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BORDERLINE PERSONALITY DISORDER Copyright 1999 John M Rathbun MD DEFINITION - a pervasive pattern of instability of interpersonal relationships self-image and affect and marked impulsiveness beginning by early adulthood and present in a variety of contexts HISTORY this diagnosis has been used over the past 30 years to label patients who get therapists upset BPD has become the most diagnosed and researched personality disorder EPIDEMIOLOGY two or three per cent of the general population are affected most common personality disorder in clinical settings diagnosed in 11 of psychiatric outpatients 19 of inpatients and about half of all personality disordered patients three times as common in women as in men five times more common in first degree relatives of affected persons ETIOLOGY well over half are victims of physical andor sexual abuse dysfunctional family dynamics are common mothers often erratic and depressed fathers often absent or have major character problems early losses common genetic data implicate constitutional factors DIAGNOSIS typically present with dependent behaviors seeking nurturance closeness and assistance within a therapeutic relationship show escalating need for support when frustrated show rage and devaluation of therapist relationships typically unstable intense and stormy they show extremes of idealization and devaluation may become extremely ill and self-destructive in reaction to fear of abandonment commonly have other personality disorders mood disorders substance dependence bulimia and PTSD DIFFERENTIAL Compared to cyclothymic and bipolar patients BPD more reactive angry in reaction to frustration in dependent relationships with chronic feelings of emptiness compared to depressive disorders BPD more manipulative in their suicidality and have poorer relationships compared to psychotic disorders BPD have brief reactive psychotic symptoms not chronic persistent ones COURSE typical BPD emerges in adolescence BPD especially severe in twenties about half improve spontaneously in thirties and forties BPD commonly
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