![]() In keeping with traditional medical conceptualizations, many scholars see BPD as a clinical syndrome with identifiable brain lesions or defects, mainly affecting fronto-limbic connections, which account for patients’ emotional dysregulation, impulsivity and inability to cope with interpersonal distress. īPD is often a comorbid condition of other psychiatric disorders (formerly conceptualized as axis-I disorders according to DSM-IV), foremost depression, other personality disorders, and there seems to be syndromal overlap and/or comorbidity with bipolar disorder (BD), attention deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD). Taken together, the experience of early adversity, particularly the emotional unresponsiveness of attachment figures, trauma or abuse, coins an individual’s expectations with regard to future resource availability, including the quality of interpersonal relationships in terms of others’ reliability and trustworthiness. ![]() The contribution of genetics to BPD is inconclusive, but heritability of BPD seems to be significant. Causal factors in this development include childhood trauma such as emotional neglect or physical and sexual abuse, though associating BPD with traumatic events alone is an oversimplification. ![]() Such a view is consistent with standard medical conceptualizations of BPD, but goes beyond classic ‘deficit’-oriented models, which may have profound implications for therapeutic approaches.Ī diagnosis is based on the presence of at least five of the following signs or symptomsĮtiological models of BPD suggest that the development of ‘mistrustful inner working models’ based on insecure attachment predisposes to perceiving others as untrustworthy and rejecting. According to Life History Theory, BPD reflects a pathological extreme or distortion of a behavioral ‘strategy’ which unconsciously aims at immediate exploitation of resources, both interpersonal and material, based on predictions shaped by early developmental experiences. In this review, it is argued that many features of BPD may be conceptualized within an evolutionary framework, namely behavioral ecology. Moreover, there is an ongoing debate about the nosological position of BPD, which impacts on research regarding sex differences in clinical presentation and patterns of comorbidity. Another counterintuitive and insufficiently resolved question is why depressive symptoms and risk-taking behaviors can occur simultaneously in the same individual. In contrast to most psychiatric disorders, some symptoms associated with BPD may improve over time, even without therapy, though impaired social functioning and interpersonal disturbances in close relationships often persist. ![]() BPD is not only common in psychiatric populations but also more prevalent in the general community than previously thought, and thus represents an important public health issue. The term ‘Borderline Personality Disorder’ (BPD) refers to a psychiatric syndrome that is characterized by emotion dysregulation, impulsivity, risk-taking behavior, irritability, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships.
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