Borderline personality disorder: identification, comorbidity, and emerging treatment opportunities

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.

Study at a glance

Abstract

This article analyses the diagnostic criteria for borderline personality disorder as defined in the 5th edition of Diagnostic and Statistical Manual of Mental Disorders and the 11th revision of International Classification of Diseases. The combination of categorical and dimensional diagnostic models improves its validity, which meets the needs of clinical practice. At the same time, the heterogeneity and persistent conceptual ambiguity of borderline personality disorder are emphasized. The phenomenology of comorbidity between borderline and addictive disorders is considered as overlapping symptoms that exacerbate overall clinical presentation. Challenges in diagnosing borderline personality disorder are noted when constitutional symptoms are masked by the consequences of psychoactive substance use. The article offers a brief overview of current approaches to the treatment of borderline personality disorder, highlighting the potential of ketamine therapy. The results of our own retrospective open study of 18 patients with dual (borderline personality disorder + alcohol/cocaine use disorder) and triple (borderline personality disorder + alcohol/cocaine use disorder + depression) diagnosis who received ketamine treatment are discussed. Patients received three ketamine infusions over one week (0.5–0.75 mg/kg over 40 minutes), followed by a booster session one month later. Preliminary results of treatment are discussed, which are quite comparable with the effectiveness of specialized psychotherapy. These findings suggest that ketamine therapy may offer a novel perspective on the traditionally pessimistic therapeutic outlook for borderline personality disorder.