Does bpd have mania
Do I have borderline or bipolar?
If you think you might have bipolar disorder or borderline personality disorder (BPD), understanding the difference can be confusing. Maybe you’ve struggled with mood swings, thoughts of self-harm, or making impulsive decisions—all of these are common among people with both conditions. But despite their similarities, bipolar disorder and BPD also have a lot of differences. Understanding these differences can help you decide what steps to take to improve your mental health.
Mood disorder vs. personality disorder
Bipolar disorder is a mood disorder—it primarily involves changes in your mood. People with bipolar disorder experience episodes of mania and depression. Mania involves feeling extremely energetic and excited. Sometimes people with mania lose touch with reality (this is called psychosis). Depression is feeling extremely sad and exhausted for several weeks at a time. In between bouts of mania and depression, people with bipolar disorder may feel relatively stable.
Unlike bipolar disorder, BPD is a personality disorder. Personality disorders involve patterns of thinking and behavior that affect all aspects of a person’s life. People with BPD often have an insecure attachment style, meaning that they have a hard time trusting other people to stick around. Their emotions—and even their identity—can depend heavily on their relationships with other people.
It’s also possible to have both BPD and bipolar disorder.
Timing and Triggers
When you’re manic, you might feel very energetic and excited for weeks or even months at a time. You might feel invincible, like nothing can bring you down. Often, your mood will stay positive even if bad things happen to you. Likewise, depressive episodes also last for a long time, and you might stay depressed even if something really good happens. Sometimes these episodes come out of nowhere, with no obvious reason why you feel one way or the other.
While mania and depression can last for weeks or months, people with BPD might experience extreme ups and downs within a single day.
These changes in mood are usually triggered by something. The trigger is usually related to the person’s relationships. Maybe you feel really good, and then someone looks at you the wrong way and you are suddenly depressed. But then they say something nice, and you’re back on top of the world. You might be able to identify a reason for why you feel a certain way, but you also may start to notice a lot of overreactions to relatively small events.
Although people with BPD often cycle through their emotions more quickly than people with bipolar disorder, it is possible for someone to experience a very short manic or depressive episode. It’s even possible to experience both at the same time—this is called a mixed episode.
Treatment
Bipolar disorder and BPD are both treatable. Making lifestyle changes, going to therapy, and/or taking medications are common ways of dealing with mental illness.
Many people with bipolar disorder feel better with medication.
Mood stabilizers can alleviate symptoms of mania and depression. It also helps to learn how to recognize mania and depression, and to develop healthy habits that add stability to your life.
People with BPD usually get better by learning to regulate their emotions and engage in healthy relationships. These skills are the focus of Dialectical Behavioral Therapy (DBT), the most common treatment for BPD. No medications treat BPD directly, but medications for anxiety and depression can sometimes be helpful for people with BPD.
The difference between bipolar and borderline personality disorder
Learn the differences between these two disorders, how to spot the signs of each, and how to treat them.
What is bipolar disorder vs. borderline personality disorder? Both diagnoses have been in the headlines, but many may wonder: what’s the difference?
Changing moods can often be a natural response to stressful situations.
But for some, mood shifts are so extreme that they could be a sign of these more serious conditions, both of which are characterized in part by major mood swings, according to Frank Yeomans, M.D., Ph.D., director of training at the NewYork-Presbyterian Borderline Personality Disorder Resource Center, an internationally recognized center for the study of personality disorders.
“This partial similarity in mood shifts, going from an extremely high mood to a very low mood, causes many people, including some clinicians, to confuse the two disorders,” says Dr. Yeomans, who is also a clinical associate professor of psychiatry at Weill Cornell Medicine Department of Psychiatry and an adjunct associate professor of psychiatry at the Columbia University Vagelos College of Physicians and Surgeons Center for Psychoanalytic Training and Research. “Yet they are two distinct and serious diagnoses with different symptoms that require different methods of treatment.”
Mental health has moved more into the spotlight since the onset of the pandemic, with COVID-19 triggering a 25% increase in the prevalence of depression and anxiety worldwide, according to the World Health Organization.
