Are There Three Types of Borderline Personality Disorder?

New preliminary research finds three clinically-relevant Borderline classes.

KEY POINTS

• Borderline Personality Disorder (BPD) is a relatively common problem, often difficult to treat.
• Because there are hundreds of possible symptom combinations, having a system for classifying BPD to guide treatment is highly desirable.
• New research using “Latent Class Analysis” identifies 3 distinct types of BPD.
• This information is useful for clinical treatment and self-assessment, and sets the stage for future research and development.

Borderline Personality Disorder (BPD[1]) is a one of several personality disorders described in the Diagnostic and Statistical Manual (DSM-5) by the American Psychiatric Association. BPD belongs to what are called “Cluster B” personality disorders, alongside Antisocial, Narcissistic and Histrionic personality disorders. They are grouped together because they share common features of emotional dysregulation, alterations in sense of self, and a proclivity for erratic and dramatic cognition, behavior, and long-standing patterns of interpersonal relationship problems associated with insecure, often disorganized, attachment style. They are classified as “disorders” if and only if they are associated with chronic, clinically-significant distress or dysfunction.

The term “borderline” relating to personality has its origins in psychoanalysis (Stern, 1938), not as a diagnosis per se but as a description of personality organization — in the borderland between higher-functioning neurosis and more profound psychosis. People with BPD tend to have difficulty reflecting on their own thoughts and behaviors. This difficulty with metacognition renders self-regulation more difficult and limits the therapeutic effectiveness of insight (Martin & Del-Monte, 2023).

While BPD is at times romanticized, even valorized, in the media because of the excitement that goes along with the heady, often exhilarating, ups, the downside of the disorder is too often tragedy and isolation. Folks with BPD are at significantly increased risk for suicide, significant physical and mental health difficulties…