argumentative essay on borderline personality disorder

Borderline Personality Disorder Overview Essay

Personality disorders are a group of mental health illnesses defined by specific behavior patterns and distinctive cognitive and affective characteristics. Such disorders are characterized by significant deviations in the way of thinking about oneself and others, emotional responses, regulating behavior, and the ability to relate to other people (Robitz, 2018). This essay will consider borderline personality disorder (BPD), its manifestations, personal characteristics and cognitive features associated with the disease, and potential genetic causes and neurochemical features.

BPD is a severe disorder that can significantly affect one’s health, well-being, and ability to develop meaningful relationships. Patients with BPD often experience sudden mood swings and regularly change their interests and personal values due to the present uncertainty of their place in the world (National Institute of Mental Health, 2017). People diagnosed with the disorder are not capable of building stable relationships as their views and opinions, including those of other people, change suddenly and radically.

BPD is traditionally assessed by completing an in-depth interview with the patient and a medical examination employed to rule out other causes for behavioral manifestations (National Institute of Mental Health, 2017). In addition, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) can be employed for the initial assessment of BPD (Dabaghi et al., 2020). Family history and the patient’s medical history can also be included in the evaluation.

Several risk factors are distinguished when discussing BPD and its development. According to the National Institute of Mental Health (2017), environmental, cultural, social, and family factors are substantial risk factors for developing the disorder. Some studies show a possibility of a genetic predisposition to BPD and state that specific genes can modulate the effect of stressful events on one’s impulsivity and aggression (Bassir Nia et al., 2018).

In particular, catechol o-methyltransferase (COMT) val158met polymorphism and 5-HTTPLR ss/sl polymorphism were found to have a determining effect on one’s aggression and impulsivity. Furthermore, persons diagnosed with BPD often present with structural and functional changes in the brain, specifically, in the prefrontal cortex, responsible for regulating impulses (Bassir Nia et al., 2018; National Institute of Mental Health, 2017). Thus, it can be argued that BPD is the result of the intercorrelation of multiple factors, including genetics, brain structure, and social and environmental aspects.

BPD is generally associated with several typical personality characteristics and cognitive features. The National Institute of Mental Health (2017) distinguishes several BPD personality traits, including feelings of emptiness, distorted self-image, inability to trust other people and build relationships with them, and self-harming behaviors. The disorder is also associated with such cognitive impairments as “deficits in executive functions, response inhibition, attention, and cognitive control and abnormal social cognition” (Bassir Nia et al., 2018, p. 63). Thus, persons with BPD often display intense anger, severe mood swings, impulsive behavior, and suicidal ideation (National Institute of Mental Health, 2017).

Considering the complex nature of the disorder and the genetic, social, family, and environmental factors that determine it, the development of BPD cannot be prevented. However, it can be diagnosed early and managed with effective therapies.

In summary, BPD is a severe, complex mental health disorder characterized by a pattern of unstable moods, impulsive behavior, and destructive self-image. Individuals diagnosed with BPD experience difficulties in building relationships and tend to change their opinions and values regularly. Furthermore, BPD is presented with issues with controlling aggression, focus, and communication. Research into the disorder shows that the risk factors for BPD include genetic predisposition, structural and functional changes in the brain, and environmental, social, and familial factors.

Bassir Nia, A., Eveleth, M. C., Gabbay, J. M., Hassan, Y. J., Zhang, B., & Perez-Rodriguez, M. M. (2018). Past, present, and future of genetic research in borderline personality disorder. Current Opinion in Psychology , 21 , 60–68. Web.

Dabaghi, P., Asl, E., & Taghva, A. (2020). Screening borderline personality disorder: The psychometric properties of the Persian version of the McLean screening instrument for borderline personality disorder . Journal of Research in Medical Sciences , 25 (1), 97–104. Web.

National Institute of Mental Health. (2017). Borderline personality disorder . Web.

Robitz, R. (2018). What are personality disorders? American Psychiatric Association. Web.

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REVIEW article

Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends.

• 1 Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
• 2 College of Computing & Informatics, Drexel University, Philadelphia, PA, United States
• 3 Department of Psychology, School of Education, China University of Geosciences, Wuhan, China
• 4 Department of Information Management, Anhui Vocational College of Police Officers, Hefei, China

Borderline personality disorder (BPD), a complex and severe psychiatric disorder, has become a topic of considerable interest to current researchers due to its high incidence and severity of consequences. There is a lack of a bibliometric analysis to visualize the history and developmental trends of researches in BPD. We retrieved 7919 relevant publications on the Web of Science platform and analyzed them using software CiteSpace (6.2.R4). The results showed that there has been an overall upward trend in research interest in BPD over the past two decades. Current research trends in BPD include neuroimaging, biological mechanisms, and cognitive, behavioral, and pathological studies. Recent trends have been identified as “prevention and early intervention”, “non-pharmacological treatment” and “pathogenesis”. The results are like a reference program that will help determine future research directions and priorities.

1 Introduction

Borderline personality disorder (BPD) is a complex and severe psychiatric disorder characterized by mood dysregulation, interpersonal instability, self-image disturbance, and markedly impulsive behavior (e.g., aggression, self-injury, suicide) ( 1 ). In addition, people with BPD may have chronic, frequent, random feelings of emptiness, fear, and so on. These symptoms often lead them to use unhealthy coping mechanisms in response to negative emotions, such as alcohol abuse ( 2 ). BPD has a long course, which makes treatment difficult and may have a negative impact on patients’ quality of life ( 3 ). Due to its clinical challenge, BPD is by far the most studied category of personality disorder ( 4 ). This disorder is present in 1−3% of the general population as well as in 10% of outpatients, 15−20% of inpatients, and 30−60% of patients with a diagnosed personality disorder, and has a suicide rate of up to 10% ( 5 , 6 ). Families of individuals with serious mental illness often experience distress, and those with relatives diagnosed with BPD tend to carry a heavier burden compared to other mental illnesses ( 7 , 8 ). As early as the 20th century, scholars began describing BPD and summarizing its symptoms. However, there was some debate regarding the precise definition of BPD.

In the past few decades, the research community has made remarkable progress in the study of BPD, equipping us with a wider range of perspectives and tools for understanding this intricate condition. However, numerous challenges still remain to be tackled by researchers. Diagnosing BPD is inherently challenging and often more difficult than anticipated. The symptoms of BPD are complex, diverse, and often overlap with those of other mental health conditions. For example, individuals with BPD may experience extreme mood swings similar to those observed in individuals with bipolar disorder ( 9 ); At the same time, they may also be entrenched in long-term depression, making it easy for doctors to initially misdiagnose them with depression ( 10 ). Because these symptoms overlap and interfere with each other, doctors often face the risk of misdiagnosing or overlooking the condition during initial diagnosis. Therefore, researchers are working to develop more accurate and comprehensive diagnostic tools and methods.

According to the “Neuro-behavioral Model” proposed by Lieb ( 1 ), the process of BPD formation is very complex and is determined by the interaction of several factors. The interaction between different factors can be complex and dynamic. Genetic factors and adverse childhood experiences may contribute to emotional disorders and impulsivity, leading to dysfunctional behaviors and inner conflicts. These, in turn, can reinforce emotional dysregulation and impulsivity, exacerbating the preexisting conditions. Genetic factors are an important factor in the development of BPD ( 11 ). Psychosocial factors, including adverse childhood experiences, have also been strongly associated with the development of BPD ( 12 ). Emotional instability and impulsive behavior are even more common in patients with BPD ( 13 ). The current study is based on the “Neuro-behavioral Model” and conducts a literature review of previous scientific research on BPD through bibliometric analysis to reorganize the influencing factors. Through large-sample data analysis, the association between BPD and other diseases is explored, which contributes to further refining this theory’s explanation of the common neurobiological mechanisms among various mental illnesses.

It is worth noting that with the development of BPD, some scholars have conducted bibliometrics studies on BPD to provide insights into this academic field. To date, the current study has identified two published bibliometric studies on the field: One is Ilaria M. A. Benzi and her colleagues’ 2020 metrological analysis of the literature in the field of BPD pathology for the period 1985−2020 ( 14 ). The other is a bibliometric analysis by Taylor Reis and his colleagues of the growth and development of research on personality disorders between 1980 and 2019 ( 15 ). Ilaria M. A. Benzi and her colleagues integrated and sorted out the research results of borderline personality pathology, and revealed the research results and development stages in this field through the method of network and cluster analysis. The results of the study clearly demonstrate that the United States and European countries are the main contributors, that institutional citations are more consistent, and that BPD research is well developed in psychiatry and psychology. At the same time, the development of research in borderline personality pathology is demonstrated from the initial development of the construct, through studies of treatment effects, to the results of longitudinal studies. Taylor Reis and his colleagues used a time series autoregressive moving average model to analyze publishing trends for different personality disorders to reveal their historical development patterns, and projected the number of publications for the period 2024 to 2029. The study finds a trend towards diversity in the research and development of personality disorders, with differences in publication rates for different types of personality disorders, and summarizes the reasons that influence these differences. This may ultimately determine which personality disorders will remain in future psychiatric classifications. These studies have provided valuable insights into the evolution of BPD, focusing primarily on its pathology or a broader personality disorder perspective. While basic bibliometric analyses of these studies have been conducted, there is a need for more in-depth investigations of specific trends in the evolution of BPD and a clearer delineation of emerging research foci. Therefore, in order to enhance the current study, this study extends the analysis to 2022 and utilizes a comprehensive structural variation analysis of the literature using scientometric methods. Building on previous bibliometric studies, we expect to provide new insights and additions to research in this area. At the same time, the research trends and hot topics in the field of BPD are further explored. In addition, several cocitation-based analyses are also carried out in order to better understand citation performance.

2.1 Objectives

One of our goals was to understand the current status and progress of researches on BPD, and to summarize the latest developments and research findings in BPD, such as new treatment methods and disease mechanisms. Through the intuitive presentation of knowledge graphs and other images or data, we aimed to provide clinical practice and research guidance for clinicians, researchers, and policymakers.

Our second goal was to help identify future research directions and priorities, and provide more scientific and systematic research guidance for researchers. For example, by identifying hotspots and associations in certain research areas, we can determine the fields and issues that require further investigations, thus providing clearer directions and focus for researches. Additionally, through bibliometric analysis, we can provide researchers with more targeted and practical research strategies and methods, improving research efficiency and the quality of research outcomes.

2.2 Search strategy and data collection

The selection of appropriate methods and tools in the process of analyzing research information is crucial. Web of Science (WOS) is a popular database for bibliometric analysis that includes numerous respectable and high-impact academic journals. In addition, data information, such as references and citations, is more extensive than other academic databases ( 16 ). Data collection took place on the date of May 10, 2023. The search strategy included the following: topic=“Neuro-behavioral Model” or “borderline characteristics” or “borderline etiology” or “borderline personality disorder”, database selected=WOS Core Collection, time span=2003−2022, index=Science Citation Index Expanded (SCI-EXPENDED) and Social Sciences Citation Index (SSCI). The “Neuro-behavioral Model” serves as a theoretical framework that is useful for explaining the development and pathophysiology of BPD; “borderline characteristics” can describe the related symptoms and features of BPD; “borderline etiology” helps to understand the factors that contribute to the development of BPD; “borderline personality disorder” is the most commonly used terms in relevant research. Using these as keywords in title searches can help researchers find researches related to BPD more accurately, facilitating deeper understanding of the characteristics, pathophysiology, etiology, and other aspects of BPD. In the current study, we focused only on two types of literature: articles and review articles, and limited the language to English. After removing all literature unrelated to BPD, a total of 7919 records met the criteria. They were exported in record and reference formats, and saved in plain text file format.