As for bipolar disorder and borderline personality disorder, these illnesses affect millions of Americans. Bipolar disorder is estimated to affect somewhere between 1 and 2.8% of U.S. adults, and studies show the prevalence of borderline personality disorder to range from 1.4 to 5.9% of the American adult population.
How do you know if you or someone you love suffers from one of these disorders? And how can you tell the difference? Health Matters spoke with Dr. Yeomans to define these disorders and explain the telltale signs and how to treat them.
What does borderline personality disorder look like?
Dr. Yeomans: Those with the disorder have extremely intense emotions that can shift rapidly from a negative, depressed state to an elated one, but with a predominance of negative feeling states. In this psychiatric illness, the extreme and intense mood swings often are precipitated by reactions to events (“trigger events”) that are disproportionate to the event and that someone else might take in stride.
The illness is also characterized by rejection-sensitivity, chaotic relationships, and an overall difficulty in managing emotions.
For example, if a boyfriend or girlfriend does not return your call, instead of being annoyed and moving on, the combination of dejection and anger in a person with borderline personality disorder could possibly lead the person to cut their own wrists. Such destructive actions, usually of an impulsive nature, are a way of putting intense feelings, like rejection and anger, that you can’t tolerate, into action in an attempt to discharge the emotion rather than to continue to feel its intensity. The behavioral manifestations of intense emotions, in addition to self-cutting, include substance abuse, eating disorders, and sexual promiscuity — dramatic ways of behaving that stem from not being able to manage emotions.
In discussing disorders that involve changes in mood, it is important to make clear that not all depressed states indicate a psychiatric condition.
If your spouse walks out on you or you lose a parent, it’s normal to feel depressed. In such cases, the depression may be an ongoing, terribly low, dejected mood but is appropriate to the circumstances. The borderline person demonstrates more reactivity to relatively minor events and demonstrates contradictory emotions that erupt over a short time.
How does borderline personality disorder affect relationships?
People with borderline personality disorder have relationships that can be chaotic and intense, veering between a desperate neediness for others to an intense anger or dismissal of others when feeling rejected, even in situations where the other person may in fact be neutral or even positive. Individuals with borderline personality disorder have difficulty accurately reading people’s emotions and trusting others. There is a difficulty with how the individual perceives others. Once, when a borderline patient told me a sad story that brought tears to my eyes, he became very angry because he was convinced that my tears, rather than an expression of empathy, were my way of mocking.
Where does the behavior stem from?
It comes from a combination of an emotionally charged temperament and the lack of a solid sense of self. Without a clear and coherent identity, the individual depends on what’s happening around them to determine what they feel and what they do.
What is the cause of this disorder?
There is no single cause of borderline personality disorder, though studies suggest that certain traits, especially a temperament characterized by intense emotional reactions, stem to a large degree from genetics.
Developmental factors, including problems with emotional attunement between a developing child and caregivers, seem to play a role, as do physical or sexual abuse, or emotional neglect. However, it’s important to note that in cases with a history of trauma, the disorder seems to stem from a combination of temperament and trauma rather than trauma alone, since many people who have experienced trauma early in life do not go on to develop serious psychiatric illnesses.
How is borderline personality disorder treated?
There is no medication that successfully treats the condition, although they may help reduce some specific symptoms, such as intense anxiety. Evidence-based models of psychotherapy are the treatment of choice. Dialectical behavioral therapy operates from the assumption that those with borderline personality disorder lack skills necessary to tolerate intense emotions or thoughts.
Transference-focused psychotherapy emphasizes the observation and interpretation of patient behavior in the relationship with the therapist to help identify unrecognized or distorted internal emotional states that are activated in relations with others and then to integrate them into a more coherent sense of self that includes emotional balance.
Mentalization-based therapy similarly helps individuals recognize their mental states and be aware of them in their relations with others.
Good psychiatric management is based on a case management model that combines a focus on the environment of the patient, psychoeducation, supportive therapy, and possibly family therapy.
What is bipolar disorder?
Like borderline personality disorder, sufferers experience extreme shifts in mood but between depressed states and episodes of mania, the bipolar patient may experience periods of stable mood.
