A complex personality disorder characterized by pervasive instability in mood, interpersonal relationships, self-image, and behavior. Affects 1-2% of the general population and up to 20% of psychiatric inpatients. Associated with high rates of self-harm, suicide attempts, and significant functional impairment.

• 1Structured Clinical Interview for DSM-5
• 2McLean Screening Instrument for BPD
• 3Borderline Evaluation of Severity over Time (BEST)
• 4Zanarini Rating Scale for BPD
• 5Comprehensive clinical assessment
• 6Assessment of self-harm and suicide risk
• 7Evaluation of trauma history

Better than previously thought - 50% achieve remission within 10 years with treatment. Suicide rate 8-10% over lifetime. 75% attempt suicide at least once. With DBT, suicide attempts reduced by 50%, hospitalizations by 70%. Relapse possible under stress. Quality of life improves significantly with treatment. Functional recovery lags behind symptom remission. Comorbid depression, substance abuse, and eating disorders common. Good social support predicts better outcomes. Ten-year remission rate 85% with sustained treatment.

• Early intervention for adolescents with emerging symptoms
• Treatment of childhood trauma
• Family psychoeducation
• Skills training in emotion regulation
• Building supportive relationships
• Distress tolerance skills
• Crisis planning and management
• Reducing access to means of self-harm