Borderline personality disorder: identification, comorbidity, and emerging treatment opportunities
Neurology Bulletin June 14, 2025 Мikhail L. Zobin
Borderline personality disorder (BPD) diagnostic criteria from the DSM-5 and ICD-11 are analyzed. Combining categorical and dimensional models improves diagnostic validity for clinical practice, but the disorder remains heterogeneous and conceptually ambiguous. Comorbidity with addictive disorders involves overlapping symptoms that worsen overall presentation, and diagnosing BPD is challenging when substance use masks constitutional symptoms. Current treatments are reviewed, highlighting ketamine therapy's potential. In an open retrospective study of 18 patients with dual (BPD plus alcohol/cocaine use disorder) or triple (plus depression) diagnoses, three ketamine infusions over one week (0.5–0.75 mg/kg for 40 minutes) plus a booster one month later yielded preliminary results comparable to specialized psychotherapy. This suggests ketamine may offer a novel perspective on the traditionally pessimistic therapeutic outlook for BPD.