For example, someone with bipolar disorder in a depressed state could be totally dejected, hopeless, and morbid, with no will to live. If they are in a manic state, they might be up all night writing page after page of a novel or playing music, with a sense that they have passed into a special state of genius. They might speak at a rapidly accelerated pace, with actions that are out of sync with appropriate social behavior — like disrobing and dancing in a park without awareness that it’s inappropriate. A full-blown manic episode shows a period of energy that could go on for days without any relief and would exhaust anybody else. In between the depressed and manic states, they may have periods of stable mood. In another variant of the disorder, some bipolar patients experience repeated depressive states without full-blown manic states; this is referred to as bipolar 2.
What is the cause of bipolar disorder?
Bipolar disorder is rooted in brain chemistry, structure and functioning, as well as genetics and family history.
How is bipolar disorder treated?
Bipolar disorder can be treated with medication, most often with lithium, which helps stabilize mood. More recently, other mood stabilizers have been developed that doctors might prescribe largely on a trial-and-error basis, depending on side effects for individual patients. Psychotherapy is usually helpful as well to aid the person in managing complications in his life that stem from the episodes of illness, and to monitor adherence to the medication regimen.
What are the key differences between the disorders?
When a person with bipolar disorder is not in a manic or depressive episode, they demonstrate stability that the borderline personality does not show. If a bipolar person is between episodes, they can function pretty well in the world.
They can have in-depth relationships that might be disturbed by their periods of illness, but when they are not experiencing episodes, they have a stability that you do not see in the borderline person.
Bipolar disorder is more rooted in the biology of the nervous system and more responsive to medication. Borderline pathology strongly involves the psychological level of the mind – the way meaning is generated – in addition to the biology of the brain and nervous system. A more biological condition like bipolar lacks these deeply rooted psychological aspects, or ways of seeing the world and perceiving the self and others, that characterizes borderline disorders.
Mood swings of bipolar disorder are more random and less related to events than those of borderline. Those with bipolar might have a hair-trigger kind of response during an episode, whereas the borderline person has a hair-trigger response all of the time.
What is important for people to know?
Each is a serious illness, and those suffering need to seek out the proper treatment.
Both illnesses can be successfully treated. Too often, individuals with borderline personality disorder are treated for depression or bipolar, when it is a more complex problem. It is essential for patients with borderline personality disorder to see a specialist. A lot of general therapists do not do a good job with this patient population: It’s like sending somebody who needs cardiac surgery to a general surgeon.
We recognize that finding the right specialist for this disorder is a problem people all across the country and the world have. To address this, we established a unique and valuable resource, the NewYork-Presbyterian Borderline Personality Disorder Resource Center. The Resource Center is a website and call center devoted to education about the disorder and to referring people to the proper specialists. We’ve had calls from literally all over the world and have connected people with help all the way from Australia to Russia and every place in between. In addition to the website, the center has an office at the NewYork-Presbyterian Westchester Behavioral Health Center campus staffed by a senior social worker.
Learn more about psychiatry and mental health services at NewYork-Presbyterian.
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Borderline personality disorder: what it is, symptoms and signs of BPD
Borderline personality disorder is characterized by emotional instability, impulsive behavior and low self-control. Forbes Life figured out what causes this disease, how to diagnose borderline personality disorder and how to help people who have experienced it
Mental personality disorders differ from other types of disorders in their intensity.
They cannot be treated like an ordinary illness, as a temporary mental disorder, because personality disorders affect a set of personal characteristics formed in childhood. There are a number of problems with diagnosing such diseases: their symptoms are quite individual, although there are a number of common signs. For borderline personality disorder (BPD), these may include difficulties with self-image, extreme mood swings, risky behavior, and self-harm. The good news is that personality disorders can still be managed—there is a cure.
Now officially: BPD is a diagnosis
Borderline personality disorder is one of the ten types of personality disorders in modern psychotherapy, which is expressed in problems of awareness and formation of personal identity. Psychologist, Gestalt therapist Valentin Oskin notes that this mental illness is associated with strong, uncontrollable and often painful emotions that lead to a distorted sense of self and unstable interpersonal relationships.