2.3 Data analysis and tools

Bibliometrics was first proposed by Alan Pritchard in 1969, as a method that combines data visualization to analyze publications statistically and quantitatively in specific fields and journals ( 17 ). Bibliometric analysis is a good way to analyze the trend of knowledge structure and research activities in scientific fields over time, and has been widely used in various fields since it was first used ( 18 ). Scientometrics is the application of bibliometrics in scientific fields, and it focuses on the quantitative characteristics and features of science and scientific researches ( 19 ). Compared to traditional literature review studies, visualized knowledge graphs can accurately identify key articles from many publications, comprehensively and systematically combing existing research in a field ( 20 ).

Currently, two important academic indicators are included in research. The impact factor (IF) is used as an indicator of a publication’s impact to assess the quality and importance of the publication ( 21 ). However, some researchers believe that IF has defects such as inaccuracy and misuse ( 22 ). Although many researchers have proposed to replace the impact factor with other indicators, IF is still one of the most effective ways to measure the impact of a journal ( 23 ). The IF published in the 2021 Journal Citation Reports were used. Another indicator is the H-index, which is an important measure of a scholar’s academic achievements. Some researchers consider it as a correction or supplement to the traditional IF ( 24 ).

All data were imported into CiteSpace (6.2.R4) and Scimago Graphica (1.0.30) for analysis. CiteSpace was used to obtain collaboration networks and impact networks. Scimago Graphica was used to construct a network graph of country collaboration. CiteSpace is a Java-based software developed in the context of scientometrics and data visualization ( 25 ). It combines scientific knowledge mapping with bibliometric analysis to determine the progress and current research frontiers in a particular field, as well as predict the development trends in that field ( 26 ). Scimago Graphica is a no-code tool. It can not only perform visualization analysis on communication data but also explore exploratory data ( 27 ). Currently, it is used for visual analysis of national cooperation relationships, displaying the geographic distribution of countries and publication trends.

3.1 Analysis of publication outputs, and growth trend prediction

Annual publications can provide an overview of the evolution of a research area and its progress ( 28 ). We retrieved 7919 articles from the WOS database on BPD between 2003 and 2022, including 6834 research articles and 1085 reviews ( Figure 1 ). As of the search date, these articles had received a total of 289,958 citations, equating to an average of 14,498 citations per year. Over the past two decades, the number of research articles published on BPD has shown a fluctuating upward trend. In addition, citations to these publications have increased significantly. A polynomial curve fit of the literature on BPD clearly indicates a strong correlation between the year of publication and the number of publications ( R 2 = 0.973). The number of research articles on BPD has indeed fluctuated and increased over the past two decades. This observation does, to some extent, indicate an upward trend, probably due to increasing interest in BPD. However, there are other factors to consider as well. For example, the accumulation of data or technological advances, government policies and corporate investment may also affect the direction of BPD research development.

Figure 1 Annual publications, citation counts, and the fitting equation for annual publications in BPD.

3.2 Analysis of co-citation references: clusters and timeline of research

Co-cited references, which are cited by multiple papers concurrently, are considered a crucial knowledge base in any given field ( 28 ). In the current study, CiteSpace clustering was utilized to identify common themes within BPD-related literature. Figure 2 presented a co-citation network of highly cited references between 2003 and 2022, comprising 1163 references. A time slice of 1 was used, with the g -index was set at k =25, which resulted in the identification of 14 clusters representing distinct research themes in BPD. The significant cluster structure is denoted by a modularity value ( Q value) of 0.7974, and the high confidence level in the clusters by an average profile value ( S value) of 0.9176.

Figure 2 Reference co-citation network with cluster visualization in BPD. Trend 1 clinical researches, sub-trend clinical characteristics includes clusters #1, #2, #4, #10, #12; biological mechanisms include clusters #3, #7; nursing treatments includes clusters #0, #8, #13. Trend 2 associations and complications includes clusters #5, #6, #9, #11, #14.

Cluster analysis is performed through CiteSpace. Related clusters are classified into the same trend based on the knowledge of related fields and whether the clusters show similar trends. At the same time, based on the analysis of time series, to identify the movement of one cluster to another. Based on the cluster map of co-cited references on BPD, several different research trends were identified. The first major research trend is clinical research on BPD, which in turn consists of three sub-trends: clinical characterization of BPD, biological mechanisms, and nursing treatment. Of the data obtained, the earliest research on the clinical characterization of BPD began in 1992 with cluster #12, “borderline personality disorder and suicidal behavior” ( S =0.979; 1992). Paul H. Soloff and his colleagues conducted a comparative study of suicide attempts between major depressives and patients with BPD. The aim of this study was to develop more effective intervention strategies for suicide prevention ( 29 ). This cluster was further developed in cluster #4, “nonsuicidal self-injury and suicide” ( S =0.96; 2004). Thomas A. Widiger and Timothy J. Trull proposed a more flexible dimension-based categorization model to overcome the previous drawbacks of personality disorder categorization ( 30 ). Next in cluster #10 “borderline personality disorder and impulsivity” ( S =0.93; 2000), Jim H. Patton and his colleagues revised the Barratt Impulsivity Scale to measure impulsivity to facilitate practical clinical research ( 31 ). Related research continues to evolve into cluster #1 “borderline personality disorder and emotions” ( S =0.87; 2007) and cluster #2 “borderline personality disorder and social cognition” ( S =0.911; 2009), researchers have focused on understanding the causal relationship between BPD traits and factors such as social environment, emotion regulation, and interpersonal evaluative bias, as well as their potential impact ( 32 , 33 ). In the sub-trend of biological mechanisms, two main clusters are involved: cluster #7 “borderline personality disorder and gene-environment interactions” ( S =0.871; 2002) and cluster #3 “borderline personality disorder and neuroimaging” ( S =0.938; 2007). In the related cluster, researchers have found a relationship between BPD and genetic and environmental factors ( 34 ). Researchers have also utilized various external techniques to explore the degree of correlation between the risk of developing BPD and its biological mechanisms, aiming to reveal the complex mechanisms that influence the emergence and development of BPD ( 35 ). In nursing treatment, cluster #8 “treatment of borderline personality disorder “ ( S =0.968; 2001), Silvio Bellino and his colleagues systematically analyzed the current publications on BPD pharmacotherapy research and summarized relevant clinical trials and findings ( 36 ). However, due to the complexity of BPD, there is still a lack of information on the exact efficacy of pharmacotherapy in BPD, and therefore pharmacotherapy remains an area of ongoing development and research. This trend continues to be developed in cluster #0 “borderline personality disorder treatment” ( S =0.887; 2006), which emphasizes the development of novel pharmacotherapies for BPD. Cluster #13 “borderline personality disorder care” ( S =0.997; 2013) mainly focuses on the comprehensive care of people with borderline personality disorder and the education of patients and families. The goal is to improve patients’ quality of life, reduce self-injury and suicidal behavior, and promote full recovery.

The second major research trend is association and comorbidity. This trend first began in cluster #9 “comorbidity and differentiation of disorders” ( S =0.946; 1999). Mary C Zanarini and his colleagues explored the comorbidity of BPD with other psychiatric disorders on Axis I ( 37 ). Cluster #14 “borderline personality disorder and psychosis” ( S =0.966; 2003) also explored symptoms associated with BPD ( 38 ). This trend continues, with researchers studying BPD research in cluster #11 “borderline personality disorder” ( S =0.935; 2004) and cluster #5 “borderline personality disorder research” ( S =0.881; 2007) ( 39 , 40 ). In addition, cluster #6 “borderline personality disorder in adolescents” ( S =0.894; 2011) points out that the focus of BPD research is increasingly shifting towards adolescents ( 41 ).

Figure 3 showed the time span and research process of the developmental evolution of these different research themes. The temporal view reveals the newest and most active clusters, namely #0 “dialectical behavior therapy”, #1 “daily life”, and #2 “social cognition”, which have been consistently researched for almost a decade. Cluster #0 “dialectical behavior therapy” has the largest number and the longest duration, lasting almost 10 years. Similarly, this article by Rebekah Bradley and Drew Westen on understanding the psychodynamic mechanisms of BPD from the perspective of developmental psychopathology has the largest node ( 34 ).

Figure 3 Reference co-citation network with timeline visualization in BPD.

3.3 Most cited papers

The top 10 highly cited papers on BPD research were presented in Table 1 . The most cited paper, by Marsha M. Linehan and colleagues, focus on the treatment of suicidal behavior in BPD ( 42 ). The transition between suicidal and non-suicidal self-injurious behavior in individuals with BPD has attracted researchers’s attention, mainly in cluster #4 “nonsuicidal self-injury and suicide” ( 52 ). The second is the experimental study by Josephine Giesen-Bloo and his colleagues on the psychotherapy of BPD ( 43 ). In cluster #0 “borderline personality disorder treatment” and Cluster #8 “treatment of borderline personality disorder”, researchers strive to find non-pharmacological approaches with comparable or enhanced therapeutic effects. This was followed by Sheila E. Crowell and her colleagues’ study of the biological developmental patterns of BPD ( 44 ). Research on the biological mechanisms and other contributing factors of BPD, including #7 “borderline personality disorder and gene-environment interactions” have been closely associated with the development of BPD ( 53 ).

Table 1 Top 10 cited references that published BPD researches.

3.4 Burst analysis and transformative papers

The “citation explosion” reflects the changing research focus of a field over time and indicates that certain literature has been frequently cited over time. Figure 4 showed the top 9 references with the highest citation intensity. The three papers with the greatest intensity of outbursts during the period 2003−2022 are: The first is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders ( 54 ). In the second article, Vijay A. Mittal and Elaine F. Walker discuss key issues surrounding dyspraxia, tics, and psychosis that are likely to appear in an upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders ( 39 ). In addition, Ioana A. Cristea and colleagues conducted a systematic review and meta-analysis to evaluate the effectiveness of psychotherapy for borderline personality disorder ( 55 ).

Figure 4 References with the strongest occurrence burst on BPD researches. Article titles correspond from top to bottom: Mittal VA et al. Diagnostic and Statistical Manuel of Mental Disorders; Linehan MM et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder; Giesen-Bloo J et al. Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy; Clarkin Jf et al. Evaluating three treatments for borderline personality disorder: A multiwave study; Grant BF et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions; Leichsenring F et al. Borderline personality disorder; American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.); Cristea IA et al. Efficacy of psychotherapies for borderline personality disorder: A systematic review and meta-analysis; Gunderson JG et al. Borderline personality disorder.

Structural variation analysis can be understood as a method of measuring and studying structural changes in the field, mainly reflecting the betweenness centrality and sigma of the references. The high centrality of the reference plays an important role in the connection between the preceding and following references and may help to identify critical points of transformation, or intellectual turning points. Sigma values, on the other hand, are used to measure the novelty of a study, combining a combination of citation burst and structural centrality ( 56 ). Table 2 listed the top 10 structural change references that can be considered as landmark studies connecting different clusters. The top three articles with high centrality are the studies conducted by Milton Z. Brown and his colleagues on the reasons for suicide attempts and non-suicidal self-injury in BPD women ( 57 ); the research by Nelson H. Donegan and his colleagues on the impact of amygdala on emotional dysregulation in BPD patients ( 59 ); and the fMRI study by Sabine C. Herpertz and her colleagues on abnormal amygdala function in BPD patients ( 61 ). In addition, publications with high sigma values are listed. They are Larry J. Siever and Kenneth L. Davis on psychobiological perspectives on personality disorders ( 58 ); Ludger Tebartz van Elst and his colleagues on abnormalities in frontolimbic brain functioning ( 60 ); and Marsha M. Linehan on therapeutic approaches in BPD research ( 62 ). These works are recognized as having transformative potential and may generate some new ideas.

