Borderline Personality Disorder: A Continuum Paradigm

Editor's Notes The definitive cause of borderline personality disorder (BPD) is unclear; BPD, along with its comorbidities, is considered one of the most complex and difficult disorders to treat; BPD and its comorbidities are consuming a disproportionately high amount of societal health care and forensic resources; and individuals experiencing BPD and its comorbidities are facing some mental health providers’ added stigma, bias, and neglect, as well as unsubstantiated treatments without any evidence basis. This qualitative systematic review comprehensively scrutinized and analyzed the research regarding BPD and its comorbidities, finding the urgency clinicians and clients face as well as the complexity of BPD. Unfortunately, the target so far of the vast majority of the research remains narrowly definition- and symptom-focused, belying the urgency and inability to think about alternative paradigms, core causes, or best treatments. Results found expanding to a biopsychosocial theoretical framework, as well as expanding to the recommended continuum paradigm better meets BPD diagnosis and treatment goals. Implications are that centering on BPD patients' experience, considering potential core causes that can presently and positively be acted upon, and gathering a variety of potentially applicable treatment resources from beyond BPD scholarship already being successfully implemented in the treatment across BPD's identified comorbidities, as provided in detailed evidence-based recommendations in this study - can help reduce these individuals' distress and improve their quality of life right now.