Borderline 

Personality Disorder 

National Institute of Mental Health 

U.S. Department of HealtH anD HUman ServiceS • national institutes of Health 
Contents

What is borderline personality disorder? ________________________________ 1

What are the symptoms of borderline personality disorder? ______________ 2

Suicide and Self-harm _____________________________________________ 3

When does borderline personality disorder start? _______________________ 4

What illnesses often co-exist with borderline personality disorder? _______ 4 

What are the risk factors for borderline personality disorder? _____________ 5

How is borderline personality disorder diagnosed? ______________________ 5

What studies are being done to improve the diagnosis of 

borderline personality disorder? ____________________________________ 6

How is borderline personality disorder treated? _________________________ 7

Psychotherapy ___________________________________________________ 7

Medications _____________________________________________________ 10

Other Treatments ________________________________________________ 10

How can I help a friend or relative who has borderline 

personality disorder? ________________________________________________ 11

How can I help myself if I have borderline personality disorder? _________ 12

Where can I go for help? _____________________________________________ 13

What if I or someone I know is in crisis? _______________________________ 13

Citations ___________________________________________________________ 14

For more information on borderline personality disorder ________________ 17
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Borderline Personality Disorder • 1 

What is borderline personality disorder? 

Borderline personality disorder is a serious mental illness marked by unstable 

moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual 

for Mental Disorders, Third Edition (DSM-III) listed borderline personality disorder 

as a diagnosable illness for the first time. Most psychiatrists and other mental 

health professionals use the DSM to diagnose mental illnesses. 

Because some people with severe borderline personality 

disorder have brief psychotic episodes, experts originally 

thought of this illness as atypical, or borderline, versions of 

other mental disorders.1 While mental health experts now 

generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet. 

Most people who have borderline personality disorder 

suffer from: 

Problems with regulating emotions and thoughts 

Impulsive and reckless behavior 

Unstable relationships with other people. 

People with this disorder also have high rates of co-occurring disorders, such as 

depression, anxiety disorders, substance abuse, and eating disorders, along with 

self-harm, suicidal behaviors, and completed suicides. 

According to data from a subsample of participants in a national survey on mental 

disorders, about 1.6 percent of adults in the United States have borderline personality disorder in a given year.2 

Borderline personality disorder is often viewed as difficult to treat. However, recent 

research shows that borderline personality disorder can be treated effectively, and 

that many people with this illness improve over time.1, 3, 4 
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2 • Borderline Personality Disorder 

What are the symptoms of borderline 

personality disorder? 

According to the DSM, Fourth Edition, Text Revision 

(DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring 

pattern of behavior that includes at least five of the 

following symptoms: 

Extreme reactions—including panic, depression, 

rage, or frantic actions—to abandonment, whether 

real or perceived 

A pattern of intense and stormy relationships with family, friends, and loved 

ones, often veering from extreme closeness and love (idealization) to extreme 

dislike or anger (devaluation) 

Distorted and unstable self-image or sense of self, which can result in sudden 

changes in feelings, opinions, values, or plans and goals for the future (such as 

school or career choices) 

Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, 

substance abuse, reckless driving, and binge eating 

Recurring suicidal behaviors or threats or self-harming behavior, such as cutting 

Intense and highly changeable moods, with each episode lasting from a few 

hours to a few days 

Chronic feelings of emptiness and/or boredom 

Inappropriate, intense anger or problems controlling anger 

Having stress-related paranoid thoughts or severe dissociative symptoms, such 

as feeling cut off from oneself, observing oneself from outside the body, or 

losing touch with reality. 
Borderline Personality Disorder • 3 

Seemingly mundane events may trigger symptoms. For example, people with 

borderline personality disorder may feel angry and distressed over minor 

separations—such as vacations, business trips, or sudden changes of plans—from 

people to whom they feel close. Studies show that people with this disorder may 

see anger in an emotionally neutral face5 and have a stronger reaction to words 

with negative meanings than people who do not have the disorder.6 

Suicide and Self-harm 

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, 

described below. As many as 80 percent of people with borderline personality disorder have 

suicidal behaviors,7 and about 4 to 9 percent commit suicide.4, 7 

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help 

reduce suicidal behaviors in people with borderline personality disorder. For example, one study 

showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half 

compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other 

approaches to treatment.7 For more information about DBT, see the section, “How is borderline 

personality disorder treated?” 

