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.
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:
- "Perceived or real fears of abandonment
- Intense mood swings, brief periods of severe depression or anxiety
- Unstable intense relationships
- Self-injurious and suicidal behaviors
- Chronic feelings of emptiness
- Inappropriate, intense anger and rage
- Unstable sense of self
- Dissociation and feelings of detachment"
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.
- 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%).