Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.

中文翻译：

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边缘性人格障碍：诊断和临床表现、病因、治疗和当前争议的全面回顾

边缘性人格障碍（BPD）于1980年在DSM-III中引入。从DSM-III到DSM-5，其定义标准没有发生重大变化。该疾病的特点是自我形象、人际关系和情感不稳定。其他症状包括冲动、强烈的愤怒、空虚感、强烈的被遗弃恐惧、自杀或自残行为以及短暂的与压力相关的偏执观念或严重的解离症状。有证据表明，通过半结构化访谈可以可靠地诊断边缘性人格障碍，并将其与其他精神障碍区分开来。该疾病与相当大的功能损伤、强化治疗利用和高社会成本有关。自残和自杀的风险很高。据报道，在一般成年人群中，BPD 的终生患病率为 0.7% 至 2.7%，而门诊患者的患病率约为 12%，住院精神病服务的患病率约为 22%。BPD 与其他精神障碍显着相关，包括抑郁症、物质使用障碍、创伤后应激障碍、注意力缺陷/多动障碍、双向情感障碍、神经性贪食症和其他人格障碍。有令人信服的证据表明，遗传因素和不良童年经历之间的相互作用在 BPD 的病因学中发挥着核心作用。尽管进行了大量研究，但该疾病的神经生物学基础仍有待阐明。心理治疗是 BPD 的首选治疗方法。各种方法已在随机对照试验中得到实证支持，包括辩证行为疗法、基于心智化的疗法、移情聚焦疗法和图式疗法。没有一种方法被证明优于其他方法。与常规治疗相比，心理治疗已被证明更有效，对于核心 BPD 症状严重程度的影响大小在 0.50 至 0.65 之间。然而，几乎一半的患者对心理治疗没有足够的反应，有必要在这一领域进行进一步的研究。目前尚不清楚某些患者是否从一种心理治疗方法中获益比从其他方法中获益更多。没有证据一致表明任何精神活性药物对 BPD 的核心特征有效。对于离散且严重的共病焦虑或抑郁症状或精神病样特征，药物治疗可能有用。BPD 的早期诊断和治疗可以减少个人痛苦和社会成本。然而，需要在青少年和成人中进行更多高质量的研究。这篇综述提供了 BPD 诊断和临床特征、危险因素、神经生物学、认知和管理的全面更新。它还讨论了当前有关该疾病的争议，并强调了需要进一步研究的领域。