Borderline Personality Disorder 665
Associated Features Supporting Diagnosis
Individuals with borderline personality disorder may have a pattern of undermining
themselves at the moment a goal is about to be realized (e.g., dropping out of school just
before graduation; regressing se verely after a discussion of ho w well therapy is going; de-
stroying a good relationship just when it is clear that the relationship could last). Some in-
dividuals develop psychotic-like symptoms (e.g ., hallucinations, body-image distortions,
ideas of reference, hypnagogic phenomena) du ring times of stress. Individuals with this
disorder may feel more secure with transition al objects (i.e., a pet or inanimate possession)
than in interpersonal relationships. Prematur e death from suicide may occur in individu-
als with this disorder, especially in those with co-occurring depressive disorders or sub-
stance use disorders. Physical handicaps may result from self-inflicted abuse behaviors or
failed suicide attempts. Recurrent job losses, in terrupted education, and separation or di-
vorce are common. Physical and sexual abuse, neglect, hostile conflict, and early parental
loss are more common in the childhood histor ies of those with borderline personality dis-
order. Common co-occurring disorders include depressive and bipolar disorders, sub-
stance use disorders, eating disorders (not ably bulimia nervosa), posttraumatic stress
disorder, and attention-defici t/hyperactivity disorder. Bo rderline personality disorder
also frequently co-occurs with the other personality disorders.
Prevalence
The median population prevalence of border line personality disorder is estimated to be
1.6% but may be as high as 5.9%. The preval ence of borderline personality disorder is