COURSE AND PROGNOSIS:

BPD is fairly stable; Patients change little overtime.

Longitudinal studies show no progression toward Schizophrenia, but
patients have a high incidence of major Depressive Disorder Episodes.
The diagnosis is usually made before the age of 40 years, when patients
are attempting to make occupational, marital, and other choices and are
unable to deal with the normal stages of life cycle.

ETIOLOGY OF BPD:
There are several views concerning the causes of BPD. Experts agree,
though, that the disorder results from a combination of factors. Factors
that seem likely to play a role include:

Some studies of twins and families suggest that personality disorders may be
inherited or strongly associated with other mental disorders among family
members.
Both twin studies and family studies support a strong heritability of BPD.
Genes account for more than 60 % of the variance in the development of
the disorder.
Consistent with the idea that emotional dysregulation may be one of the
components of this disorder, the parents of people with BPD have elevated
rates of mood disorder.

GENETIC FACTOR:
NEUROBIOLOGICAL FACTORS;
People with BPD demonstrate lower Serotonin Function. (Soloff et
al,2000).
In brain-imaging studies, people with BPD show low levels of activity and
structural changes in the prefrontal cortex. (van Elst et al. 2001, Van
Elst,2003).
SOCIAL FACTORS: CHILDHOOD ABUSE
People with BPD are much more likely to report a history of parental
separation, verbal abuse, and emotional abuse during childhood than are
people diagnosed with other Axis II disorders (Reich & Zanarini, 2001).

MEDIATING AND MODERATING FACTORS:-
Family environment:-
Family environment mediates the effect of child sexual abuse on the
development of BPD.
An unstable family environment predicts the development of the
disorder, while a stable family environment predicts a lower risk.
One possible explanation is that a stable environment buffers
against its development.

RISK FACTORS:-
Hereditary predisposition.
You may be at a higher risk if a close family member your mother, father, brother or sister has
the same or a similar disorder, particularly a mood or anxiety disorder.
Childhood abuse.
Many people with the disorder report being sexually or physically abused during childhood.
Neglect.
Some people with the disorder describe severe deprivation, neglect and abandonment during
childhood.
PSYCHOTHERAPY
Borderline personality disorder treatment may include psychotherapy,
medications or hospitalization.
TREATMENT:-
Psychotherapy also called talk therapy is a fundamental treatment
approach for borderline personality disorder.

DIALECTICAL BEHAVIOR THERAPY (DBT):
DBT was designed specifically to treat borderline personality disorder.
Generally done through individual, group and phone counseling,

COGNITIVE BEHAVIORAL THERAPY (CBT):
With CBT, the mental health counselor (therapist) become aware of
inaccurate, negative or ineffective thinking; view challenging situations
more clearly and objectively; and search for and put into practice
alternative solution strategies.

MENTALIZATION-BASED THERAPY (MBT):-
MBT is a type of talk therapy that helps you identify and separate your
own thoughts and feelings from those of people around you. MBT
emphasizes thinking before reacting.

SCHEMA-FOCUSED THERAPY (SFT):-
SFT combines therapy approaches to help you evaluate repetitive life
patterns and life themes (schema) so that you can identify positive
patterns and change negative ones.
HOSPITALIZATION:-
At times, patient may need more intense treatment in a psychiatric
hospital or clinic. Hospitalization can also keep him safe from self-injury or
suicidal thoughts or behaviors.

MEDICATIONS:-
Medications may include antidepressants, antipsychotics and anti-anxiety
drugs.
Medications must be appropriately prescribed by doctor, in adequate
doses, and with consistent supervision through scheduled follow-up visits.