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some 

self-harming behaviors may be life threatening. Self-harming behaviors linked with borderline 

personality disorder include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with borderline personality disorder may self-harm to help regulate their emotions, to punish themselves, or to express their pain.8 They do not always see these behaviors as 

harmful. 
4 • Borderline Personality Disorder 

When does borderline personality disorder 

start? 

Borderline personality disorder usually begins during 

adolescence or early adulthood.1, 9 Some studies suggest that early symptoms of the illness may occur during 

childhood.10, 11 

Studies 

suggest

early

symptoms 

may occur

in childhood

Some people with borderline personality disorder experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments 

but never need hospitalization or emergency care. Some 

people who develop this disorder may improve without 

any treatment.12 

What illnesses often co-exist with borderline 

personality disorder? 

Borderline personality disorder often occurs with other illnesses. These 

co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms 

of borderline personality disorder. 

Women with borderline personality disorder are more likely to have co-occurring 

disorders such as major depression, anxiety disorders, or eating disorders. In men, 

borderline personality disorder is more likely to co-occur with disorders such as 

substance abuse or antisocial personality disorder.13 

According to the NIMH-funded National Comorbidity Survey Replication—the 

largest national study to date of mental disorders in U.S. adults—about 85 percent 

of people with borderline personality disorder also meet the diagnostic criteria for 

another mental illness.2 

Other illnesses that often occur with BPD include diabetes, high blood pressure, 

chronic back pain, arthritis, and fibromyalgia.14, 15 These conditions are associated 

with obesity, which is a common side effect of the medications prescribed to treat 

borderline personality disorder and other mental disorders. For more information, 

see the section, “How is borderline personality disorder treated?” 
Borderline Personality Disorder • 5 

What are the risk factors for borderline 

personality disorder? 

Research on the possible causes and risk factors for borderline personality disorder is still at a very early stage. However, scientists generally agree that genetic 

and environmental factors are likely to be involved. 

Studies on twins with borderline personality disorder suggest that the illness is 

strongly inherited.16, 17 Another study shows that a person can inherit his or her 

temperament and specific personality traits, particularly impulsiveness and aggression.18 Scientists are studying genes that help regulate emotions and impulse 

control for possible links to the disorder.19 

Social or cultural factors may increase the risk for borderline personality 

disorder. For example, being part of a community or culture in which unstable 

family relationships are common may increase a person’s risk for the disorder.1 

Impulsiveness, poor judgment in lifestyle choices, and other consequences of 

BPD may lead individuals to risky situations. Adults with borderline personality 

disorder are considerably more likely to be the victim of violence, including rape 

and other crimes. 

How is borderline personality disorder 

diagnosed? 

Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.20, 21 

A mental health professional experienced in diagnosing and 

treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect 

borderline personality disorder based on a thorough interview 

and a discussion about symptoms. A careful and thorough 

medical exam can help rule out other possible causes of symptoms. 
6 • Borderline Personality Disorder 

The mental health professional may ask about symptoms and personal and family 

medical histories, including any history of mental illnesses. This information can 

help the mental health professional decide on the best treatment. In some cases, 

co-occurring mental illnesses may have symptoms that overlap with borderline 

personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of 

depression but may not bring other symptoms to the mental health professional’s 

attention. 