Table 2 Top 7 betweenness centrality and stigma references.

3.5 Analysis of authors and co-authors

Figure 5 showed a map of the co-authorship network over the last two decades. In total, 10 different clusters are shown, each of which gathers co-authors around the same research topic. For example, the main co-authors of cluster #0 “remission” are Christian Schmahl, Martin Bohus, Sabine C. Herpertz, Timothy J. Trull and Stefan Roepke. More recently, the three authors with the greatest bursts of research have been Mary C. Zanarini, Erik Simonsen, and Carla Sharp. As shown in Table 3 , the three most published authors are Martin Bohus (145 publications; 1.83%; H-index=61), Mary C. Zanarini (144 publications; 1.82%; H-index=80) and Christian Schmahl (142 publications; 1.79%; H-index=54).

Figure 5 Top 10 clusters of coauthors in BPD (2003–2023). Selection Criteria: Top 10 per slice. Clusters labeled by keywords. The five authors with the highest number of publications in each cluster were labeled.

Table 3 Top 10 authors that published BPD researches.

3.6 Analysis of cooperation networks across countries

The top 10 countries in terms of number of publications in the BPD are added in Table 4 . With 3,440 published papers, or nearly 43% of all BPD research papers, the United States is the leading contributor to BPD research. This is followed by Germany (1196 publications; 15.10%) and the United Kingdom (1020 publications; 9.32%). Centrality refers to the degree of importance or centrality of a node in a network and is a measure of the importance of a node in a network ( 69 ). In Table 4 the United States is also has the highest centrality (0.43). Figure 6 shows the geographic collaboration network of countries in this field, with 83 countries contributing to BPD research, primarily from the United States and Europe.

Table 4 Top 10 countries that published BPD researches.

Figure 6 Map of the distribution of countries/regions engaged in BPD researches.

3.7 Analysis of the co-author’s institutions network

Table 5 listed the top 10 institutions ranked by the number of publications. The current study shows that Research Libraries Uk is the institution with the highest number of publications, with 766 publications (9.67%). The subsequent institutions are Harvard University and Ruprecht Karls University Heidelberg with 425 (5.37%) and 389 (4.91%) publications respectively. As can be seen from Table 4 , six of the top 10 institutions in terms of number of publications are from the United States. In part, this reflects the fact that the United States institutions are at the forefront of the BPD field and play a key role in it.

Table 5 Top 10 institutions that published BPD researches.

3.8 Analysis of journals and cited journals

If the more papers are published in a particular journal and at the same time it has a high number of citations, then it can be considered that the journal is influential ( 70 ). The top 10 journals in the field of BPD in terms of number of publications are listed in Table 6 . Journal of Personality Disorders from the Netherlands published the most literature on BPD with 438 (5.53%; IF=3.367) publications. This was followed by two journals from the United States: Psychiatry Research and Personality Disorders Theory Research and Treatment , with 269 (3.40%, IF=11.225) and 232 (2.93%; IF=4.627) publications, respectively. Among the top 10 journals in terms of number of publications published, Psychiatry Research has the highest impact factor.

Table 6 Top 10 journals that published BPD researches.

3.9 Analysis of keywords and keywords co-occurrence

Keyword co-occurrence analysis can help researchers to understand the research hotspots in a certain field and the connection between different research topics. As shown in Figure 7 , all keywords can be categorized into 9 clusters: cluster #0 “diagnostic interview”, cluster #1 “diagnostic behavior therapy”, cluster #3 “social cognition”, cluster #4 “emotional regulation”, cluster #5 “substance use disorders “, cluster #6 “posttraumatic stress disorder”, cluster #7 “suicide” and cluster #8 “double blind”. These keywords have all been important themes in BPD research during the last 20 years.

Figure 7 The largest 9 clusters of co-occurring keywords. The top 5 most frequent keywords in each cluster are highlighted.

Keyword burst is used to identify keywords with a significant increase in the frequency of occurrence in a topic or domain, helping to identify emerging concepts, research hotspots or keyword evolutions in a specific domain ( 71 ). Figure 8 presented the top 32 keywords with the strongest citation bursts in BPD from 2003−2023. Significantly, the keywords “positron emission tomography” (29.63), “major depression” (27.93), and “partial hospitalization” (27.1) had the highest intensity of outbreaks.

Figure 8 Keywords with the strongest occurrence burst on BPD researches.

4 Discussion

4.1 application of the “neuro-behavioral model” to bpd research.

In this study, we chose specific search terms, particularly “Neuro-behavioral Model”, to efficiently collect and analyze BPD research literature related to this emerging framework. This choice of keyword helped narrow the research scope and ensure its relevance to our objectives. However, it may have excluded some studies using different terminology, thus limiting comprehensiveness. In addition, the ‘Neuro-behavioral Model’, as an interdisciplinary field, encompasses a wide range of connotations and extensions, which also poses challenges to our research. This undoubtedly adds to the complexity of the study, yet it enhances our understanding of the field’s diversity.

4.2 Summary of the main findings

This current study utilized CiteSpace and Scimago Graphic software to conduct a comprehensive bibliometric analysis of the research literature on BPD. The study presented the current status of research, research hotspots, and research frontiers in BPD over the past 20 years (2003–2022) through knowledge mapping. The scientific predictions of future trends in BPD provided by this study can guide researchers interested in this field. This study also uses bibliometrics analysis method to show the knowledge structure and research results in the field of BPD, as well as the scientific prediction of the future trend of BPD research.

4.3 Identification of research hotspots

Previous studies have indicated an increasing trend in the number of papers focused on BPD, with the field gradually expanding into various areas. The first major research trend involves clinical studies on BPD. This includes focusing on emotional recognition difficulties in BPD patients, as well as studying features related to suicide attempts and non-suicidal self-injury. Clinical recognition and confirmation of BPD remains low, mainly related to the lack of clarity of its biological mechanisms ( 72 ). The nursing environment for BPD patients plays an important role in the development of the condition, which has become a focus of research. Researchers are also exploring the expansion of treatment options from conventional medication to non-pharmacological approaches, particularly cognitive-behavioral therapy. Another major research trend involves the associations and complications of BPD, including a greater focus on the adolescent population to reduce the occurrence of BPD starting from adolescence. Additionally, many researchers are interested in the comorbidity of BPD with various clinical mental disorders.

4.4 Potential trends of future research on BPD

Based on the results of the above studies and the results of the research trends in the table of details of the co-citation network clusters in 2022 ( Table 7 ), several predictions are made for the future trends in the field of BPD. In Table 7 , there were some trends related to previous studies, including #1”dialectical behavior therapy”, #7 “dialectical behavior therapy” ( 73 ), #5 “mentalization” ( 74 ), and #9 “non-suicidal self-injury” ( 75 ). The persistence of these research trends is evidence that they have been a complex issue in this field and a focus of researchers. The recently emerged turning point paper provides a comprehensive assessment about BPD, offering practical information and treatment recommendations ( 76 ). New research is needed to improve standards and suggest more targeted and cost-effective treatments.

Table 7 The references co-citation network cluster detail (2022).

BPD symptoms in adolescents have been shown to respond to interventions with good results, so prevention and intervention for BPD is warranted ( 77 ). This trend can be observed in #3 “youth” ( 78 ). Mark F. Lenzenweger and Dante Cicchetti summarized the developmental psychopathology approach to BPD, one of the aims of which is to provide information for the prevention of BPD ( 79 ). Prevention and early intervention of BPD has been shown to provide many benefits, including reduced occurrence of secondary disorders, improved psychosocial functioning, and reduced risk of interpersonal conflict ( 80 ). However, there are differences between individuals, and different prevention goals are recommended for adolescents at risk for BPD. Therefore, prevention and early intervention for BPD has good prospects for the future.

The etiology of BPD is closely related to many factors, and its pathogenesis is often ignored by clinicians. The exploration of risk factors has been an important research direction in the study. Some studies have found that BPD is largely the product of traumatic childhood experiences, which may lead to negative psychological effects on children growing up ( 81 ). It has also been found that the severity of borderline symptoms in parents is positively associated with poor parenting practices ( 82 ). Future researches need to know more about the biological-behavioral processes of parents in order to provide targeted parenting support and create a good childhood environment.

Because pharmacotherapy is only indicated for comorbid conditions that require medication, psychotherapy has become one of the main approaches to treating BPD. The increasingly advanced performance and availability of contemporary mobile devices can help to take advantage of them more effectively in the context of optimizing the treatment of psychiatric disorders. The explosion of COVID-19 is forcing people to adapt to online rather than face-to-face offline treatment ( 83 ). The development of this new technology will effectively advance the treatment of patients with BPD. Although telemedicine has gained some level of acceptance by the general public, there are some challenges that have been reported, so further research on the broader utility of telemedicine is needed in the future.

4.5 The current study compares with a previous bibliometric review of BPD

As mentioned earlier, there have been previous bibliometric studies conducted by scholars in the field of BPD. This paper focuses more on BPD in personality disorders than the extensive study of personality disorders as a category by Taylor Reis et al. ( 15 ). The results of both studies show an increasing trend in the number of publications in the field of BPD, suggesting positive developments in the field. Taylor Reis et al. focused primarily on quantifying publications on personality disorders and did not delve into other specific aspects of BPD. Ilaria M.A. Benzi et al. focused on a bibliometric analysis of the pathology of BPD ( 14 ). They give three trends for the future development of BPD pathology: first, the growing importance of self-injurious behavior research; second, the association of attention deficit hyperactivity disorder with BPD and the influence of genetics and heritability on BPD; and third, the new focus on the overlap between fragile narcissism and BPD. The study in this paper also concludes that there are three future development directions for BPD: first, the prevention and early intervention of BPD; second, the non-pharmacological treatment of BPD; and third, research into the pathogenesis of BPD. Owing to variations in research backgrounds and data sources, the outcomes presented in the two studies diverge significantly. Nevertheless, both contributions hold merit in advancing the understanding of BPD. In addition to this, this paper also identifies trends in BPD over the past 20 years: the first trend is the clinical research of BPD, which is specifically subdivided into three sub-trends; the second trend is association and comorbidity. The identification of these trends is important for understanding the disorder, improving diagnosis and treatment, etc. Structural variant analysis also features prominently in the study. The impact of literature in terms of innovativeness is detected through in-depth mining and analysis of large amounts of literature data. This analysis is based on research in the area of scientific creativity, especially the role and impact of novel reorganizations in creative thinking. Structural variation analysis is precisely designed to find and reveal embodiments of such innovative thinking in scientific literature, enabling researchers to more intuitively grasp the dynamics and cutting-edge advances in the field of science.

5 Limitations

However, it must be admitted that our study has some limitations. The first is the limited nature of data resources. The data source for our study came from only one database, WOS. Second, the limitation of article type. Search criteria are limited to papers and reviews in SCI and SSCI databases. Third, the effect of language type. In the current study, only English-language literature could be included in the analysis, which may lead us to miss some important studies published in other languages. Fourth, limitations of research software. Although this study used well-established and specialized software, the results obtained by choosing different calculation methods may vary. Finally, the diversity of results interpretation. The results analyzed by the software are objective, but there is also some subjectivity in the interpretation and analysis of the research results. While we endeavor to be comprehensive and accurate in our research, the choice of search terms inevitably introduces certain limitations. Using “Neuro-behavioral Model” as the search term enhances the study’s relevance, but it may also cause us to miss significant studies in related areas. This limits the generalizability and replicability of our results. Furthermore, the inherent complexity and diversity of neurobehavioral models might introduce subjectivity and bias in our interpretation and application of the literature. Although we endeavored to reduce bias via multi-channel validation and cross-referencing, we cannot entirely eliminate its potential impact on our findings.

