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Contributing Author: Andres Abreu, MD, Alexandria Marino, PhD, and Sarah Fineberg, MD, PhD

Contributing Editor: David A. Ross, MD, PhD

Overview: Borderline personality disorder (BPD) has an estimated lifetime prevalence as high as 6% [1]. The prevalence of BPD is substantially higher than that of bipolar I disorder and schizophrenia [2]. Within treatment settings, BPD is present in approximately 10% of psychiatric outpatients [3] and 20% of psychiatric inpatients [4]. Thus it is reasonable to agree with Harvard psychiatrist and BPD expert John Gunderson when he says “the treatment of patients with borderline personality disorder poses a major public health issue” [5]. The economic burden of this disorder is very high, with direct and indirect per patient costs on par with that of psychotic disorders [6]. In addition to high societal costs, BPD is associated with grave impairments in quality of life for patients [7]. Recurrent suicidality and self-injurious behavior occur frequently [8] and 10% of patients with borderline personality disorder ultimately commit suicide [9].

The present session learning objectives is to a) be able to articulate current standard of care treatments and expected prognosis for patients, b) describe the negative attribution bias in borderline personality disorder, the relationship to amygdala hyperactivity, and novel approaches using neurofeedback that may offer next-generation treatment.

Author Affiliations: Dr. Abreu, from Austen Riggs Center, and Dr. Fineberg, from the Department of Psychiatry at the Yale School of Medicine, developed the content for this article together. Alexandria Marino, from Yale School of Medicine, assembled the initial draft, Drs. Abreu and Fineberg wrote the final version. David Ross, MD, PhD is the Contributing Editor for this publication. The National Neuroscience Curriculum Initiative is a collaborative effort with AADPRT and the American Psychiatric Association (APA) Council on Medical Education and Lifelong Learning and receives support from the NIH (R25 MH10107602SI) ©National Neuroscience Curriculum Initiative

Section 1Introduction / Background for Faculty Moderator
Section 2Session Learning Objectives
Section 3Review Clinical Vignette
Section 4Formulate Treatment Plan
Section 5Facilitated Case Discussion
Section 6Review Assigned Articles
Section 7Additional Learning Opportunities
Section 8APPENDIX 1: Borderline personality disorder symptoms
Section 9APPENDIX 2: Standard of care for the treatment of borderline personality disorder
Section 10References
Section 11Guided Discussions of Articles

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