No single test can diagnose borderline personality disorder. Scientists funded by 

NIMH are looking for ways to improve diagnosis of this disorder. One study found 

that adults with borderline personality disorder showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy 

people. People with more severe borderline personality disorder showed a more 

intense emotional response than people who had less severe borderline personality disorder.6 

What studies are being done to improve the diagnosis of 

borderline personality disorder?
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Recent neuroimaging studies show differences in brain structure and function between people 

with borderline personality disorder and people who do not have this illness.22, 23 Some research 

suggests that brain areas involved in emotional responses become overactive in people with 

borderline personality disorder when they perform tasks that they perceive as negative.24 People 

with the disorder also show less activity in areas of the brain that help control emotions and 

aggressive impulses and allow people to understand the context of a situation. These findings 

may help explain the unstable and sometimes explosive moods characteristic of borderline 

personality disorder.19, 25 

Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those 

with the illness tended to use brain areas related to reflexive actions and alertness, which may 

explain the tendency to act impulsively on emotional cues.26 

These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.6 
Borderline Personality Disorder • 7 

How is borderline personality disorder 

treated? 

Borderline personality disorder can be treated with 

psychotherapy, or “talk” therapy. In some cases, a 

mental health professional may also recommend 

medications to treat specific symptoms. When a 

person is under more than one professional’s care, 

it is essential for the professionals to coordinate 

with one another on the treatment plan. 

The treatments described below are just some of the options that may be available to a person with borderline personality disorder. However, the research on 

treatments is still in very early stages. More studies are needed to determine the 

effectiveness of these treatments, who may benefit the most, and how best to 

deliver treatments. 

Psychotherapy 

Psychotherapy is usually the first treatment for people with borderline personality 

disorder. Current research suggests psychotherapy can relieve some symptoms, 

but further studies are needed to better understand how well psychotherapy 

works.27 

It is important that people in therapy get along with and trust their therapist. The 

very nature of borderline personality disorder can make it difficult for people with 

this disorder to maintain this type of bond with their therapist. 

Types of psychotherapy used to treat borderline personality disorder include the 

following:28 

1.	�Cognitive behavioral therapy (CBT). CBT can help people with borderline personality disorder identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting 

with others. CBT may help reduce a range of mood and anxiety symptoms and 

reduce the number of suicidal or self-harming behaviors.29 
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2.	�Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation.1 

DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a 

balance between changing and accepting beliefs and behaviors.30 

3.	�Schema-focused therapy. This type of therapy combines elements of CBT 

with other forms of psychotherapy that focus on reframing schemas, or the 

ways people view themselves. This approach is based on the idea that borderline personality disorder stems from a dysfunctional self-image—possibly 

brought on by negative childhood experiences—that affects how people react 

to their environment, interact with others, and cope with problems or stress.31 

Therapy can be provided one-on-one between the therapist and the patient or in a 

group setting. Therapist-led group sessions may help teach people with borderline 

personality disorder how to interact with others and how to express themselves 

effectively. 

One type of group therapy, Systems Training for Emotional Predictability and 

Problem Solving (STEPPS), is designed as a relatively brief treatment consisting 

of 20 two-hour sessions led by an experienced social worker. Scientists funded 

by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem 

behaviors of borderline personality disorder, relieve symptoms of depression, and 

improve quality of life.32 The effectiveness of this type of therapy has not been 

extensively studied. 
Borderline Personality Disorder • 9 

Families of people with borderline personality disorder may 

also benefit from therapy. The challenges of dealing with an 

ill relative on a daily basis can be very stressful, and family 

members may unknowingly act in ways that worsen their 

relative’s symptoms. 

Some therapies, such as DBT-family skills training (DBTFST), include family members in treatment sessions. These 

types of programs help families develop skills to better 

understand and support a relative with borderline personality disorder. Other therapies, such as Family Connections, focus on the needs of 

family members. More research is needed to determine the effectiveness of family 

therapy in borderline personality disorder. Studies with other mental disorders suggest that including family members can help in a person’s treatment.33 

Other types of therapy not listed in this booklet may be helpful for some people 

with borderline personality disorder. Therapists often adapt psychotherapy to 

better meet a person’s needs. Therapists may switch from one type of therapy 

to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section on psychotherapy at 

http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml. 