People with BPD are reverse solipsists: they are convinced of the inviolability of the world around them, but doubt the reality of their own existence - their image of the inner “I” is so mobile and unstable. In addition to depersonalization, "borderguards" are characterized by impulsiveness, dependence on other people, unstable behavior, a tendency to a chaotic life, and even a need to harm themselves and injure themselves. "Border guards" are characterized by chronic suicidality: 75% of people with BPD try to commit suicide, of which about 10% die as a result of suicide. Moreover, a third of all completed suicides were committed by those suffering from borderline personality disorder.
Despite the statistics, until 2022 the diagnosis of BPD in Russia could not be officially diagnosed - borderline personality disorder in psychiatry was defined as a disease only in foreign classifications of diseases.
It was often called impulsive personality disorder or generally diagnosed as sluggish schizophrenia: the diseases are similar in symptoms, among the signs of BPD there are no hallucinations and delusions. BPD also resembles bipolar affective disorder (up to 40% of "border guards" get an erroneous diagnosis of bipolar disorder), only periods of depressive and elated mood are replaced with bipolar disorder less often. The transition to the International Classification of Diseases of the 11th revision will finally allow doctors to make an accurate diagnosis for Russian citizens and prescribe the appropriate treatment.
Diagnosis is not a sentence, the boundary between the norm and pathology is very flexible: “Each of us has borderline responses. For some, they are deeply hidden and appear only in crises, traumas, stressful situations. And for some, life as such is stressful, and therefore the ways of responding turn into what psychologists could call the borderline organization of the personality,” notes Irina Mlodik, Candidate of Psychological Sciences, in the book “House of Cards.
Psychotherapeutic assistance to clients with borderline disorders.
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Ghost hints
Most people with BPD are unaware of their diagnosis and do not seek medical attention. And it's not just that BPD in psychology does not have a clear definition. The disease does not allow you to objectively assess your mental state and understand that the indomitable monster inside is raging not because of the permanent retrograde Mercury and the fatal force of circumstances. The absence of obvious mental abnormalities like hallucinations makes it possible to attribute emotional behavior to character traits. Colleagues, friends and relatives often believe that behind the disgusting behavior of such a person is hysteria and selfishness. Therefore, systematic treatment of borderline personality disorder begins in most cases after a suicide attempt.
The most striking and obvious sign of borderline personality disorder is a craving for auto-aggression, or self-harm. This is not only the infliction of bodily harm (cuts, blows or burns), but also the intention to deprive oneself of sleep, nutrition. This practice is not necessarily a consequence of suicidal behavior: physical pain serves as a way to drown out inner pain, to switch attention from uncontrollable emotions to those that have become the result of an effort of will. The problem is that self-harm is either carefully hidden by people with BPD because it is not normal in our culture, or they perceive it as controlled behavior (eg, exhausting workouts in the gym, striving to do work tasks in their free time).
Borderline personality disorder can be accompanied by alcohol, drug, gambling addiction and a number of other diseases. “For example, depression, anxiety disorders, eating disorders are common in people with BPD.
Often, a history of PTSD or CPTSD is found, ”notes Valentin Oskin. That is, constant panic attacks or overeating in the evenings can be a sign of more serious mental disorders than just a reaction to stress.
Mind, a British mental health information resource, highlights the following symptoms that may indicate borderline personality disorder. If they last long enough and have a negative impact on your life, it makes sense to consult a psychotherapist or psychiatrist:
- Fear of being alone. You constantly worry about people leaving you and are ready to do everything to prevent this from happening.
- Impulsivity and affectivity. You are overcome by strong emotions that last from several hours to several days and can change quickly (for example, from feelings of happiness and confidence to sudden depression and sadness). This is especially evident in a state of anger, which is difficult to control.
In a state of severe stress, you may also experience paranoia or dissociation (as if everything is not happening to you, but to someone else). - Depersonalization. There is no clear idea of who you really are: the sense of self and behavior changes radically depending on where and with whom you are. As an option - a constant feeling of emptiness inside, boredom, misunderstanding of one's true desires and values.
- Communication problems. It is very difficult for you to create and maintain stable relationships, you are prone to masochistic communication, cyclically idealize and devalue even the closest people, and do not always correctly interpret the motives of the actions of others.
“Borderline personality disorder can manifest itself in a wide range of signs,” says Valentin Oskin, “the symptoms of borderline personality disorder are most fully described in the DSM-5 and ICD-11 reference books.
