In terms of the etiology, much of the work on the etiology of borderline personality disorder has been done within the realm of psychoanalysis. Many theorists focus on the time in childhood between the age of six months and two years when the child is learning to separate from the mother. It was once thought that it is basically disturbances in this separation and individuation phase, of the child wanting to move away from the mother and then know that there is a safe haven to come back to. It is disturbances in that process that engender this intense hostile dependency and these fears of abandonment. It is most commonly diagnosed first in older adolescents and in In terms of differential diagnoses, I ve talked about the other personality disorders that one would try to distinguish the borderline disorder from, but again, remember it is the unstable intense relationships and the chronic self-destructive and impulsive acts that taken together often point to borderline personality disorder in particular.
Affective disorders are quite common.
Also, when we treat the affective disorder someone will often look much less dysfunctional in terms of their personality functioning. This is easier now that the antidepressants that we have are not so easy to overdose on. Using the SSRI s is much more reassuring to the clinician than using the MAOI s or tricyclics with these people who are prone to impulsive overdoses. Treatment is quite difficult. Usually the treatment is some form of psychodynamic or behavior therapy, or a combination of the two.