Borderline personality disorder often goes undetected

Abstract

Borderline personality disorder (BPD) is a complex mental disorder characterised by mood instability, impulsivity, relationship difficulties and disturbed self-image. There is a pervasive pattern of emotional instability, impulsive aggression, repeated self-harm and chronic suicidal tendencies often associated with suicide attempts. Some patients are able to sustain a certain level of social and occupational functioning, while others experience a very high level of emotional distress. There is often rapid fluctuation from periods of confidence to despair. A large proportion of those affected are unrecognised and untreated. Women present to services three times more often than men. Most people show symptoms in late adolescence or early adult life. BPD is not entirely related to environmental factors. A study of more than 40 twin pairs showed high heritability. One common denominator of BPD appears to be dysfunctional regulation of emotions. People with BPD present at times of crisis, often following an episode of self-harm. Presentation is accompanied by a sense of urgency and anxiety. People with BPD have marked difficulty differentiating reality from fantasy, so that health problems may be perceived as life threatening. This may result in loss of perspective and miscommunication with the GP. The doctor should provide very clear information to counter any elaborate fantasies about their illness. Patients with suspected BPD should be referred to a psychiatrist for assessment and diagnosis.