatment more often than men.
  • The lifetime prevalence rate of BPD does not show a significant difference in the number of female sufferers compared to male sufferers.
  • About 70% of BPD patients will attempt suicide at least once.
  • A recent study found that 40% of people with BPD have been "misdiagnosed with other disorders like bipolar disorder or major depressive disorder."
  • About 60.5% of people with BPD also have an anxiety disorder.
  • About 38.2% of people with BPD also have a substance abuse disorder.
  • Nearly half (49%) of people with BPD also have an impulse control disorder.
  • In the past 12 months, approximately 42.4% of BPD sufferers have received some form of treatment.
  • As many as 40% of teens "hospitalized in mental health treatment facilities" are diagnosed with BPD.
  • Of BPD sufferers who attempt suicide, 10% complete the act.
  • Between 36% and 58% of inpatients with BPD also suffer from post-traumatic stress disorder (PTSD).
  • Between 25% and 55% of outpatient BPD sufferers have also been diagnosed with PTSD.
  • Between 61% and 76% of people with BPD have suffered from some form of child abuse.
  • Approximately 50% of people diagnosed with BPD self-report a history of prescription drug abuse.
  • BPD can be diagnosed in children as young as 11 years of age and the prevalence of BPD in adolescence is about 3%.
  • BPD is present in between 11% (outpatient) and 78% (inpatient) of adolescents seeking outpatient consultation or emergency treatment for suicidal behaviors.
  • As many as 70% of BPD sufferers claim to have been sexually abused, usually by "non-caregivers outside the family unit."
  • There are almost as many people affected by BPD as by "schizophrenia and bipolar disorder combined."
  • Up to 20% of BPD patients also have bipolar disorder.
  • A 2019 study published by Medicina found that 53.9% of patients with both BPD and bipolar disorder were between the ages of 18 and 35.
  • Suicidal ideation among patients with both BPD and bipolar disorder is slightly higher at 44.7% than patients with only BPD (43.7%) and significantly higher than patients with only bipolar disorder (30%).
Part
02
of four
Part
02

Borderline Personality Disorder: Germany

In Germany, about 3,000 people per year receive treatment for borderline personality disorder across 700 day clinics. Overall, there are about 650,000 people who have been diagnosed with borderline personality disorder in Germany. These statistics and others have been compiled below.

Methodology

Our research team searched the NCBI, Cambridge, medical journals, white papers and scientific studies to find you statistics for borderline personality disorder (BPD) that were specific to Germany. Our team used source that were 2016 or recent. Typically, we only use sources from the past two years, but there were no contradictions in any of the information found in more recent studies. The data found is still being used in current publications so our research team considered it current as well. Below you will found a deep dive of our results.

STATISTICS

1. Approximately 650,000 people in Germany suffer from borderline personality disorder.

2. The mean waiting period prior to treatment for borderline personality disorder in Germany is 14.3 weeks. Long wait times in Germany for borderline personality disorder treatment can be interpreted as an imbalance between the number of patients and the number of facilities able to treat these patients.

3. There are 700 borderline personality disorder day clinics and inpatient facilities in Germany and 3,000 patients receive treatment each year.

4. Schema therapy (ST) has been found to be effective in the treatment of borderline personality disorder. A recent study was conducted involving patients from Germany, Australia, and Holland. Results showed an improvement in the patient's awareness, self-understanding, and management of emotions.

5. German researchers believe that men with borderline personality disorder are more likely to end up in prison. A recent study by the University of Heidelberg’s Katja Bertsch concluded that there may be "neural mechanisms, which underlie the tendency for men with BPD to show such extreme, anger-related aggression."

6. Borderline personality disorder (BPD) is a severe mental disorder with a 5.9% prevalence rate in the general population. However, 31.1% of the population in Germany suffers from at least one symptom of borderline personality disorder. Another 25.2% have between 1-2 symptoms, 3.8% have between 3–4 symptoms, and 1.1% of the population suffers from over 5 symptoms. (Please note that a diagnosis may not be made for those suffering from one symptom)

7. Germany's health care system faces a substantial burden in terms of indirect and costs from those suffering from a borderline personality disorder. The German Health Risk Institute research estimated that the average patient suffering from borderline personality disorder incurred 8,508 EUR in expenses after one year of treatment. This is equivalent to 9,477.49 USD.
Part
03
of four
Part
03

Borderline Personality Disorder: Japan

While there is no publicly available information to fully answer your question, we've used the available data to pull together various interesting statistics on borderline personality disorder (BPD) in Japan. Below is an outline of our research methodology to better understand why the information requested is publicly unavailable, as well as a deep dive into our findings.

Methodology

We initially turned to scientific databases like Google Scholar, ResearchGate and Lens.org to gather relevant studies and research on borderline personality disorder (BPD) in Japan. We quickly discovered that there is not a robust volume of work on this illness from the last two years specific to Japan. We were only able to gather a limited number of statistics dated from more recent studies, which was not nearly enough to paint a thorough picture of BPD in Japan. Furthermore, we were limited by the fact that most studies and research are behind paywalls, with only a limited number of full-text articles available. Therefore, we expanded our time frame to search for further studies and publications on BPD among the Japanese from the last several years, as many studies cover long swathes of time and therefore have much longer publication cycles. This yielded few additional results and not much in the way of general statistics about BPD and Japan in general.

We changed tactics slightly and utilized a translation tool to then search Japanese websites in the local language for relevant keywords. We had hoped to find public health reports, news articles, local BPD charitable organization websites or other relevant sources that might report quantitative information on BPD in Japan. Unfortunately, this strategy again produced limited results, though we hypothesize this strategy was likely limited by the capacity of automated translation software.

