Borderline personality disorder – the ‘good prognosis diagnosis’?

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Perry Hoffman
Dr Perry Hoffman

The new journal Borderline Personality Disorder and Emotion Dysregulation (BPDED) launches today. In this guest blog, Dr Perry Hoffman, President of the NEA.BPD, tells us about borderline personality disorder and the impact this new journal can have, not just for researchers but for patients and their families.

Borderline personality disorder (BPD) is a disorder that occurs in the context of relationships. With its hallmark symptoms of rapid mood changes, fears of abandonment, self-injury, suicide/suicide attempts, impulsivity and stormy relationships, it is a challenging diagnosis. And yet it is also termed the ‘good prognosis diagnosis’.  

Fortunately, the past two decades have seen a sea change in the disorder, with evidenced-based treatments, albeit not readily available, offering hope for symptom reduction. Research documents that more than 5% of the general population in the United States meet criteria for the disorder and those that enter into recovery often remain in recovery.  Research from Dr. Mary Zanarini’s longitudinal study reported a 90% remission rate with few recurrences.

Unfortunately, there have not been changes with other aspects of the disorder. There is considerable stigma surrounding BPD, and its under- and misdiagnosis remains exceptionally high. At the same time, awareness and education on the illness remain relatively low.   

Borderline Personality Disorder and Emotion Dysregulation (BPDED) journal which launches today, offers an opportunity with its open access availability to effect change in many areas, including these. Reducing the lag time between article submission and article access creates a venue where state-of-the-art research is made available to all stakeholders, researchers, clinicians, patients and their family members. 

BPDED is the official journal of the National Education Alliance for Borderline Personality Disorder (NEA.BPD) – of which I am a co-founder and President. The organization is not-for-profit, run by volunteers and has received two grants from the National Institute of Mental Health, convened over 60 conferences in its 12-year existence, published two books and has another under contract, conducts a manualized course for relatives of persons with BPD called Family Connections, and has been recognized by the American Psychiatric Association with its 2012 Distinguished Organizational Award.

The new journal is an important part of our work to support people affected by BPD. A considerable amount of BPD research is currently focused on genetics,  the brain, and other biological factors.  BPDED will provide a valuable platform for the latest information in those areas. 

Another focus of emerging interest is that, although BPD symptomatology may be reduced, the level of functioning of recovered individuals remains low. Addressing this important deficit is crucial for people to establish lives of fulfillment and satisfaction.

Of equal importance is the recognition of the disorder in adolescents. Early detection and prevention is an area that has not received the attention needed. As with other psychiatric diagnoses, for example bipolar disorder and schizophrenia, recognition of early signs of illness and intervening during that time can make all the difference.

The NEA.BPD is hosting the first Think Tank on this issue. World renowned researchers will gather for a day during the annual American Psychiatric Association meeting in New York City in May to brain storm and set an agenda with early detection as its focus. I look forward to reporting on the outcomes of that landmark meeting on this blog, along with new research papers and updates on the work of the journal.

BPDEDlogoBPDED journal launched today and you can access the first articles on its website: www.bpded.com.

The NEA.BPD website, www.borderlinepersonalitydisorder.com, offers the largest media library on BPD in the world, and BPDED will become one of its featured products. You can also read the NEA.BPD blog, or follow them on Twitter.

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Mark Osterloh, MD, JD, RPH

Borderline Personality Disorder is the most difficult to understand and diagnose mental illnesses. As a consequence there is little awareness of its existence in the general public. If there were greater awareness, more resources would be brought to the table to help these people. I believe the biggest problem is its name. “Borderline” means nothing in helping us understand the condition. I have proposed that we change the name to Faultfinding Personality Disorder based on the most important diagnostic criterion – chronic finding of fault with themselves and others due to their black-and-white thinking which leads to disturbed interpersonal relationships. To back this up I wrote the book “Faultfinders: The impact of borderline personality disorder.” I explained the condition using examples of numerous famous people to make the symptoms memorable. I would be interested to hear what others think about a possible name change.

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