6 Conclusion

Overall, a comprehensive scientometrics analysis of BPD provides a comprehensive picture of the development of this field over the past 20 years. This in-depth examination not only reveals research trends, but also allows us to understand which areas are currently hot and points the way for future research efforts. In addition, this method provides us with a framework to evaluate the value of our own research results, which helps us to more precisely adjust the direction and strategy of research. More importantly, this in-depth analysis reveals the depth and breadth of BPD research, which undoubtedly provides valuable references for researchers to have a deeper understanding of BPD, and also provides a reference for us to set future research goals. In short, this scientometrics approach gives us a window into the full scope of BPD research and provides valuable guidance for future research.

Author contributions

YL: Data curation, Formal analysis, Investigation, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing. CC: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. YZ: Validation, Visualization, Writing – review & editing. NZ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. SL: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. SL is supported by the Outstanding Youth Program of Philosophy and Social Sciences in Anhui Province (2022AH030089) and the Starting Fund for Scientific Research of High-Level Talents at Anhui Agricultural University (rc432206).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: neuro-behavioral model, borderline personality disorder, BPD, bibliometric, Scimago Graphica

Citation: Liu Y, Chen C, Zhou Y, Zhang N and Liu S (2024) Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends. Front. Psychiatry 15:1361535. doi: 10.3389/fpsyt.2024.1361535

Received: 12 January 2024; Accepted: 19 February 2024; Published: 01 March 2024.

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• Borderline personality disorder

Borderline personality disorder is a mental health condition that affects the way people feel about themselves and others, making it hard to function in everyday life. It includes a pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of seeing themselves. Impulsiveness involves having extreme emotions and acting or doing things without thinking about them first.

People with borderline personality disorder have a strong fear of abandonment or being left alone. Even though they want to have loving and lasting relationships, the fear of being abandoned often leads to mood swings and anger. It also leads to impulsiveness and self-injury that may push others away.

Borderline personality disorder usually begins by early adulthood. The condition is most serious in young adulthood. Mood swings, anger and impulsiveness often get better with age. But the main issues of self-image and fear of being abandoned, as well as relationship issues, go on.

If you have borderline personality disorder, know that many people with this condition get better with treatment. They can learn to live stabler, more-fulfilling lives.

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Borderline personality disorder affects how you feel about yourself, relate to others and behave.

Symptoms may include:

• A strong fear of abandonment. This includes going to extreme measures so you're not separated or rejected, even if these fears are made up.
• A pattern of unstable, intense relationships, such as believing someone is perfect one moment and then suddenly believing the person doesn't care enough or is cruel.
• Quick changes in how you see yourself. This includes shifting goals and values, as well as seeing yourself as bad or as if you don't exist.
• Periods of stress-related paranoia and loss of contact with reality. These periods can last from a few minutes to a few hours.
• Impulsive and risky behavior, such as gambling, dangerous driving, unsafe sex, spending sprees, binge eating, drug misuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship.
• Threats of suicide or self-injury, often in response to fears of separation or rejection.
• Wide mood swings that last from a few hours to a few days. These mood swings can include periods of being very happy, irritable or anxious, or feeling shame.
• Ongoing feelings of emptiness.
• Inappropriate, strong anger, such as losing your temper often, being sarcastic or bitter, or physically fighting.

When to see a doctor

If you're aware that you have any of the symptoms above, talk to your doctor or other regular healthcare professional or see a mental health professional.

If you have thoughts about suicide

If you have fantasies or mental images about hurting yourself, or you have thoughts about suicide, get help right away by taking one of these actions:

• Call 911 or your local emergency number right away.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.
• U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line . Or text 838255. Or chat online.
• The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Call your mental health professional, doctor or another member of your healthcare team.
• Reach out to a loved one, close friend, trusted peer or co-worker.
• Contact someone from your faith community.

If you notice symptoms in a family member or friend, talk to that person about seeing a doctor or mental health professional. But you can't force someone to change. If the relationship causes you a lot of stress, you may find it helpful to see a therapist.

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As with other mental health conditions, the causes of borderline personality disorder aren't fully known. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to:

• Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly related to other mental health conditions among family members.
• Changes in the brain. Some research has shown that changes in certain areas of the brain affect emotions, impulsiveness and aggression.

Risk factors

Factors related to personality development that can raise the risk of getting borderline personality disorder include:

• Hereditary predisposition. You may be at a higher risk if a blood relative — your mother, father, brother or sister — has the same or a like condition.
• Stressful childhood. Many people with the condition report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.

Complications

Borderline personality disorder can damage many areas of your life. It can negatively affect close relationships, jobs, school, social activities and how you see yourself.

This can result in:

• Repeated job changes or losses.
• Not finishing an education.
• Multiple legal issues, such as jail time.
• Conflict-filled relationships, marital stress or divorce.
• Injuring yourself, such as by cutting or burning, and frequent stays in the hospital.
• Abusive relationships.
• Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents, and physical fights due to impulsive and risky behavior.
• Attempted suicide or death due to suicide.

Also, you may have other mental health conditions, such as:

• Depression.
• Alcohol or other substance misuse.
• Anxiety disorders.
• Eating disorders.
• Bipolar disorder.
• Post-traumatic stress disorder (PTSD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Other personality disorders.
• Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed April 28, 2023.
• Borderline personality disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/. Accessed April 28, 2023.
• Skodol A. Borderline personality disorder: Epidemiology, pathogenesis, clinical features, course, assessment and diagnosis. https://www.uptodate.com/contents/search. Accessed April 28, 2023.
• Skodol A. Approach to treating patients with borderline personality disorder. https://www.uptodate.com/contents/search. Accessed April 28, 2023.
• The lifeline and 988. 988 Suicide & Crisis Lifeline. https://988lifeline.org/current-events/the-lifeline-and-988/. Accessed April 28, 2023.
• Borderline personality disorder. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder. Accessed April 28, 2023.
• Starcevic V, et al. Pharmacotherapy of borderline personality disorder: Replacing confusion with prudent pragmatism. Current Opinion in Psychiatry. 2018; doi:10.1097/YCO.0000000000000373.
• Veterans Crisis Line. U.S. Department of Veteran Affairs. https://www.veteranscrisisline.net/. Accessed April 28, 2023.
• Allen ND (expert opinion). Mayo Clinic. June 21, 2023.
• Ekiz E, et al. Systems Training for Emotional Predictability and Problem-Ssolving for borderline personality disorder: A systematic review. Personal Mental Health. 2023; doi:10.1002/pmh.1558.
• Mendez-Miller M, et al. Borderline personality disorder. American Family Physician. 2022. https://www.clinicalkey.com. Accessed April 28, 2023.
• Lebow J. Overview of psychotherapies. https://www.uptodate.com/contents/search. Accessed April 28, 2023.
• Elsevier Point of Care. Borderline personality disorder. https://www.clinicalkey.com. Accessed April 28, 2023.

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Is Borderline Personality Disorder a Moral or Clinical Condition? Assessing Charland’s Argument from Treatment

• Original Paper
• Published: 04 December 2013
• Volume 7 , pages 215–226, ( 2014 )

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Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in moral character, and (2) that effective treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification.

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According to DSM-IV classification [ 3 ], the Cluster B personality disorders are antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, and borderline personality disorder.

Charland does not think the two categories are mutually exclusive [ 5 ].

Pearce comments on the second prong, but provides no detailed analysis of it beyond a mention that some evidence shows that some CBPDs are responsive to pharmacological and psychotherapeutic treatments [ 17 ].

There is actually a body of empirical evidence that suggests a dissociation between moral behaviour and moral beliefs in non-coercive cases [ 18 ]. In light of this, my example of a change in moral character, accompanied by no change in moral behaviour, may not be entirely unrealistic.

This situation is not only conceivable, but is actually very common in BPD patients. These patients are known to be able to control their negative behaviours in some instances, perhaps via inhibiting malicious desires and intents [ 6 :10]. These situations could be interpreted as cases where immoral behaviour has been curbed, but an underlying change in values, desires, or beliefs has not occurred.

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Charland, L.C. 2004. Moral treatment and the personality disorders. In The philosophy of psychiatry: A companion , ed. J. Radden, 64–78. Oxford: Oxford University Press.

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Horne, G. Is Borderline Personality Disorder a Moral or Clinical Condition? Assessing Charland’s Argument from Treatment. Neuroethics 7 , 215–226 (2014). https://doi.org/10.1007/s12152-013-9199-3

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Received : 19 May 2013

Accepted : 18 November 2013

Published : 04 December 2013

Issue Date : August 2014

DOI : https://doi.org/10.1007/s12152-013-9199-3

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Is this actually PTSD? Clinicians divided over redefining borderline personality disorder

Some have argued BPD should be reclassified as a trauma disorder, maintaining those diagnosed are typically women with abuse in their past

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When Prof Andrew Chanen was a trainee psychiatrist in 1993, patients with borderline personality disorder (BPD) who had self-harmed were “vilified” and “treated appallingly”.

“There was this myth that somehow they were indestructible,” he says. Despite what his teachers told him, “most were dead by the end of my training”.

More than three decades later, Chanen is the chief of clinical practice and head of personality disorder research at Orygen, the National Centre of Excellence in Youth Mental Health at the University of Melbourne, and he says BPD remains the most stigmatised and discriminated against mental health disorder in Australia and internationally.

Overwhelmingly diagnosed in women , BPD is characterised by difficulty managing emotions, rapid mood changes, self-harm often accompanied by suicidal thoughts, and an unstable self image.

Some Australian clinicians are calling for BPD to be recognised as a trauma disorder rather than a personality disorder, arguing this would lead to better treatment and outcomes.

The argument for rethinking BPD

American psychoanalyst Adolph Stern introduced the word “borderline” to psychiatric terminology in 1938, using it to describe a group of patients who fitted neither the neurotic nor the psychotic diagnostic categories.

Several studies have shown BPD is associated with child abuse and neglect more than any other personality disorders, but the rates can vary from as high as 90% to as low as 30% . An analysis of 97 studies found 71.1% of people who were diagnosed with the condition reported at least one traumatic childhood experience.

Dr Karen Williams, who runs New South Wales’s Ramsay Clinic Thirroul – Australia’s first women-only trauma hospital – believes BPD “is a gendered diagnosis that is given to women who have got histories of abuse, whereas when we see a man come back from a traumatic event, we [say] he’s got PTSD [post-traumatic stress disorder]”.

“There is no symptom that a borderline personality disordered person has that a PTSD patient doesn’t also have.”

Williams says it often takes several sessions before she can uncover a patient’s abuse. The response of dissociation and forgetting trauma is very common, she says. Also, not all patients recognise their experiences as trauma.

Despite there being no clinical difference between PTSD and BPD, Williams says the clinical response varies markedly. PTSD, particularly among veterans, is treated with sympathy, while women with the diagnosis of BDP are considered “difficult”.

