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Borderline personality disorder: Epidemiology, clinical features, course, assessment, diagnosis, and differential diagnosis

Andrew Skodol, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, as well as by impulsivity across a wide range of situations, causing significant impairment or subjective distress.

BPD has a lifetime prevalence of approximately 6 percent. The disorder is associated with receiving extensive clinical attention and the disorder is more widely studied than any other personality disorder. Despite these efforts, patients with BPD continue to suffer considerable morbidity and increased mortality compared with the general population [1,2].

The epidemiology, clinical features, diagnosis, and differential diagnosis of BPD will be reviewed here. The treatment and prognosis of BPD is discussed separately. Other personality disorders are also discussed separately. (See "Treatment of borderline personality disorder" and "Personality disorders" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Treatment of antisocial personality disorder".)


Borderline personality disorder (BPD) is common in both the general population and in clinical settings. Large, nationally representative, nonclinical surveys of the United States general population estimate that the point prevalence of BPD is 1.4 percent and the lifetime prevalence is 5.9 percent [3,4]. Studies in clinical settings found BPD was present in 6.4 percent of urban primary care patients, 9.3 percent of psychiatric outpatients, and approximately 20 percent of psychiatric inpatients [5-7].

The ratio of females to males with the disorder is greater in clinical populations than it is in the general population. The ratio is 3:1 in clinical settings [5]. Multiple epidemiologic surveys of the United States general population, however, have found the lifetime prevalence of BPD does not differ significantly between men and women [3,4]. This discrepancy suggests that women with BPD are more likely to seek treatment than men. In a study of patients with BPD, men and women were found to have similar rates of childhood-trauma history and levels of current psychosocial functioning [8].


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Literature review current through: Sep 2016. | This topic last updated: Feb 9, 2016.
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