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Borderline Personality Disorder

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2 Key Points Key Points   ➤ The lifetime prevalence of borderline personality disorder (BPD) in the United States is approximately 1.4%-2.7%, although estimates can vary. Symptom onset may extend back to early adolescence although the diagnosis of BPD may not be made until later in adolescence or adulthood.   ➤ Specific symptoms include a long-term pattern of instability of interpersonal relationships, unstable self-image, marked impulsivity and/or affective instability, fear of abandonment, feelings of emptiness, intense anger, an unstable self-image, suicide attempts and transient paranoid ideation or stress-related dissociative symptoms.   ➤ Individuals with BPD commonly suffer from other psychiatric disorders such as major depressive disorder (MDD), bipolar disorder, posttraumatic stress disorder (PTSD), anxiety disorders, eating disorders, attention-deficit/ hyperactivity disorder (ADHD), and substance use disorders (SUDs).   ➤ This condition can remit, and BPD symptoms can be reduced and managed with a comprehensive, person-centered treatment plan that includes structured psychotherapy and adjunct pharmacotherapy for targeted symptoms. Assessment and Determination of Treatment Plan Statement 1 - Initial Assessment   ➤ APA recommends (1C) that the initial assessment of a patient with possible BPD include the reason the individual is presenting for evaluation; the patient's goals and preferences for treatment; a review of psychiatric symptoms, including core features of personality disorders and common co- occurring disorders; a psychiatric treatment history; an assessment of physical health; an assessment of psychosocial and cultural factors; a mental status examination; and an assessment of risk of suicide, self-injury, and aggressive behaviors, as outlined in APA's Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd Edition. Statement 2 - Quantitative Measures   ➤ APA suggests (2C) that the initial psychiatric evaluation of a patient with possible BPD include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment. Assessment

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