Therefore, our final approach was to consult official government organizations to see if any statistics on BPD have been reported in Japan. We checked the Ministry of Health website. Neither an English- nor Japanese-language search of published statistical reports and the website as a whole yielded relevant data specific to the illness. Even the Ministry of Health webpage on BPD cites an American study for prevalence rates, which implies there has been no official Japanese prevalence rate reported for BPD. However, there were some results in Japanese in file formats (like spreadsheets or PDFs) which we have been unable to translate to confirm whether they contain any useful statistics or not.

As a final measure, we also checked the World Health Organization (WHO) for Japanese data on BPD, as many research studies referenced the WHO's work on studying mental illnesses in countries around the world. However, we could not find any Japanese-related BPD data from the WHO.

After concluding there was limited information in the public domain on BPD in Japan, we gathered what statistics we were able to find across the various strategies described above. While we were unable to paint a robust picture of BPD in Japan regarding prevalence, diagnosis rates or treatment rates, we did, nevertheless, find some interesting data on the illness. It is likely that paid access to major scientific/research databases and proficiency in Japanese may yield additional results.

Statistics for bpd in japan

  • For Japanese youth, BPD is the most common personality disorder among those patients who have attempted suicide.
  • Adolescent suicide attempters are more likely to have BPD than adults (23% of youth versus 17% of adults).
  • Patients attempting suicide via overdose were also more likely to have BPD in Japan (21% vs 10%).
  • As many as 90% of Japanese undergraduate students with BPD have experienced physical and/or sexual abuse in their past.
  • BPD is also associated with intimate partner violence, gender hostility and violence socialization in various Japanese studies.
  • In a longitudinal study, 54.2% of adult patients previously hospitalized with BPD were employed in the period after.
  • For another long-term follow-up study, there was a reported 6.9% suicide rate among BPD patients from Fukuoka University Hospital.
  • There is limited evidence that co-morbidity of BPD with depression in Japan is declining. 15 years ago, 61.5% of university students reported both, which has declined to only 8.8% in more recent years. However, the sample size of this study is extremely small.
  • There is no standard scale or validated questionnaire in Japan (such as the Zanarini Rating Scale) to rate the severity of BPD, which is likely why there are no statistics available on different population figures for the illness.
  • The original WHO study on BPD in 1994 found a worldwide lifetime prevalence of between 14.5% (DSM) to 14.9% (ICD-10). A more recent meta-analysis reports a mean global lifetime prevalence rate of 9.7%. The most recent publication we could find, from December 2018, gives a median prevalence point of 1%.
  • Japan does have a higher prevalence of obsessive-compulsive personality disorder than the USA and Europe, but there is no information on whether BPD has a higher or lower prevalence rate in the country.
  • The most common treatments in Japan for BPD are psychiatric therapy along with mood stabilizers and antipsychotics.
Part
04
of four
Part
04

Borderline Personality Disorder: China

Our research team learned that borderline personality disorder is not recognized in China. Both the 10th revision of the International Classification of Diseases (ICD-10)5 and the third Edition of the Chinese Classification of Mental Disorders (CCMD-3)6 create different diagnostic categories to describe patients with clinical profiles comparable to the DSM-BPD construct. These are both the most recent publishings and this information is current as of 2019.

METHODOLOGY

Our research team conducted an exhaustive search of the most recent editions of the International Classification of Diseases and the Chinese Classification of Mental Disorders. We hoped to find statistics on borderline personality disorder specific to China, but instead found that the disorder is not uniformly accepted in China. We also learned that there was limited research available on this topic. The logic behind this strategy was these are the standard diagnostic tools for epidemiology, clinical purposes, and health management and that any statistics related to borderline personality disorder would typically be found in these publishings.

As a second research strategy, our team searched medical journals such as NCBI, to find any related information on the topic. Here, we learned that a "different diagnostic category of impulsive personality disorder (IPD) overlaps extensively with BPD." Our team decided to further research IPD, which indicated that "although a different diagnostic category of impulsive personality disorder (IPD) overlaps extensively with BPD, 75% of BDP patients are female, as compared to 40% of IPD patients being female." This discrepancy was concerning to our team, thus we did not provide statistics on IPD.

Lastly, our team reviewed scientific articles such as Scientific Direct and other science websites. Here, we learned that as of 2017, little data on the topic for China has been published. We also found an interesting study regarding the prevalence of borderline personality disorder in Chinese inmates, which we have included below. Our logic was that since Science Direct "hosts over 12 million pieces of content from 3,500 academic journals," it would be highly probable that information related to borderline personality disorder in China could be found here. Our research team concluded that until borderline personality disorder is recognized in China, it is highly unlikely that studies will be published on it.

FINDINGS

10.6% of Chinese female inmates suffer from borderline personality disorder.

China has a higher prevalence of personality disorders when compared to Western Europe but a lower prevalence when compared to that in the United States.

In China, the diagnosis of borderline personality disorder has not been uniformly accepted. There is "no BPD diagnosis in the third edition of the Chinese Classification of Mental Disorders (CCMD-3)," although a different diagnostic category of impulsive personality disorder (IPD) overlaps extensively with BPD. These criteria describe patients comparable to the Diagnostic and Statistic Manual of Mental disorders BPD construct.

The third version of the Chinese Classification of Mental Disorders (CCMD-3) rejected BPD as a valid diagnostic category and instead adopted the term impulsive personality disorder (IPD).

According to Research Gate, because the CCMD-3 does not include BPD as a formal diagnostic category, "China lags behind the West in empiric studies of the prevalence, symptom expression, etiologic processes and treatment outcomes."

About 39.3% of those with symptoms of borderline personality disorder, also suffer from depression in China.
Sources
Sources

From Part 03