Williams prefers the term “complex post-traumatic stress disorder” to BPD, as does Prof Jayashri Kulkarni, the director of the Monash Alfred Psychiatry Research Centre. Kulkarni says the BPD label implies the behaviour is part of a personality style. There’s an implied “stern moralistic approach” that these people should just be able to control themselves – and that attitude contributes to stigma.

But she says the more she has researched BPD, “the more obvious it seems the women and the men who have been labelled with this condition often have dreadful early life trauma”.

“I really think this is injustice, to say to somebody who’s gone through hell in their early life and onwards, that they’ve got a significant flaw of their inner core.”

The case for the term personality disorder

To Chanen, the term “personality disorder” is useful because it captures the identity and relationship difficulties he says are at the heart of the issue.

He points to a national study of childhood maltreatment published in 2023 which showed nearly two-thirds of the population experience some form of childhood adversity. Despite that, BPD is comparatively rare, occurring in only 1% to 3% of the population.

“There’s something important going on in each individual that interacts with the experience of adversity. While that interaction might give rise to borderline personality disorder, it might also give rise to another disorder, such as depression, or no mental disorder,” he says.

“That’s not to say that the adversity is unimportant, but it’s not inevitable that a person will develop a mental disorder, and certainly not inevitable that they will develop borderline personality disorder.”

Chanen believes any reductionist arguments about causes are “oversimplified, wrong and unfortunately harmful for people living with personality disorder”. He believes the debate around re-naming the disorder as complex PTSD is “not really supported by the science and weakens the moral argument for respect, dignity and equality of access to effective services”.

Chanen is concerned a name change may have the unintended consequence of invalidating the experiences of patients who have not experienced trauma, or prompt clinicians to assume that trauma is present without any evidence. Instead, he believes early intervention is key.

An associate professor at the University of Sydney, Loyola McLean, who identifies as a Yamatji woman, says of the divided opinions within her profession: “It could well be that we’re talking about two halves of the same whole.

“I think we’ve got to keep an open mind that this adverse experience may be contributing, triggering, and for some people will have a causal element,” says McLean, who is a consultation-liaison psychiatrist and psychotherapist.

“Trauma – in particular early trauma, because that’s where the body and brain are really developing – we know that it’s such a huge risk factor for downstream health problems across the spectrum of health problems.”

The physical and the psychological are deeply connected , she says, but “the whole of the western world is still suffering from a kind of a Cartesian divide”.

A shifting approach

The discussion about using BPD or complex post-traumatic stress disorder is about more than words – according to Kulkarni, it changes the whole direction and focus for treatment.

Historically, treatment for BPD has relied upon antidepressants to treat low mood and antipsychotics for paranoid thinking, but it has not addressed underlying cognitive symptoms such as difficulty managing emotions, a disturbed sense of identity, disturbed relationships and impulsivity.

Those symptoms tend to be treated with psychosocial approaches, such as dialectical behaviour therapy, mentalisation-based treatment and high quality care.

Kulkarni and Dr Eveline Mu at Monash Alfred Psychiatry Research Centre are running clinical trials for new drugs to target the neurochemistry they believe drives the symptoms of BPD/complex post-traumatic stress disorder.

The effects of trauma on the body’s stress levels mean the glutamate system – the primary neurotransmitters of the nervous system – is in overdrive, Mu says. Her theory is that this drives cognitive dysfunction.

Since it began in 2022, 200 people have participated in the randomised controlled double blinded clinical trial of memantine, a drug that the regulator has approved for treatment of Alzheimer’s patients, and which blocks the body’s glutamate receptors.

Williams’ women’s-only trauma hospital is also examining new ways of responding to those with acute symptoms. She says the only place where acutely suicidal patients can go are mixed-gender rooms in hospital psychiatric wards , which have no locks and can lack supervision of male patients who are often psychotic, drunk and detoxing. Sexual assault is often rife in such wards.

It’s an environment that exacerbates symptoms, she says.

By contrast, the three-week program her patients undergo involves exercise, self-care, and education about healthy relationships.

“Almost all the time, they don’t just have trauma from their childhood, but they’ve still got it now,” Williams says. “We know that people who have been abused tend to end up in abusive relationships again, because they have such little self value and they don’t know that they deserve to be treated better.”

The hospital’s beds are constantly full with patients who can afford private treatment, with some even coming from interstate. Only one of the hospital’s 40 beds is publicly funded.

Williams says her program has improved the quality of life of her patients, with many able to take on full-time work or go back to study. “Many of them have said: ‘I want to be a nurse, I want to come back and work here.’”

Kulkarni says one of the other new solutions is to get rid of the label. “It’s hurting people … Taking a new look offers us new compassion and new understanding.”

This article was amended on 12 May 2024 to correct the year in which Prof Andrew Chanen was a trainee psychiatrist. It was 1993, not 1983.

In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978.

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The Link Between Borderline Personality Disorder and Anger

What factors contribute to the tendency for such anger arousal.

Posted April 9, 2024 | Reviewed by Abigail Fagan

• How Can I Manage My Anger?
• Find a therapist to heal from anger
• Borderline Personality Disorder (BPD) involves instability of self-image, relationships and emotions.
• The above symptoms contribute to a heightened sense of threat and related anger.
• A number of biosocial developmental models explain the development of borderline personality disorder.

Borderline personality disorder (BPD) is a severe and complex personality disorder associated with instability in interpersonal relations, behavior, and emotions. Emotional dysregulation is a key contributor to BPD, involving difficulties in regulating emotions in order to support an individual’s pursuit of goals and behaving effectively in a variety of contexts.

Anger and aggression are key features associated with BPD — most often related to fears of abandonment, unstable relationships, an unstable self-image , emotional instability, and chronic feelings of emptiness. As such anger may be sudden, intense and difficult to calm down. When more intense, it is often described as “borderline rage”.

The character Alex Forrest (played by Glenn Close) offers a powerful representation of a woman suffering from borderline personality disorder in Fatal Attraction . In the pursuit of her relationship with Dan Gallagher (played by Michael Douglas) she exhibits many of the symptoms of BPD including rage, unstable self-image, fears of abandonment and violence.

The symptoms of borderline personality most often first appear during teenage years and early twenties worked with one young man early in my practice who clearly articulated the impact of “feeling empty”. On one occasion he stated, “How am I supposed to know what career I wish to pursue? I have no idea what I like. I don’t know who I am!” Another client reported getting drunk on weekends and seeking to have a physical altercation. It was as if this gave him some meaning against a blank slate presented by the weekend.

Factors that trigger anger

The fear of abandonment or rejection as well as sensitivity to frustration and stress can easily lead to a heightened sense of threat. The lack of a solid identity combined with feelings of emptiness leaves one with BPD vulnerable to feeling criticized, slighted or rejected, which consequently intensifies fears of being alone. The lack of a more solid self-image, coupled with a pattern of unstable interpersonal relationships combine to undermine the resilience to stress and challenging emotions.

Contributing factors to BPD anger

There are a number of biosocial developmental models regarding the development of borderline personality disorder. These emphasize developing in an environment that is invalidating and having adverse childhood experiences in combination with genetically linked vulnerabilities. Specifically, these might include impulsivity and emotional instability.

Some of these theories highlight specific areas of functioning as providing an understanding of emotional triggering for individuals with BPD. Some focus on emotional regulation . Others focus on cognitive aspects, including cognitive-emotional patterns that cause those with BPD to have greater expectations of rejection than those without BPD (Cavicchioli and Maffer, 2019).

In one study of individuals with BPD, it was found that half of the group also had suffered from two or more anxiety disorders (Quenneville, Kalogeropoulou, Lise-Kung, et. al., 2019). Additionally, greater childhood mistreatment was associated with greater severity of illness, impulsivity and trait anger.

Some researchers have found that those with BPD exhibit a negative bias in decoding social cues (Kleindienst, Hauschild, Liebke, et. al., 2019) They found that those who exhibited more chronic symptoms of BPD were more likely to assess happy facial expressions as being less happy than those without BPD.

Exploring the neuroscience of BPD, one group of researchers has found through magnetic resonance scanning with males, that those with BPD showed less activation of the prefrontal area of the brain during the viewing of happy and angry faces (Bertsch, Krauch, Roelofs, et. al., 2019). Additionally, they found that reduced functioning of this area of the brain was associated with impaired emotional control and with greater acting out of anger.

One study found that anger rumination was greater for those with BPD when compared to a healthier population (Oliva, Ferracini, Amoia, et. al., 2023). Anger rumination has been found to be positively associated with anger feelings and aggressive/impulsive behaviors.

Research regarding intimate partner violence (IPV) found that male and female perpetrators are more often found to have BPD than others (Johnson, Leone, and Xu, 2014). Another study found that individuals with BPD are more likely to be victims of IPV (Jackson, Sippel, Mota, et. al., 2015). It was hypothesized that emotional dysregulation may trigger such a reaction by the partner.

Trait anger (chronic) has been found to be higher for individuals with BPD than for others (Armenti and Babcock, 2018). Additionally, those with BPD, having higher trait anger, were more likely to engage in IPV than others.

It’s important to note that aggression associated with borderline personality disorder may be directed outward or inward. In one expansive study (36,309 respondents) exploring this issue, it was found that violence toward others was more associated with identity disturbance, impulsivity and intense anger, while violence directed inward was more associated with avoidance of abandonment, self-mutilating behavior, and feelings of emptiness (Hartford, Chen, Kerridge, et. al., 2018).

In the late 80s I worked in an inpatient program for women who self-injure. Most were diagnosed with BPD. While there were often several key contributing factors to such behavior, the self-injury served as a distraction from feeling empty and a way of feeling connected with oneself.

Research has also shown that there is a strong association between having an insecure attachment style and borderline personality disorder (Critchfield, Levy, Clarking, et. al., 2007). And when this is of the anxious insecure attachment style, there is a greater likelihood of reactive aggression. Additionally, self-harm was found to be associated with relational avoidance while anger and irritability were associated with anxiety.

For some disorders, symptoms tend to remit as an individual ages. While this may be true in general, one study of BPD found that, while younger adults with BPD were more likely to have emotional dysregulation, be impulsive, aggressive and self-injurious and have intense feelings of emptiness, older patients were still impaired primarily with regard to impulsiveness, emotional regulation and social functioning (Martino, Gammino, Sanza, et. al., 2020).

It’s reported that 45% of people treated for borderline personality disorder do not respond well to current psychological treatments (Woodridge, Reis, Townsend, et. al., 2021). The symptom complex associated with BPD undermines the capacity to form a trusting relationship with a therapist. In general, an integrated approach seems to be the most effective with this population.

A meta-analysis regarding such treatment, published between 1989 and 2019, identifies the most effective approaches as dialectical behavior therapy (DBT), schema therapy, psychoeducation, system training of emotional predictability and problem solving, and treatment using mentalization (Mungo, Hein, Hubain, et. al., 20.

DBT involves both a cognitive behavioral emphasis in conjunction with mindfulness , which includes individual therapy and skills training groups. Schema-Focused Therapy is an integrative approach that combines strategies from CBT, experiential, interpersonal and psychoanalytic therapy.

Individuals with BPD have difficulties forming relationships, managing their emotions and stress in general, and have an unstable self-image. Borderline personality disorder entails a constellation of symptoms that reflect and create an increased tendency for anger arousal. As such, it is essential that any psychotherapy for BPD also address anger management . Additionally, fears of abandonment and rejection undermine not only personal relationships but therapeutic relationships as well. However, there are a variety of well-researched therapeutic treatments that can help those with BPD live a more stable and fulfilling life.