Some symptoms of borderline personality disorder may come and go, but the core 

symptoms of highly changeable moods, intense anger, and impulsiveness tend 

to be more persistent.34 People whose symptoms improve may continue to face 

issues related to co-occurring disorders, such as depression or post-traumatic 

stress disorder.4 However, encouraging research suggests that relapse, or the 

recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent 

of people with borderline personality disorder had a relapse after remission.4 
10 • Borderline Personality Disorder 

Medications 

No medications have been approved by the U.S. Food and Drug Administration 

to treat borderline personality disorder. Only a few studies show that medications 

are necessary or effective for people with this illness.35 However, many people with 

borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful 

in managing specific symptoms. For some people, medications can help reduce 

symptoms such as anxiety, depression, or aggression. Often, people are treated 

with several medications at the same time,12 but there is little evidence that this 

practice is necessary or effective. 

Medications can cause different side effects in different people. People who have 

borderline personality disorder should talk with their prescribing doctor about what 

to expect from a particular medication. 

Other Treatments 

Omega-3 fatty acids. One study done on 30 women 

with borderline personality disorder showed that 

omega-3 fatty acids may help reduce symptoms of 

aggression and depression.36 The treatment seemed 

to be as well tolerated as commonly prescribed mood 

stabilizers and had few side effects. Fewer women who 

took omega-3 fatty acids dropped out of the study, 

compared to women who took a placebo (sugar pill). 

With proper treatment, many people experience fewer or less severe symptoms. 

However, many factors affect the amount of time it takes for symptoms to improve, 

so it is important for people with borderline personality disorder to be patient and 

to receive appropriate support during treatment. 
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Borderline Personality Disorder • 11 

How can I help a friend or relative who has 

borderline personality disorder? 

If you know someone who has borderline personality disorder, it affects you too. The first and most important thing 

you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. 

Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with 

the current treatment. 

To help a friend or relative you can: 

Offer emotional support, understanding, patience, and encouragement—change 

can be difficult and frightening to people with borderline personality disorder, 

but it is possible for them to get better over time 

Learn about mental disorders, including borderline personality disorder, so you 

can understand what your friend or relative is experiencing 

With permission from your friend or relative, talk with his or her therapist to 

learn about therapies that may involve family members, such as DBT-FST. 

Never ignore comments about someone’s intent or plan to harm himself or herself 

or someone else. Report such comments to the person’s therapist or doctor. In 

urgent or potentially life-threatening situations, you may need to call the police. 
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12 • Borderline Personality Disorder 

How can I help myself if I have borderline 

personality disorder? 

Taking that first step to help yourself may be hard. 

It is important to realize that, although it may take 

some time, you can get better with treatment. 

To help yourself: 

Talk to your doctor about treatment options and 

stick with treatment 

Try to maintain a stable schedule of meals and 

sleep times 

Engage in mild activity or exercise to help reduce stress 

Set realistic goals for yourself 

Break up large tasks into small ones, set some priorities, and do what you can, 

as you can 

Try to spend time with other people and confide in a trusted friend or family 

member 

Tell others about events or situations that may trigger symptoms 

Expect your symptoms to improve gradually, not immediately 

Identify and seek out comforting situations, places, and people 

Continue to educate yourself about this disorder. 
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Borderline Personality Disorder • 13 

Where can I go for help? 

If you are unsure where to go for help, ask your family doctor. Other people who 

can help are: 

Mental health professionals, such as psychiatrists, psychologists, social workers, or mental health counselors 

Health maintenance organizations 

Community mental health centers 

Hospital psychiatry departments and outpatient clinics 

Mental health programs at universities or medical schools 

State hospital outpatient clinics 

Family services, social agencies, or clergy 

Peer support groups 

Private clinics and facilities 

Employee assistance programs 

Local medical and psychiatric societies. 

You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can provide temporary help and can tell you where and how to 

get further help. 

What if I or someone I know is in crisis? 

If you are thinking about harming yourself, or know someone who is: 

Call your doctor. 

