How Common Is Borderline Personality Disorder?

The answer may surprise you; it's more common than you think.

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Question: How common is borderline personality disorder (BPD)? Is it very rare?

Answer:

BPD is much more common than you might imagine. A recent study on the prevalence of mental health disorders in the U.S. found that about 1.6% of the population has BPD. While that number may sound small, that means that there are more than four million people with BPD in the U.S. alone. Although many people have never heard of BPD, it is actually more common than many well-known disorders, such as schizophrenia.

There is a large difference in the prevalence of BPD in women versus men; women are much more likely to be diagnosed with BPD. In fact, about 75% of those diagnosed with BPD in the U.S. are women. However, it is not known whether women are actually more prone to develop BPD or whether this is due to gender biases in the diagnosis of BPD. For example, it may be that men with the symptoms of BPD are just more likely to be misdiagnosed with other conditions like post-traumatic stress disorder or major depressive disorder. 

In addition, that 1.6% statistic may not be accurate because many people with BPD have not yet been diagnosed or they have been misdiagnosed. In one study from Brown University, more than forty percent of those with BPD had originally been misdiagnosed as having bipolar disorder. One hypothesis for this issue is that bipolar disorder is more easily treated through medication, so it is more commonly diagnosed so that symptoms can be quickly managed with a prescription.

 

Misdiagnosis can be a serious problem, as no medications have been approved by the Food and Drug Administration (FDA) for BPD and medications for bipolar disorder are often ineffective in treating BPD. BPD patients who have been misdiagnosed may then be exposed to dangerous side effects from their prescriptions.

Some patients have reported issues with endocrine and cardiac problems after taking these prescriptions. 

While bipolar disorder and borderline personality disorder may share some symptoms, they are very different diseases. Bipolar disorder can cause severe depression or mood swings, but in between episodes, those with bipolar are able to function normally. Those with BPD may have a more chronic condition that can cause self-harming behaviors or suicidal tendencies. 

When a bipolar disorder patient is rapidly cycling, they can exhibit destructive or harmful behaviors very similar to BPD, so misdiagnosis is extremely common during these phases. Another fact that makes defining the two more difficult is that some people can actually have both diseases. About 20% of those with borderline personality disorder have been found have bipolar disorder as well. 

Finally, other patients with BPD go undiagnosed because they refuse to seek treatment. Whether they feel they don't need help or that counseling will be useless, many people go without therapy and struggle with BPD on their own.

 

With these issues in mind, it is likely that the number of people with borderline personality disorder is much higher than 1.6%, but that is the only number researchers have been able to find evidence to support. 

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision. Washington, DC, 2013.

Lenzenweger, MF, Lane, MC, Loranger, AW, and Kessler, RC. "DSM-IV Personality Disorders in the National Comorbidity Survey Replication." Biological Psychiatry, 62: 553-654, September 2007.

Widiger, T. "Invited Essay: Sex Biases in the Diagnosis of Personality Disorders." Journal of Personality Disorders, 12:95-118, 1998.

Zimmerman, M. "Is bipolar disorder overdiagnosed?" Journal of Clinical Psychiatry. 2008, 935-940. 

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