If grouped together, the symptoms will reflect a lack of control in the emotional, behavioral, cognitive spheres, as well as a distortion of the sense of self and a violation of interpersonal relationships. According to the psychologist, it is extremely difficult for people with BPD to break off relationships, even those that need to be broken off. Instead, they may go to great lengths to keep the people who matter to them around them.
At the same time, “border guards” tend to involuntarily throw out their emotions on those who are dear to them: “Often this ends with an interruption in communication, because not everyone is able to endure such a bolt from the blue. And even more so if this thunder rumbles once every couple of months, ”Ksenia Ivanenko notes in her Telegram channel, where she describes her personal experience in dealing with BPD.
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To determine if you are at risk, you can take several tests for borderline personality disorder that are publicly available.
It is important to understand that the result obtained is not a final diagnosis, it can only be made by a qualified doctor after analyzing the symptoms.
The Root of the Problem: What Causes Borderline Personality Disorder
Effective treatment for most mental illnesses requires identifying the cause. Borderline personality disorder is problematic in that it arises from a number of factors and affects the basic components of the personality. That is, there is simply no specific reason that triggers the PRL processes. “While BPD is one of the most researched personality disorders, there is no consensus on what exactly causes it. Severe stresses experienced by children and adolescents, such as neglect, prolonged painful separation, loss of a parent, violence, are common in people with BPD. There is also evidence of a genetic predisposition: among first-line relatives of a person with borderline disorder, the likelihood of developing a similar disorder is 3-5 times higher when compared with the general population,” notes Valentin Oskin.
Any person can be at risk, especially if he is going through a difficult stressful situation. It is known that this diagnosis is made more often in women than in men, and that in almost all cases of BPD it is driven by a deep emotional shock. Most researchers agree that the development of BPD is promoted by a combination of two groups of factors:
- Stress and traumatic life situations. For example, sexual, physical or emotional abuse, persistent feelings of fear or abandonment in childhood, family problems, repressed feelings of anger, anxiety, and sadness. Stress or trauma in adulthood can trigger the onset of borderline personality disorder.
- Genetic predisposition and environmental influences. The disease can be inherited, but more often borderline occurs as a pattern of behavior unconsciously borrowed from parents or close people, reactions to external stimuli.
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No reason to break ties
If there is a “border guard” in your environment, you can build constructive communication with him, although this will require a lot of effort. “It is important to understand that a person with borderline personality disorder takes criticism extremely hard, for him it sounds like rejection, which he is terribly afraid of. At the same time, emotional jumps do not allow him to get the desired intimacy. Relations with such a person are usually like a swing between the poles "I love you, don't leave me - I hate you, I'll leave you." It is important to understand that with borderline personality disorder it is impossible to consciously change your behavior, thinking, emotional reactions and response patterns to certain situations, ”says Valentin Oskin.
Many "border guards" live with a constant oppressive feeling of guilt, they feel broken, bad and unworthy of normal communication, which they badly need. They are unable to correctly read the reactions of others and the motives of their actions. This determines their strange behavior and repels potential partners and friends. Often, people with borderline personality disorder have a Favorite Person - a person on whom the "borderguard" is extremely dependent and who replaces not only everyone around him, but also himself. If this person is busy or there is a conflict with him, the “border guard” literally collapses the world: he drowns in a storm of emotions, reflects on death and looks for thousands of reasons why he was rejected.
There are a number of rules that psychologists have developed for those who seek to communicate as "border guards", minimizing chaos, conflicts and the possibility of a tragic denouement: could end in disaster.
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How to get rid of BPD
The main way to deal with borderline personality disorder is psychotherapy, in which work is done on the accompanying manifestations of an unstable mental state (depression, addictions, eating disorders, etc.
) and syndromes (it is often necessary to treat alcohol withdrawal symptoms). syndrome). This is a long and complicated process, but statistics show that 70% of the “border guards” get rid of the main symptoms during therapy within six years, and remission occurs in a third of patients after two years.
“In therapy, people with BPD are primarily trained in emotional control, responsibility, and interpersonal skills. Dialectico-behavioral psychotherapy, a specially developed method for the treatment of BPD based on cognitive behavioral therapy, is well suited for this. No less effective is schema therapy, which also has special developments for the treatment of BPD. In the course of treatment, pharmacotherapy can also be prescribed, for example, for the treatment of associated depression or anxiety disorder, ”says Valentin Oskin.