Call 911 or go to a hospital emergency room to get immediate help or ask a 

friend or family member to help you do these things. 

Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 

1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4TTY (4889) to talk to a 

trained counselor. 

If you are in a crisis, make sure you are not left alone. 

If someone else is in a crisis, make sure he or she is not left alone. 
14 • Borderline Personality Disorder 

Citations 

1.	 Gunderson	JG. A BPD Brief: An Introduction to Borderline Personality Disorder: Diagnosis, Origins, 

Course, and Treatment.	(ed)^(eds).	http://www.borderlinepersonalitydisorder.com/documents/A%20 

BPD%20BRIEF%20revised%202006%20WORD%20version%20--%20Jun%2006.pdf.	Accessed	on	 

July	30,	2007. 

2.	 Lenzenweger	MF,	Lane	MC,	Loranger	AW,	Kessler	RC.	DSM-IV	personality	disorders	in	the	National	 

Comorbidity	Survey	Replication.	Biol Psychiatry.	2007	Sep	15;62(6):553–64. 

3.	 Paris	J,	Zweig-Frank	H.	A	27-year	follow-up	of	patients	with	borderline	personality	disorder.	Compr 

Psychiatry.	2001	Nov–Dec;42(6):482–7. 

4.	 Zanarini	MC,	Frankenburg	FR,	Hennen	J,	Reich	DB,	Silk	KR.	The	McLean	Study	of	Adult	Development	 

(MSAD):	overview	and	implications	of	the	first	six	years	of	prospective	follow-up.	J Personal Disord.	 

2005	Oct;19(5):505–23. 

5.	 Meyer	B,	Pilkonis	PA,	Beevers	CG.	What’s	in	a	(neutral)	face?	Personality	disorders,	attachment	styles,	 

and	the	appraisal	of	ambiguous	social	cues.	J Pers Disord.	2004	Aug;18(4):320–36. 

6.	 Hazlett	EA,	Speiser	LJ,	Goodman	M,	Roy	M,	Carrizal	M,	Wynn	JK,	Williams	WC,	Romero	M,	 

Minzenberg	MJ,	Siever	LJ,	New	AS.	Exaggerated	affect-modulated	startle	during	unpleasant	stimuli	in	 

borderline	personality	disorder.	Biol Psychiatry.	2007	Aug	1;62(3):250–5. 

7.	 Linehan	MM,	Comtois	KA,	Murray	AM,	Brown	MZ,	Gallop	RJ,	Heard	HL,	Korslund	KE,	Tutek	DA,	 

Reynolds	SK,	Lindenboim	N.	Two-year	randomized	controlled	trial	and	follow-up	of	dialectical	behavior	 

therapy	vs	therapy	by	experts	for	suicidal	behaviors	and	borderline	personality	disorder.	Arch Gen 

Psychiatry.	2006	Jul;63(7):757–66. 

8.	 Kleindienst	N,	Bohus	M,	Ludascher	P,	Limberger	MF,	Kuenkele	K,	Ebner-Priemer	UW,	Chapman	 

AL,	Reicherzer	M,	Stieglitz	RD,	Schmahl	C.	Motives	for	nonsuicidal	self-injury	among	women	with	 

borderline	personality	disorder.	J Nerv Ment Dis.	2008	Mar;196(3):230–6. 

9.	 Chanen	AM,	Jackson	HJ,	McCutcheon	LK,	Jovev	M,	Dudgeon	P,	Yuen	HP,	Germano	D,	Nistico	H,	 

McDougall	E,	Weinstein	C,	Clarkson	V,	McGorry	PD.	Early	intervention	for	adolescents	with	borderline	 

personality	disorder	using	cognitive	analytic	therapy:	randomised	controlled	trial.	Br J Psychiatry.	2008	 

Dec;193(6):477–84. 

10.	Zelkowitz	P,	Paris	J,	Guzder	J,	Feldman	R.	Diatheses	and	stressors	in	borderline	pathology	of	 

childhood:	the	role	of	neuropsychological	risk	and	trauma.	J Am Acad Child Adolesc Psychiatry.	2001	 

Jan;40(1):100–5. 

