Borderline personality disorder

Borderline personality disorder is defined as a lasting personality change that occurs in adolescence, characterised primarily by significant emotional fluctuation, sensitivity to abandonment with chaotic interpersonal relationships, significant impulsivity that can lead to self-harming behaviour such as scarification and repeated suicide attempts. Although clearly defined in symptomatological terms and affecting between 4 and 6% of the general population, borderline personality disorder is still not recognised as a disability by the WHO. However, the suicide rate (around 10%) is considerable and the existence of a borderline personality disorder could in fact be at the origin of a large proportion of suicides mistakenly attributed to other psychiatric disorders. Mainly affecting young adults (between 16 and 30 years of age), the socio-economic cost of this disorder is all the greater as this pathology is very often complicated by depression or an anxiety disorder. This disorder is still not well recognised and rarely identified while many patients who suffer from it are often diagnosed as suffering from other disorders including bipolar disorder. This is all the more regrettable as the therapeutic strategies (essentially drug-based) given to patients suffering from bipolar disorder do not work and may even cause other difficulties in borderline patients. The delay in diagnosis is therefore also a reality for these patients. New specific therapeutic strategies are needed and this can only be achieved through a better knowledge of this disorder, both at the general population level and at the caregiver level.

Treatments - the promise of research:

The search for better treatments represents great hope for people with borderline personality disorder. Early management and detection of the disorder leading to the implementation of personalised therapeutic strategies, essentially psychotherapeutic, can improve the prognosis for these patients and thus their quality of life. Studies have shown that appropriate management significantly reduces suicidal behaviour, suicide deaths and hospitalisations; subjects with borderline disorder account for up to 20% of psychiatric inpatients. If properly managed and followed-up, the disorder may even “disappear”. Thus, there is hope for these patients, because borderline disorder, unlike bipolar disorder, is not a pathology that progresses chronically.

The main aetiological factor of the disorder lies in traumatic life events in childhood such as childhood abuse (up to 60% of patients with borderline personality disorder have experienced sexual abuse in their childhood), but biological factors including genetics also appear to play a determining role. Unfortunately, neuroimaging, biochemistry and genetic and/or epigenetic studies remain too few and limit the possibility of understanding the underlying neurobiological mechanisms of the disorder. It is by exploring these mechanisms that the correlates of response to treatment will be better identified, differential diagnosis assisted, treatment provided better targeted/personalised, and new care strategies developed.

Thanks to functional brain imaging, which allows “access to brain function” under experimental conditions reflecting life situations, it has already been shown that certain regions involved in emotional regulation are involved in the genesis of borderline disorder. This line of research must be pursued.

Management of borderline disorder is based on specific psychotherapies, such as behavioural and dialectical therapy. Staff training in these specific approaches is necessary to develop a well-adapted offer of care. Furthermore, the use of new communication technologies is an avenue to be explored.

Finally, researchers are interested in the problem of suicidal and self-harming behaviour in borderline personality disorder: an innovative approach in this field aims to identify biological factors that will make it possible to detect subjects who will take action in order to propose appropriate preventive therapies.