Comprehensive treatment may include the following therapies:
- Dialectical Behavioral Therapy (DBT).
Allows the "border guard" to realize that problems can be viewed from different angles, eliminates black and white thinking. - Mentalization (MBT). It helps to explain to oneself the behavior of other people, logically argue their motives and work to improve interpersonal interaction.
- Transference Psychotherapy (TFP) teaches to perceive positive and negative qualities simultaneously, to get out of the "deification/devaluation" paradigm.
- Cognitive Behavioral Therapy helps to change the way of thinking, reactions to stress and correct affective patterns of behavior.
- Schematic therapy is a complex treatment based on psychoanalysis and gestalt therapy. It changes the behavioral patterns laid down in childhood or adolescence.
- Self help. It consists in tracking the dynamics of emotions, asking yourself questions like “how do I feel now?”, “What does he (a) specifically want from me?”, “Is this reality or my fiction?”.
To improve their inner state, people with BPD are advised to start meditating, exercising, walking more often in the fresh air, trying to rationalize their own mood swings, learning self-soothing techniques and training willpower in order to stop emotional breakdowns in time.
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Borderline personality disorder
Borderline personality disorder is associated with unstable mood and behavior that has a significant impact on a person's daily life
Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable moods and behaviors, and an altered "feeling of self."1 everyday life. 1.2
Borderline personality disorder is a serious illness associated with self-harm and suicidal attempts. One in ten patients complete suicide. 2
Facts About Borderline Personality Disorder
Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable mood and behavior, and an altered sense of self.
1
One in ten patients complete suicide. 2
Patients with borderline personality disorder are very sensitive to changes in their environment, and may respond inappropriately and acutely to such changes. They may, for example, be afraid of being abandoned by a loved one.2 If the person whom patient
is expecting arrives late, the patient easily changes the feeling of attachment to dislike or anger.1,2 This reflects the extreme perception of the world by the patient, who sees everything and everyone - including oneself – either good or bad.1,2
People with borderline personality disorder are often insecure, may suddenly change their life goals and views on career, life values and friends.2 Such patients have impulsive and dangerous behavior: reckless spending, unsafe driving, addiction to chemicals. 2 They may develop intense unwarranted anger or feelings of emptiness, and are prone to self-harm.
2 Patients with borderline personality disorder may also experience depression and anxiety.1,2
Facts about Borderline Personality Disorder
Estimates of the proportion of people who have borderline personality disorder vary from less than 1% to around 6%. 2-4
Borderline personality disorder affects a roughly equal number of men and women, but appears to be more disabling in women the same frequency in men and women, but in women it is more severe.3
Symptoms of borderline personality disorder most often first appear during adolescence.4 The disease is most severe and problematic in young adults and tends to improve with age.2 Symptoms may persist throughout life, but most patients with borderline personality disorder by the age of 30-40 have a stable job and a home.2
People with borderline personality disorder are emotionally and functionally unstable, which places a significant burden on their families.
5 Mood swings are a source of stress for both the patient and his or her others, which can lead to the development of mental disorders in the latter.1,5
People who are concerned that they – or their loved ones – are experiencing symptoms of borderline personality disorder should see their doctor for help and advice.
Borderline personality disorder is diagnosed by a mental health professional using interviews and discussions about symptoms and medical history. 1
Psychotherapy can help people with borderline personality disorder by, for example, teaching them how to interact with others and to express their thoughts and feelings more clearly. 1 It may also be beneficial for caregivers and family members of those affected to receive therapy and guidance on how best to care for a person with borderline personality disorder. 1 There is currently no cure, but one study showed that, after 10 years, 50% of people with borderline personality disorder had recovered, being able to function at work and maintain personal relationships.
6
- National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.
- National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. Available from: https://www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317 [accessed 30 September 2019].
- Bailey RC, Grenyer BFS. Burden and support needs of carers of persons with borderline personality disorder: a systematic review. Harv Rev Psychiatry. 2013;21(5):248–258.
- Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry. 2010;167(6):663–667.
1. National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
3. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.