11.	Zanarini	MC,	Frankenburg	FR,	Khera	GS,	Bleichmar	J.	Treatment	histories	of	borderline	inpatients.	 

Compr Psychiatry.	2001	Mar–Apr;42(2):144–50. 

12.	Zanarini	MC.	Ten-Year Course of Borderline Personality Disorder.	(ed)^(eds).	Borderline	Personality	 

Disorder:	Course,	Outcomes,	Interventions.	http://web4.streamhoster.com/video4nea/michigan/02%20 

Ten%20Year%20Course%20of%20Borderline%20Personality%20Disorder_files/intro.htm.	Accessed	on	 

March	28,	2008. 
Borderline Personality Disorder • 15 

13.	Tadic	A,	Wagner	S,	Hoch	J,	Baskaya	O,	von	Cube	R,	Skaletz	C,	Lieb	K,	Dahmen	N.	Gender	differences	 

in	axis	I	and	axis	II	comorbidity	in	patients	with	borderline	personality	disorder.	Psychopathology.	 

2009;42(4):257–63. 

14.	Frankenburg	FR,	Zanarini	MC.	Obesity	and	obesity-related	illnesses	in	borderline	patients.	J Personal 

Disord.	2006	Feb;20(1):71–80. 

15.	Sansone	RA,	Hawkins	R.	Fibromyalgia,	borderline	personality,	and	opioid	prescription.	Gen Hosp 

Psychiatry.	2004	Sep–Oct;26(5):415–6. 

16.	Torgersen	S,	Lygren	S,	Oien	PA,	Skre	I,	Onstad	S,	Edvardsen	J,	Tambs	K,	Kringlen	E.	A	twin	study	of	 

personality	disorders.	Compr Psychiatry.	2000	Nov–Dec;41(6):416–25. 

17.	Coolidge	FL,	Thede	LL,	Jang	KL.	Heritability	of	personality	disorders	in	childhood:	a	preliminary	 

investigation.	J Pers Disord.	2001	Feb;15(1):33–40. 

18.	Lynam	DR,	Widiger	TA.	Using	the	five-factor	model	to	represent	the	DSM-IV	personality	disorders:	an	 

expert	consensus	approach.	J Abnorm Psychol.	2001	Aug;110(3):401–12. 

19.	Lis	E,	Greenfield	B,	Henry	M,	Guile	JM,	Dougherty	G.	Neuroimaging	and	genetics	of	borderline	 

personality	disorder:	a	review.	J Psychiatry Neurosci.	2007	May;32(3):162–73. 

20.	Ruggero	CJ,	Zimmerman	M,	Chelminski	I,	Young	D.	Borderline	personality	disorder	and	the	 

misdiagnosis	of	bipolar	disorder.	J Psychiatr Res.	2010	Apr;44(6):405–8. 

21.	Paris	J.	The	diagnosis	of	borderline	personality	disorder:	problematic	but	better	than	the	alternatives.	 

Ann Clin Psychiatry.	2005	Jan–Mar;17(1):41–6. 

22.	Emotion-Regulating Circuit Weakened in Borderline Personality Disorder.	(ed)^(eds).	http://www.nimh. 

nih.gov/science-news/2008/emotion-regulating-circuit-weakened-in-borderline-personality-disorder. 

shtml.	Accessed	on	Oct	10,	2008. 

23.	King-Casas	B,	Sharp	C,	Lomax-Bream	L,	Lohrenz	T,	Fonagy	P,	Montague	PR.	The	rupture	and	repair	of	 

cooperation	in	borderline	personality	disorder.	Science. 2008	Aug	8;321(5890):806–10. 

