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In 2000, the American Psychiatric Association declared that borderline personality disorder affected two percent of the population in the United States; in comparison, only one percent of Americans are bipolar or schizophrenic. However, in 2008 a group of psychiatric researchers discovered that the number of adults suffering with borderline personality disorder (BPD) in the U.S. was more like six percent, or eighteen million.

By all accounts, borderline personality disorder is one of the most difficult mental illnesses to define and also one of the most intractable to treat. In essence, someone with borderline personality disorder (BPD) lacks the emotional capacity of a normal human being and even the most innocuous physical movement or contact can be excruciating. People with a borderline personality do not have a traditional moral compass and can swing from overly loving to a violent rage in mere seconds. In an effort to “feel”, these patients tend to develop profound connections with those closest to them and are often afraid of losing them. However, simultaneously, the borderline may treat his loved ones so poorly that he may lose them anyway.

All but a quarter of “borderlines” harm themselves at one point or another (often in bizarre ways), and 10 percent commit suicide. Many borderlines report that the self-mutilation is borne out of desire to feel something in an otherwise bleak existence. Mental health professionals are often wary of taking on borderline patients, especially given their inability to show appropriate affection to loved ones. Therapists who do not specialize in the illness are at a loss as to how best reach these patients and often overmedicate for depression, anxiety or insomnia for lack of a better solution.

Although early research into borderline personality disorder suggested that the illness was more prevalent in women, more recent studies show that it affects the sexes equally. It is true, however, that borderline is most likely to manifest when a patient is in his twenties. In addition to emotional symptoms, those suffering from borderline personality disorder may also exhibit problems with impulse control, resulting in overeating, addiction, or self-harm.

Although borderline remains one of psychiatry’s “problem” disorders, practitioners can agree that BPD patients all lack the ability to modulate their behavior to match what they should be feeling. For instance, when a situation would normally call for mere sadness, the borderline may fly into a rage or be inconsolable.

The underlying pathology of borderline personality disorder is still unknown. However, many mental health professionals believe that a combination of genetics and environment may be at play. Studies have shown that many borderlines had terrible childhoods, often being raised in abusive situations or by parents who did not tolerate the expressing of emotions. Other patients seemed to come from families with money problems or where one or more members had medical problems that disrupted the family unit; these children were likely not taught the proper way to express emotions or handle stress. As a result, they either bottle it all up or explode.

Given that borderline diagnoses seem to be on the rise, researchers are eager to learn why. One school of thought is that since there are more resources available now to diagnose and treat some of the more complicated mental issues, patients who may have been misdiagnosed in the past are now being properly categorized as borderline. Others feel that, since the prognosis for borderline is no longer dismal, more mental health professionals are willing to diagnose their patients as borderline, whereas before they may have been reluctant to saddle patients with such a stigma. There is also a theory that the current financial crises may drive more and more Americans to “crack” emotionally.

Like many mental illnesses, there is no “cure” for borderline personality disorder. However, in the past twenty years research has shown that some borderline patients do respond positively to therapy, often within just twelve months. In fact, a study by Harvard-affiliated McLean Hospital indicated that only 10 percent of patients diagnosed as borderline still met the definition 10 years later.

For the most part, there is no pharmacological substance that will alleviate all of the symptoms of a borderline patient. Therapists often employ dialectical behavioral therapy (DBP) when treating borderlines, which has shown success in reducing both self-harm and inpatient hospital stays. Dialectical behavioral therapy is all about pointing out contradictions between the patient’s thinking and reality. It has helped borderlines see how their one-sided thinking thwarts their own success and also learn effective coping mechanisms. However, because DBT is more “tough love” than other types of mental health treatment, laypeople tend to view the method as overly harsh.