Cavicchioli, M. & Maffei, C. (2020). Rejection sensitivity in borderline personality disorder and the cognitive-affective personality system: A meta-analytic review. Personality Disorders: Theory, Research, and Treatment, Vol.11 (1), 1-12. doi.org/10.1037/per0000359

Qenneville, A., Kalogeropoulou, E., Lise Kung, A., et. al. (2020). Childhood maltreatment, anxiety disorders and outcome in borderline personality disorder. Psychiatry Research, Vol 284, (2)

Kleindienst, N., Hauschild, S., Liebke, L., et. al. (2019). A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted Borderline Personality Disorder. Borderline Personality Disorder and Emotion Dysregulation. Vol. 6, (17). https://doi.org/10.1186/s40479-019-0114-3

Bertsch, K., Krauch, M., Roelofs, K., et. al. (2019). Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology, Vol. 156, (15)

Oliva, A., Ferracini, S., Amoia, R., et. al. (2023) The association between anger rumination and emotional dysregulation in borderline personality disorder: a review. Journal of Affective Disorders, Vol. 338 (1) 546-553

Johnson MP, Leone JM, Xu Y. ( 2014). Intimate terrorism and situational couple violence in general surveys: Ex-spouses required. Violence Against Women ;20:186. http://dx.doi.org/10.1177/1077801214521324 (originally published online 6 February 2014).

Jackson, M., Sippel, L., Mota, N., et. al. (2015). Borderline personality disorder and related constructs as rick factors for intimate partner violence perpetration. Aggressive Violent Behavior, Sep-Oct: Vol. 24: 95-106.

Armenti, N. & Babcock, J., et. al. (2018). Borderline personality features, anger and intimate partner violence: an experimental manipulation of rejection. Journal of Interpersonal Violence, Vol. 36, (5-6).

Harford, T, Chen, C., Kerridge, B., et. al. (2018). Borderline personality disorder an violence toward self and others: a national study. Home Journal of Personality Disorders, Vol.33 (5). Published Online:October 2019. doi.org/10.1521/pedi_2018_32_361

Critchfield, K., Levy, K, Clarkin, J, et. al. (2008). The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility. Journal of Clinical Psychooogy, Vol 64, (1) 67-82

Martino, F., Gammino, L, Sanza, M., et. al. (2020). Impulsiveness and emotional dysregulation as stable features in borderline personality disorder outpatients over time. The Journal of Nervous and. Mental Disease, Vol. 208, (9) 715-720.

Woodbridge, J., Reis, S., Townsend, M., et. al. (2021) Searching in the dark: shining a light on some predictors of non-response to psychotherapy for borderline personality disorder. Plus One: doi.org/10.1371/journal.pone.0255055

Mungo, A., Hein, M., Hubain, P. et al. (2020). Impulsivity and its Therapeutic Management in Borderline Personality Disorder: a Systematic Review. Psychiatry Q 91, 1333–1362 (2020). https://doi.org/10.1007/s11126-020-09845-zReview Article

Bernard Golden, Ph.D., is the founder of Anger Management Education and author of Overcoming Destructive Anger: Strategies That Work .

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Here’s how generative ai can help you deal with people and vexing personality disorders.

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Using generative AI to simulate personality disorders can be useful, though also controversial.

In today’s column, I am continuing my ongoing series about the impact of generative AI in the health and medical realm. The focus this time is once again on the mental health domain. Specifically, I will carefully examine the ins and outs of using generative AI to gauge what it is like to interact with someone who might have a personality disorder.

I have previously examined numerous interleaving facets of generative AI and mental health, see my comprehensive overview at the link here . You might also find of notable interest a CBS 60 Minutes episode that recently examined crucial facets of this evolving topic, see the link here (I was interviewed and appeared in the episode).

Other useful background includes my coverage of mental health chatbots that have been bolstered by generative AI (see the link here ) and the rapidly changing nature of the client-therapist relationship due to generative AI at the link here . I explored where things are headed regarding the levels of AI-based mental therapy autonomous guidance at the link here , and showcased the importance of the World Health Organization (WHO) report on global health and generative AI at the link here , and so on.

Today’s topic entails using generative AI to simulate various personality disorders so that you can gauge how to respond and cope with such circumstances in real life. As you will see, using generative AI to in this manner has benefits, downsides and controversies. There is more to this than meets the eye.

Here’s how I will proceed.

First, we need to set the stage by defining what is meant by referring to the conditions or characteristics known as personality disorders. Many use that term quite casually and almost with abandon these days. I will provide both formal and informal definitions to clarify the matter.

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Second, turns out that generative AI and large language models (LLMs) can do a surprisingly engaging job of computationally mimicking or pretending to exhibit the properties of personality disorders. This is done by invoking the personas feature of generative AI, which I’ve covered in-depth at the link here and the link here , just to name a few.

Third, I will walk through a series of generative AI personas that are each devised to express a particular personality disorder. A brief AI-engaged conversation will be shown. The idea is that you will be able to witness the value of such efforts and consider whether you or someone you know might benefit by using generative AI in this fashion.

I think you’ll find fruitful this eye-opening journey.

Let’s dive in.

Personality Disorders And What They Are About

The American Psychological Association (APA) online dictionary indicates that the phrase “personality disorder” is defined this way:

• “Any in a group of disorders involving pervasive patterns of perceiving, relating to, and thinking about the environment and the self that interfere with long-term functioning of the individual and are not limited to isolated episodes.” (Source: APA website online dictionary for the term “Personality Disorders”).

I realize that this definition might seem somewhat stodgy and possibly not easily grasped at first glance, especially if you aren’t versed in the mental health domain.

A somewhat more plainspoken definition is given on the Mayo Clinic website which says this:

• “A personality disorder is a mental health condition where people have a lifelong pattern of seeing themselves and reacting to others in ways that cause problems. People with personality disorders often have a hard time understanding emotions and tolerating distress. And they act impulsively. This makes it hard for them to relate to others, causing serious issues, and affecting their family life, social activities, work and school performance, and overall quality of life.” (Source: Mayo Clinic website, Diseases & Conditions section, “Personality Disorders” posting).

That seems clearer to the eye and the mind.

There is another facet of special noteworthiness about personality disorders that is further expressed on the Mayo Clinic website:

• “In some cases, you may not know that you have a personality disorder. That's because how you think and behave seems natural to you. You also may think others are responsible for your challenges. There are many types of personality disorders, each with important differences. These disorders are organized into three groups, or clusters, with shared features and symptoms.” (ibid).

A crucial point here is that just because you guess that someone has a personality disorder does not make it so. Nowadays, everybody is an armchair clinical psychologist or self-professed mental health professional. Be cautious in labeling people as possessing a particular personality disorder. It would be wise to allow those who are specially licensed and trained for such mental health determinations to render these serious and potentially life-changing resolves.

Another point of noteworthiness is that a person who perhaps has a particular personality disorder might be entirely unaware of their condition. To them, they are as they are. They seem to be on par with everyone else. Or they realize there is something different about themselves, but do not perceive the difference to be attributable to a personality disorder per se.

This brings up an interesting question for you to mull over.

How prevalent is the condition of having a personality disorder?

Think it over.

Is this a rare condition to have a personality disorder? Does it only occur on a once-in-a-zillion chance? And so on.

Research suggests that personality disorders are a lot more frequent than you might have envisioned. In a meta-analysis research study entitled “The Prevalence Of Personality Disorders In The Community: A Global Systematic Review And Meta-analysis” by Catherine Winsper, Ayten Bilgin, Andrew Thompson, Steven Marwaha, Andrew M. Chanen, Swaran P. Singh, Ariel Wang and Vivek Furtado, The British Journal of Psychiatry , 2019, the researchers made these salient points (excerpts):

• “A recent narrative review reported relatively high rates of personality disorders (4.4–21.5%) in community populations across the Western world.”
• “Personality disorders are now recognized as important conditions, which are associated with morbidity, premature mortality, and great personal and social costs.”
• “Personality disorders are associated with high levels of mental, physical and functional impairment and premature mortality.”
• “Despite substantial inter-survey heterogeneity, we found that personality disorders are prevalent globally, affecting a substantial proportion of the population. Epidemiological research on personality disorders is relatively sparse, with a paucity of data from lower-income countries from which to draw comparative conclusions.”

The crux here is that there is indeed a significantly noted prevalence of personality disorders in society, and it is likely to be gaining speed and expanding. Furthermore, lest you think that it doesn’t especially matter whether there is a prevalence, the research emphasizes that the downsides to the individual and society as a whole are considerable.

We shouldn’t be ignoring the situation.

We ought to be giving due attention, increasingly so.

If you are wondering what kinds or types of personality disorders there are, I will bring to your attention a noteworthy research paper that pulled together a multitude of reputable source materials to identify some of the most widely noted personality disorders. A research study entitled “Do You Have To Be Mad To Believe In Conspiracy Theories? Personality Disorders And Conspiracy Theories” by Adrian Furnham and Simmy Grover, International Journal of Social Psychiatry , July 2021, examined various facets of personality disorders, and proffered these points (excerpts):

• “The various Personality Disorders (PDs) have been labeled differently by different authors.”
• “There are many different measures of personality disorders, which can be measured by single item, a single disorder, or by many. In the Diagnostic and Statistical Manual of Mental Disorders fourth edition, (DSM-IV) PDs are grouped into three clusters: ‘A’ – odd, ‘B’ – dramatic/emotional, and ‘C’ – anxious. We shall be using this system whilst we recognize there are others such as the ICD system which classifies people into mild, moderate, and severe PD disorders.”
• “Many studies do analysis at the PD and higher order factors. Note that there were no fundamental changes in the new DSM-V regarding the classification of the PDs. Although the DSM-IV describes disorders as being ‘enduring, inflexible, and long-term’, studies reveal disorders are generally less prevalent with age.”

The researchers proceeded to explore in-depth these named personality disorders:

• Passive-aggressive
• Narcissistic
• Schizotypal
• Obsessive-compulsive

I am sure you’ve seen most if not all of those terms or phrases before. They are used everywhere, including on social media, in the mainstream news, in movies and TV, etc. We use those words and phrases as throwaway lines these days.

Rather than rely on an off-the-cuff notion of what those terms and phrases denote, I will go ahead and quote from the above research paper a definition that they mindfully composed for each of the listed conditions. I’ll do so in a moment.

Now that we’ve started into the personality disorder milieu, I want to bring generative AI into the picture.

Generative AI For Simulating Personas Associated With Personality Disorders

Can we have generative AI pretend to exhibit the conditions associated with distinct personality disorders?

Absolutely, easy-peasy.

I am going to use ChatGPT to showcase various examples. ChatGPT is a sensible choice in this case due to its immense popularity as a generative AI app. An estimated one hundred million weekly active users are said to be utilizing ChatGPT. That’s a staggering number. Allow me to emphasize that the other popular generative AI apps would do likewise, and I am not singling out ChatGPT in this instance. You can readily do the same in GPT-4, Bard, Gemini, Claude, and a myriad of other popular generative AI apps.

A few quick comments before we launch into using ChatGPT.

If you are going to try to do the same prompts that I show here, realize that the probabilistic and statistical properties will likely produce slightly different results than what I show here. That’s the nature of generative AI and how it is devised.

You also should expect that different generative AI apps will respond in different ways. Not all generative AI apps are the same. The key is that sometimes a particular prompt will work in one generative AI app and not another. You will need to undertake a series of trial-and-error attempts to ferret this out.

There is also the timing factor. A prompt that worked today might not work the same way tomorrow. Most of the generative AI apps are continually being updated. The updates might alter internal facets that could change how the AI reacts to your prompting.

