ABSTRACT

Borderline personality disorder (BPD) is not a singular nosologic entity but a complex syndrome with heterogeneity concerning etiology, neuropathophysiology, symptomatology, and comorbidity. The prevalence in the general population amounts to 1.5 to 2% and BPD is diagnosed 10 to 20% among psychiatric patients (Verheul & van den Brink, 1999). The mortality in this group is high because of a suicide rate of about 10%. This rate is approximately 50 times higher than in a general population. BPD is considerably more often diagnosed in women than in men, with gender differences in the clinical presentation (Johnson et al., 2003; Zlotnick, Rothschild, & Zimmerman, 2002). Chronic traumatic stress or an accumulation of adverse childhood experiences (ACE) is strongly associated with the development of severe personality disorders, chronic depression, and to a lesser extent, post-traumatic stress disorder (PTSD) in adulthood (Felitti et al., 1998). This finding is consistent with the high prevalence of ACE in borderline patients and the high comorbidity of BPD with depression and PTSD (Zanarini et al., 1998; Yen et al., 2002).