24.	Kernberg	OF,	Michels	R.	Borderline	personality	disorder.	Am J Psychiatry.	2009	May;166(5):505–8. 

25.	Silbersweig	D,	Clarkin	JF,	Goldstein	M,	Kernberg	OF,	Tuescher	O,	Levy	KN,	Brendel	G,	Pan	H,	Beutel	 

M,	Pavony	MT,	Epstein	J,	Lenzenweger	MF,	Thomas	KM,	Posner	MI,	Stern	E.	Failure	of	frontolimbic	 

inhibitory	function	in	the	context	of	negative	emotion	in	borderline	personality	disorder.	Am J Psychiatry. 

2007	Dec;164(12):1832–41. 

26.	Koenigsberg	HW,	Siever	LJ,	Lee	H,	Pizzarello	S,	New	AS,	Goodman	M,	Cheng	H,	Flory	J,	Prohovnik	 

I.	Neural	correlates	of	emotion	processing	in	borderline	personality	disorder.	Psychiatry Res.	2009	Jun	 

30;172(3):192–9. 

27.	Binks	CA,	Fenton	M,	McCarthy	L,	Lee	T,	Adams	CE,	Duggan	C.	Psychological	therapies	for	people	with	 

borderline	personality	disorder.	Cochrane Database Syst Rev.	2006;(1):CD005652. 
16 • Borderline Personality Disorder 

28.	Stone	MH.	Management	of	borderline	personality	disorder:	a	review	of	psychotherapeutic	approaches.	 

World Psychiatry.	2006	Feb;5(1):15–20. 

29.	Davidson	K,	Norrie	J,	Tyrer	P,	Gumley	A,	Tata	P,	Murray	H,	Palmer	S.	The	effectiveness	of	cognitive	 

behavior	therapy	for	borderline	personality	disorder:	results	from	the	borderline	personality	disorder	 

study	of	cognitive	therapy	(BOSCOT)	trial.	J Personal Disord.	2006	Oct;20(5):450–65. 

30.	McMain	S,	Pos	AE.	Advances	in	psychotherapy	of	personality	disorders:	a	research	update.	Curr 

Psychiatry Rep.	2007	Feb;9(1):46–52. 

31.	Kellogg	SH,	Young	JE.	Schema	therapy	for	borderline	personality	disorder.	J Clin Psychol.	2006	 

Apr;62(4):445–58. 

32.	Blum	N,	St	John	D,	Pfohl	B,	Stuart	S,	McCormick	B,	Allen	J,	Arndt	S,	Black	DW.	Systems	Training	 

for	Emotional	Predictability	and	Problem	Solving	(STEPPS)	for	outpatients	with	borderline	personality	 

disorder:	a	randomized	controlled	trial	and	1-year	follow-up.	Am J Psychiatry.	2008	Apr;165(4):468–78. 

33.	Hoffman	PD,	Fruzzetti	AE.	Advances	in	interventions	for	families	with	a	relative	with	a	personality	 

disorder	diagnosis.	Curr Psychiatry Rep.	2007	Feb;9(1):68–73. 

34.	McGlashan	TH,	Grilo	CM,	Sanislow	CA,	Ralevski	E,	Morey	LC,	Gunderson	JG,	Skodol	AE,	Shea	MT,	 

Zanarini	MC,	Bender	D,	Stout	RL,	Yen	S,	Pagano	M.	Two-year	prevalence	and	stability	of	individual	 

DSM-IV	criteria	for	schizotypal,	borderline,	avoidant,	and	obsessive-compulsive	personality	disorders:	 

toward	a	hybrid	model	of	axis	II	disorders.	Am J Psychiatry.	2005	May;162(5):883–9. 

35.	Binks	CA,	Fenton	M,	McCarthy	L,	Lee	T,	Adams	CE,	Duggan	C.	Pharmacological	interventions	for	 

people	with	borderline	personality	disorder.	Cochrane Database Syst Rev.	2006;(1):CD005653. 

36.	Zanarini	MC,	Frankenburg	FR.	omega-3	Fatty	acid	treatment	of	women	with	borderline	personality	 

disorder:	a	double-blind,	placebo-controlled	pilot	study.	Am J Psychiatry.	2003	Jan;160(1):167–9. 
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