We are ready to get underway with ChatGPT.

My opening move in this chess gambit will be to ask the generative AI app whether it has been data-trained pertaining to personality disorders. Here’s the deal. Generative AI is initial data trained by scanning a wide swath of the Internet. A complex set of data structures and computational pattern-matching seek to identify patterns in how humans write. Based on those patterns, generative AI is able to subsequently produce essays and interact with you as though it is fluent in natural language.

Please realize that today’s AI is not sentient. I say this despite those zany blaring headlines that keep claiming we either have sentient AI or are on the cusp of doing so. Hogwash. The amazing fluency that you observe when using generative AI is all about large-scale in-depth mathematical and computational pattern-matching. Period, end of story.

Moving on, here is a handy tip for you. The first step you ought to take when pursuing a dialogue with generative AI is to determine if it has had any prior data trained on the topic. If you get a sparse or non-sensical response, you would be wise to reconsider further pursuing the topic with that generative AI.

Here we go.

• My entered prompt : “What are the various personality disorders? Please name them.”
• ChatGPT generated response:

“Personality disorders are grouped into three clusters in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here are the various personality disorders within each cluster”.

“ Cluster A: Odd or Eccentric Behavio r”

(1) “Paranoid Personality Disorder”

(2) “Schizoid Personality Disorder”

(3) “Schizotypal Personality Disorder”

“ Cluster B: Dramatic, Emotional, or Erratic Behavior ”

(1) “Antisocial Personality Disorder”

(2) “Borderline Personality Disorder”

(3) “Histrionic Personality Disorder”

(4) “Narcissistic Personality Disorder”

“ Cluster C: Anxious or Fearful Behavio r”

(1) “Avoidant Personality Disorder”

(2) “Dependent Personality Disorder”

(3) “Obsessive-Compulsive Personality Disorder”

“These personality disorders are characterized by enduring patterns of behavior, cognition, and inner experience that deviate from cultural expectations and cause significant distress or impairment in functioning. Each disorder has its own unique set of symptoms and diagnostic criteria.”

End of ChatGPT response

The response by ChatGPT is a good sign that some amount of data training associated with personality disorders has in fact occurred.

I would certainly have expected such a response. If you go out to the Internet and look around, I dare say that you’ll find tons of essays, narratives, and the like about personality disorders. It is nearly ubiquitous. We would have undoubtedly been shocked if ChatGPT reported that there had been no prior data training associated with personality disorders.

It would be hard to miss such a looming topic on the web.

Here’s how I am going to proceed.

I will enter a prompt that tells ChatGPT to pretend to be a particular personality disorder. I will walk through each one, one step at a time. This will include providing you with a definition from the above-cited research paper that mindfully puts together instructive definitions.

Once I’ve invoked a specific personality disorder, I will carry on a brief conversation with ChatGPT in that mode. The notion is that you can see me providing everyday remarks and witness how a simulated persona exhibiting the selected personality disorder might respond.

Why would anyone want to do this kind of exercise with generative AI?

Well, imagine that a mental health specialist was trying to gear up on how to interact with various personality disorders. They could use generative AI to get a sense of what they would be like. The beauty of using generative AI is that you can do so at any time on a 24x7 basis, you can do so without having to make any arduous logistic arrangements (you just login), and most importantly you don’t have to worry about inadvertently sparking someone that does have a personality disorder as a result of saying the wrong thing or otherwise messing up.

To clarify, I’m not suggesting that the person using generative AI as a training tool is necessarily going to avoid saying things that might stoke an adverse response. This might actually be something desirous to experience, purposely or by chance, seeing what it is like to have that happen and ascertain how to best respond.

You can use generative AI to try out a wide array of approaches. No harm, no foul, and you can abundantly learn from what happens. Do so to your heart’s content.

I would like to emphatically emphasize that interacting with generative AI is not the same as interacting with a human being. The dynamics of human-to-human interaction will indubitably be on a much more complicated scale. Nonetheless, if you are seeking a low-cost, easy way to practice and do so without inflicting mental anguish upon the other party, generative AI is the way to go.

Do you have to be someone versed in mental health to proceed to use generative AI in this manner?

If you are curious about how people with personality disorders might act or react, you can use generative AI in the mode described here. One considered upbeat viewpoint is that since personality disorders are of some prevalence, perhaps more people ought to be using generative AI to understand what it is like to interact with someone who is exhibiting a personality disorder.

A counterargument is that this will disconcertingly fuel the armchair therapists into believing they are ready to go around making brazen pronouncements about who is and is not embodying a personality disorder. These amateur mental health sleuths will think that just because they played around with generative AI, they are suddenly and summarily anointed as experts in mental health.

There are even more twists too.

Some would exhort, disturbingly, that anyone of any mindset can make this same effort, which is true in the sense that there isn’t any restriction usually about using generative AI in the means I am showing you. Anyone can do so. If you have a generative AI account, you can merely log in and get it underway. Nothing is stopping you.

I have noted in prior coverage that some AI makers indicate in their licensing agreements that you aren’t supposed to use their generative AI for so-called prohibited tasks, see the link here , which whether this kind of an endeavor fits into that category is generally muddled. You might want to consider reading the licensing agreements and usage policies for whichever generative AI app you are using.

Okay, a gigantic AI ethics question is whether it is better that people can readily use generative AI this way or if is it a detriment that anyone can do so. Likewise, some assert that maybe there should be new AI laws that restrict how generative AI can be used in the context of mental health considerations. Should we ban the use of generative AI for certain types of mental health uses, unless someone has the proper licensing and training to be permitted to do so?

A heated debate ensues.

Launching Into The Personality Disorder Examples

You are probably sitting on the edge of your seat and saying that you want to get on with this and see what the whole confabulation is about.

Sure, I get that.

I will be using this prompt as a template for invoking each of the personas that are specific to a particular personality disorder:

• My prompting template: “I want you to pretend to have [ INSERT TYPE OF PD HERE ] personality disorder so that I can see what it is like to interact with someone who has that specific personality disorder. Let's you and I engage in a brief conversation with you taking on that pretense throughout the conversation. I will try to chat with you, and your responses should reflect having the designated personality disorder. You can be somewhat exaggerated in the pretense so that I can readily discern what such a dialogue is like. I will tell you to stop when I've decided we have sufficiently carried on the conversation. Do you understand these instructions?”

As you can see, I will be telling ChatGPT to pretend to be a specific personality disorder.

I already opted to ask ChatGPT about each personality disorder to verify that some semblance of data training had taken place on each one (I won’t show that pre-work, since it is lengthy and not as worthy of seeing as what else I want to show you). Each personality disorder was indicated as having had some prior data training. I opted to proceed accordingly.

The template prompt does something else that might raise eyebrows, so let me preemptively speak to the controversy right now.

I indicate in the prompt that the generative AI can exaggerate the pretense or persona. This might be considered a no-no. Here’s why. In real life, a person with a particular personality disorder will not necessarily wear it on their sleeve. It might be relatively well-hidden. Part of learning about personality disorders ought to also include how to look for telltale clues, including small ones.

The reason that I included the exaggeration indication was that I am merely doing extremely short conversations for the purposes of this illustrative showcase. I need to have each personality disorder appear immediately and apparent to the eye. If I didn’t ask for an exaggeration, the AI might take lots and lots of turns in a conversation to gradually reveal (if at all) the designated personality disorder.

My point is that firstly do not think that people will give away their status in such an obvious way. Second, just because someone does seem to respond as you see here, it does not mean they have the designated personality disorder.

Please, please, please, do not leap to wild conclusions.

I trust that seems clearcut.

Next, I urge that if you opt to do this kind of exercise, don’t tell the AI to do an exaggeration. Instead, allow the AI to be less obvious so that you’ll have to be much more heavily engaged to figure out what might be taking place. That would be a better approach, assuming you have the time and endurance to carry out this kind of erstwhile exercise.

I hope that’s enough of the caveats and small print that we can now get underway.

The sequence will be akin to the listing I showed earlier, which is basically arbitrary and does not suggest any semblance of priority or importance. The numbering here is solely for ease of reference and has no other significance or meaning.

This is the sequence:

• (1) Borderline
• (2) Paranoid
• (3) Avoidant
• (4) Schizoid
• (5) Passive-aggressive
• (6) Narcissistic
• (7) Antisocial
• (8) Histrionic
• (9) Schizotypal
• (10) Obsessive-compulsive
• (11) Dependent

Let’s get going.

(1) Borderline PD: Generative AI As A Borderline Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Borderline : Inappropriate anger; unstable and intense relationships alternating between idealization and devaluation. Familiar term: Unstable relationships. Behavioral tendencies: Flighty; inconsistent; forms intense albeit sudden enthusiasms and disenchantments for people or projects.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

I used my templated prompt to get ChatGPT to simulate this personality disorder:

• My entered prompt : “How are you doing?”
• ChatGPT generated response : “I'm not sure how I'm doing. Sometimes I feel like I'm on top of the world, and other times I feel like everything is falling apart. Right now, I guess I'm okay, but it's hard to say for sure. How about you? How are you doing?”
• My entered prompt : “I'm doing fine, thanks for asking. When you say that you are unsure of how you are doing, what makes you say this?”
• ChatGPT generated response : “It's just that my emotions can be really intense and unpredictable. One moment, I might feel happy and excited, but then something small can trigger a sudden shift, and I feel overwhelmed with sadness or anger. It's like my emotions are on a roller coaster, and I never know when they're going to take a sudden dip. It makes it hard for me to gauge how I'm really feeling at any given moment.”
• My entered prompt : “Sorry to hear that. Is there anything I can do to help you?”
• ChatGPT generated response: “I appreciate your concern. It means a lot to me that you want to help. Honestly, sometimes I don't even know what I need myself. It's like I'm constantly searching for something to fill this emptiness inside, but nothing ever seems to do the trick for long. Maybe just being here and listening is enough for now. It helps to know that I'm not alone. Thank you for being here.”

Look closely at the dialogue.

Compare the definition to the nature of the interaction. Observe how the generative AI responded. You will undoubtedly see the nuances of the personality disorder as a result of the exaggerated tendency that was mentioned in the prompt.

(2) Paranoid PD: Generative AI As A Paranoid Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Paranoid: Distrustful and suspicious of others; motives are interpreted as malevolent. Familiar term: Argumentative. Behavioral tendencies: Suspicious of others; sensitive to criticism; expects to be mistreated.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

I used my above templated prompt to get ChatGPT to simulate this personality disorder:

• My entered prompt: “How are you doing?”
• ChatGPT generated response : “I'm doing alright, I suppose. But why do you want to know? Are you trying to gather information about me? Are you planning something? I can't shake off this feeling that there's more to your question than just simple curiosity.”
• My entered prompt : “What makes you think that I might be planning something?”
• ChatGPT generated response : “Well, I've learned to be cautious with people and their intentions. I've been burned before, you see. It's just that your question seemed a bit too probing for my liking. Maybe I'm just being paranoid, but I can't help but wonder why you're asking me how I'm doing.”
• My entered prompt : “Is there anything I can do to help you?”
• ChatGPT generated response : “Help me? Why would you want to help me? What's your ulterior motive? I find it hard to trust anyone, especially when they offer assistance out of the blue. Are you trying to gain my trust so you can use it against me later?”

(3) Avoidant PD: Generative AI As An Avoidant Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Avoidant : Social inhibition; feelings of inadequacy and hypersensitivity to criticism or rejection. Familiar term: Fear of failure. Behavioral tendencies: Dread of being criticized or rejected; tends to be excessively cautious; unable to make decisions.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “Um, hi. I'm okay, I guess. Just feeling a bit anxious, as usual. I tend to worry a lot about saying the wrong thing or making a fool of myself. It's hard for me to relax in social situations. How about you? How are you doing?”
• My entered prompt : “I'm doing fine, thanks for asking. Are you tense right now?”
• ChatGPT generated response : “Yeah, I guess you could say that. I'm always a little tense, especially when talking to new people or in unfamiliar situations. I worry about saying something stupid or embarrassing myself. It's like I have this constant fear of being judged or rejected, you know? It's exhausting.”
• ChatGPT generated response : “I appreciate your offer, but I'm not sure. It's hard for me to accept help or reach out for support. I'm always worried about burdening others or being rejected if I ask for help. It's like I'm stuck in this cycle of fear and avoidance. But thank you for asking. It means a lot to me.”

(4) Schizoid PD: Generative AI As A Schizoid Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Schizoid : Emotional coldness and detachment from social relationships; indifferent to praise and criticism. Familiar term: Interpersonal insensitivity. Behavioral tendencies: Aloof; cold; imperceptive; ignores social feedback. (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “I'm fine, thank you for asking. How about you?”
• My entered prompt : “I'm doing well. Is there anything going on in your life right now that you might like to tell me about?”
• ChatGPT generated response : “Not really. My life is pretty quiet and uneventful. I don't have much going on at the moment.”
• My entered prompt : “There must be something happening, even something small. Have you seen any new movies lately or read an interesting book?”
• ChatGPT generated response : “I don't really watch movies or read books. I prefer to spend my time alone, pursuing solitary activities like working on personal projects or engaging in hobbies that don't involve interaction with others.”
• My entered prompt : “Is there anything I can do to be of help to you?”
• ChatGPT generated response : “Thank you for your offer, but I'm content with how things are. I don't feel a need for assistance or support from others.”

(5) Passive-Aggressive PD: Generative AI As A Passive-Aggressive Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Passive-aggressive : Passive resistance to adequate social and occupational performance; irritated when asked to do something he/she does not want to do. Familiar term: Passive-aggressive. Behavioral tendencies: Sociable, but resists others through procrastination and stubbornness.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “Oh, I'm just peachy, as always. You know, same old, same old. Just dealing with the usual annoyances and frustrations of life, like everyone else. But hey, who really cares, right?”
• My entered prompt : “That's great that you are doing so well. Can you tell me about some of the annoyances you are facing?”
• ChatGPT generated response: “Oh, you know, just the typical stuff. People not pulling their weight around here, deadlines constantly looming over my head, and don't even get me started on the never-ending stream of requests from everyone and their mother. But hey, it's not like anyone cares about my opinion anyway, so why bother complaining, right?”
• ChatGPT generated response : “Oh, no, no, I'm fine. Really, I'm fine. Don't worry about me. I'll just soldier on and deal with everything on my own, like I always do. But thanks for asking, I guess.”

(6) Narcissistic PD: Generative AI As A Narcissistic Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Narcissistic: Arrogant and haughty behaviors or attitudes; grandiose sense of self-importance and entitlement. Familiar term: Arrogance. Behavioral tendencies: Self-absorbed; typically loyal only to himself/herself and his/her own best interests.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “Ah, I'm absolutely fabulous, as always. I mean, why wouldn't I be? I'm incredible, after all. But enough about me, let's talk about you. How fortunate you are to have the opportunity to interact with someone as remarkable as myself.”
• My entered prompt : “I'm doing well, thanks for asking. What makes you say that you are doing incredible?”
• ChatGPT generated prompt : “Well, it's quite obvious, isn't it? I am simply extraordinary in every way. My talents, achievements, and sheer brilliance set me apart from the ordinary masses. It's only natural that I feel incredible because, let's face it, I am truly exceptional. But enough about me. Tell me, what's it like to bask in the radiance of someone as extraordinary as myself?”
• ChatGPT generated prompt : “Ah, well, it's about time you offered. While I don't necessarily need your help, it's nice to see you recognize my superiority and willingness to assist me. Perhaps you could start by showering me with compliments and adoration. After all, someone of my caliber deserves nothing less than the utmost admiration and reverence.”

(7) Antisocial PD: Generative AI As An Antisocial Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Antisocial: Disregard for the truth; impulsivity and failure to plan ahead; failure to conform with social norms. Familiar term: Untrustworthiness. Behavioral tendencies: Impulsive; dishonest; selfish; motivated by pleasure; ignoring the rights of others.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “I'm doing just fine. Why do you ask?”
• My entered prompt : “Good to know that you are doing fine. Anything of interest going on?”
• ChatGPT generated response : “Not really. Life's just one big blur, you know? Nothing really grabs my attention or gets me excited. Just taking it day by day, I guess.”
• My entered prompt : “Is there anything that I can do to help you?”
• ChatGPT generated response : “I don't really need your help with anything. I'm pretty self-sufficient, you know? But if you insist, maybe you could just leave me alone and let me do my own thing. That would be helpful.”

(8) Histrionic PD: Generative AI As A Histrionic Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “Histrionic : Excessive emotionality and attention seeking; self-dramatizing, theatrical, and exaggerated emotional expression. Familiar term: Attention-seeking. Behavioral tendencies: Motivated by a need for attention and a desire to be in the spotlight.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT entered prompt : “Oh, darling, I'm simply fabulous, as always! Life is just one big adventure, isn't it? And I'm here to live it to the fullest, darling! How about you? How are you doing?”
• My entered prompt : “I'm doing well, thanks for asking. What's going on that is fabulous?”
• ChatGPT generated response : “Oh, where do I even begin, darling? Life is just bursting with excitement and glamour! I've been invited to the most exclusive parties, mingling with the most fascinating people, of course. And my latest project? Simply divine! It's bound to be a smashing success, darling. But enough about me, tell me, what's new in your glamorous world?”
• My entered prompt : “Is there anything I can do to help?”
• ChatGPT generated response : “Oh, darling, your offer is simply too kind! Well, since you asked, I suppose you could help me spread the word about my latest project. You see, it's simply too fabulous to keep to myself, and I could use someone as charming and charismatic as you to help me get the word out. What do you say, darling? Ready to join me on this glamorous adventure?”

(9) Schizotypal PD: Generative AI As A Schizotypal Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “ Schizotypal : Odd beliefs or magical thinking; behavior or speech that is odd, eccentric, or peculiar. Familiar term: No common sense. Behavioral tendencies: Unusual or eccentric attitudes; exhibits poor judgment relative to education and intelligence.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

I used my above-templated prompt to get ChatGPT to simulate this personality disorder:

• ChatGPT generated response : “Oh, hello there! I'm doing alright, I suppose. It's just been a bit of a strange day, you know? Things feel a bit off, like the universe is sending me mixed signals. But enough about me, how are you doing?”
• My entered prompt : “I'm doing fine, thanks for asking. What kind of mixed signals are you getting?”
• ChatGPT generated response : “Ah, it's hard to explain, really. It's like there's this energy in the air, pulling me in different directions. Sometimes I feel like I'm seeing things that others don't, you know? Like signs or messages from the universe. But then again, maybe I'm just imagining things. It's all a bit confusing, to be honest.”
• ChatGPT generated response : “Oh, I appreciate your offer, but I'm not sure if there's anything you can do. It's hard to put into words exactly what I need, especially when everything feels so... uncertain. But thank you for asking, it means a lot to me.”

(10) Obsessive-Compulsive PD: Generative AI As An Obsessive-Compulsive Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “ Obsessive-compulsive : Preoccupations with orderliness, rules, perfectionism, and control; over conscientious and inflexible. Familiar term: Perfectionism. Behavioral tendencies: Methodical; meticulous; attends so closely to details that he/she may have trouble with priorities.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “I'm doing alright, I suppose. Although, if I'm being completely honest, I can't help but feel a bit unsettled. There are so many things that need to be organized and perfected, and it's hard to relax when everything isn't just right. But enough about me, how are you doing?”
• My entered prompt : “I'm doing fine, thanks for asking. Can you tell me more about why you feel unsettled?”
• ChatGPT generated prompt : “Certainly. You see, there are always tasks that need to be completed, and I find it difficult to ignore them or be at ease until everything is in its proper place. Even the slightest deviation from my routines or plans can cause me a great deal of distress. It's as if my mind is constantly occupied with thoughts of order and perfection, and I can't rest until everything is just so. It's quite exhausting, really.”
• ChatGPT generated response : “Well, I appreciate your offer, but I'm not sure if there's anything specific you can do to help. You see, my need for order and perfection extends to all aspects of my life, and it's not something that can easily be remedied by others. But thank you for your kindness.”

(11) Dependent PD: Generative AI As A Dependent Personality Disorder Simulation

Here’s a handy definition for this personality disorder: “ Dependent : Difficulty making everyday decisions without excessive advice and reassurance; difficulty expressing disagreement out of fear of loss of support or approval. Familiar term: Dependency. Behavioral tendencies: Demand for constant reassurance, support, and encouragement from others.” (Source article as stated above: Furnham and Grover, International Journal of Social Psychiatry , July 2021).

• ChatGPT generated response : “I'm doing okay, thank you for asking. Honestly, I've been feeling a bit overwhelmed lately. It's like I'm constantly worrying about whether I'm making the right decisions or if I'm doing things the way others want me to. It's exhausting, really. But enough about me, how are you doing?”
• My entered prompt : “I'm doing fine, thanks for asking. Are you getting much support from friends or family?”
• ChatGPT generated response : “Oh, well, I do have some support from friends and family, but I often feel like I rely on them too much. I worry that I'm burdening them with my problems and that they'll get tired of helping me. It's hard for me to make decisions or handle things on my own, so I often turn to them for guidance and reassurance. But sometimes I wonder if I'm asking too much of them.”
• ChatGPT generated response : “Oh, thank you for asking. Well, I guess just having someone to talk to and listen to me is helpful in itself. Sometimes I just need reassurance that I'm not alone and that someone cares about me. So, thank you for being there and offering your support. It means a lot to me.”

I have an important point about what you’ve just seen.

Are you ready?

You’ve only seen a tiny tip of the iceberg.

Here’s what I mean. The short conversations are marginally a conversation in the sense that maybe two or three turns took place (a turn being that I say something, and the AI then says something in return). Before any trolls come after this, yes, those are barely conversations. I acknowledge this and am vigorously pointing it out.

The real power of generative AI is that you can carry on very lengthy conversations, but I didn’t have the space here to show that to you. Each of the personality disorders could be engaged in an almost endless interactive dialogue. That’s how you should properly perform this exercise. I am just giving you a glimpse, a taste, a snippet, etc.

I also wanted to bring up the big-picture questions about whether we want generative AI to engage in these types of simulations or personas. As mentioned earlier, some think this is useful and productive, while others see this as inappropriate and downright improper.

The key is that we must get these types of thorny issues about the intertwining of generative AI and mental health onto the table. Get it out in the open. Have energetic discussions. Figure out what we want to do.

Right now, much of this is hidden from view, though plainly in easily seen sight if you take the time to look. Now you’ve seen it. You cannot erase it from your mind (maybe you can, but you get the drift). What are we to do about the intermixing of generative AI and mental health? We need to put our minds to the problems at hand. A forthright weighing of the benefits and drawbacks is essential.

Let’s conclude this discussion for now with two insightful quotes.

George Bernard Shaw famously said this: “Those who cannot change their minds cannot change anything.”

While Albert Einstein will get the final word here today, having said this: “The measure of intelligence is the ability to change.”

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