The care of patients with borderline personality disorder (BPD) places a significant burden on emergency inpatient mental health services. The aim of this study was to investigate predisposing risk factors for early rehospitalization over 12 months.

A total of 117 inpatients with BPD were included. The Beck Hopelessness Scale, Adolescent/Adult Sensory Profile, Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered.

Forty-seven percent of the sample was rehospitalized. Divorced marital status, current substance abuse, a higher score on the TAS-20 externally oriented thinking score and on the COPE Alcohol and drug disengagement subscales, and a lower score on the COPE. Use of social–emotional support subscale were significantly associated with rehospitalization. Therefore, alcohol and substance misuse, impaired social support, and alexithymia were the most relevant predictors for rehospitalization.

Maladaptive coping, depressive symptoms, and history of high service utilization and multiple high-lethality suicide attempts were also found to be more common in readmitted subjects. Further research could help to better define potential different therapeutic interventions.

Despite being common and linked to significant morbidity and mortality, personality disorders (PD) are underdiagnosed. Stigma, professionals’ therapeutic nihilism and lack of effective treatments are contributing factors. This survey aimed to explore the experiences of a service user group of being assessed for and receiving a diagnosis of personality disorder and to examine the impact of the diagnosis and the disorder on their life.

Patients under the care of two consultant-led teams who had received a diagnosis of personality disorder using Structured Clinical Interview for DSM-5 PD (SCID-5-PD) in 2019 and 2020 were invited by email to complete a qualitative survey. Responses were analysed using thematic analysis.

Participants were predominantly aged 41–50 years, with most discharged over three years previously. Borderline personality disorder was most commonly reported. Thematic analysis identified three themes: Understanding and Being Understood – highlighting variable levels of comprehension and agreement with the diagnosis; A turning point – describing both abandonment and access to targeted treatment; and Restriction – capturing stigma, secrecy, and perceived negative impacts on care, relationships, and functioning.

Findings highlight the complexity of delivering diagnoses in a meaningful and therapeutic way. Participants reported limited understanding, underscoring the need for clear, repeated psychoeducation and collaborative formulation while others described positive experiences leading to self understanding and recovery. Many were relieved to get the diagnosis after significant delays and lack of appropriate treatment. Revisiting formulation over time and linking diagnosis to treatment pathways appear crucial for acceptance, empowerment, and positive outcomes.

The co-occurrence of psychotic disorders and borderline personality disorder (BPD) complicates clinical management, with overlapping symptoms exacerbating morbidity and impairing therapeutic outcomes. This systematic review and meta-analysis aimed to estimate the prevalence of psychotic disorders and BPD co-occurrence, including with first-episode psychosis (FEP) and to describe associated sociodemographic and clinical characteristics.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases were systematically searched from inception to June 2025. Eighteen studies met the inclusion criteria. Data extraction and quality appraisal (Effective Public Health Practice Project tool) were conducted independently by two reviewers. Random-effects meta-analyses estimated pooled prevalence rates.

The pooled prevalence of BPD in people with psychotic disorders was 22.7% (95% CI: 14.2–34.3%), while 14.3% (95% CI: 5.5–32.1%) of individuals with BPD had a comorbid psychotic disorder. In FEP samples, 40.0% (95% CI: 21.9–61.3%) met the criteria for BPD. People with both conditions, often young women, showed greater emotional dysregulation, suicidality, psychotic symptoms, and social dysfunction. Trauma, dissociation and substance use emerged as frequent vulnerability factors. However, most studies were cross-sectional, with small samples and high heterogeneity (I2 > 80%), limiting generalizability.

This co-occurrence constitutes a distinct clinical subgroup with complex needs. Categorical diagnostic approaches may fail to capture the dimensional nature of overlapping affective and psychotic symptoms. Integrative and personalized care pathways, especially in early intervention settings, are warranted. This review was registered in PROSPERO (CRD42024577525).

Borderline personality disorder (BPD) is characterised by instability in interpersonal relationships, self-image, and affect. Dysregulated negative emotional processing involving prefrontal and limbic circuits is considered a neural basis of BPD. However, it remains unclear how prefrontal modulation of social decision-making in BPD differs from non-psychiatric controls.

To investigate social decision-making in response to unfairness, we conducted an functional magnetic resonance imaging study involving adults with a diagnosis of BPD (n = 77) and healthy controls (HCs; n = 60). Using an inequality aversion model, we derived parameters of social norm adaptation and inequality sensitivity from behavioural data during a modified ultimatum game designed to measure responses to offer norm shifts. Valence and salience signal-processing models isolated prefrontal activations related specifically to social norm prediction error.

Cumulative rejection rates indicated that individuals diagnosed with BPD exhibited consistent differences in overall offer rejection rates but similar adaptation to HC when responding to norm shifts. Preservation of normative social decision-making in BPD (no significant difference vs. HC) was evident in regression analyses of rejection rates and in reinforcement learning models, with no group differences observed in Rescorla–Wagner parameters. Furthermore, we detected no significant neural activation differences between groups, although ventral regions of the medial prefrontal cortex were preferentially involved in valence-related rather than salience-related polynomial modulation.

Contrary to our hypotheses, neither behavioural nor neural responses to economic norm violations differed significantly between BPD and HC groups across one-shot games involving unknown partners. Future research could explore whether more personally relevant or higher-stress social contexts elicit differences not observed here.

While increasing research is reporting a higher presence of autistic traits (AT) in patients with borderline personality disorder (BPD), both autism spectrum disorder (ASD) and BPD have been associated in literature with a vulnerability to trauma and eating disorders.

The present study aimed at evaluating trauma-related symptoms and eating disorder symptoms in BPD patients with or without significant AT.

A sample of 73 BPD patients was assessed with the adult autism subthreshold (AdAS) Spectrum, trauma and loss spectrum-self report (TALS-SR), and EDI-2 questionnaires.

The findings revealed that BPD patients with autistic traits (BPD-AT) scored significantly higher on the eating disorder inventory (EDI-2) and trauma and loss scale (TALS-SR) compared to those without AT. Moreover, while both AdAS Spectrum and TALS-SR scores predicted higher EDI-2 scores, a significant mediating effect of TALS-SR on the relationship between AdAS Spectrum and EDI-2 scores was reported.

These results suggest that AT may imply more severe clinical correlates in the BPD population, including an enhanced vulnerability toward psychopathological traits frequently reported in BPD patients such as eating disorders and trauma-related symptoms, stressing the need to clarify the complex interactions among these disorders and the factors that may shape specific illness trajectories.

Alterations in the central and peripheral energy metabolism are increasingly recognized as key pathophysiological processes in psychiatric disorders. We investigated mitochondrial respiration and density linked to cellular energy metabolism and oxidative DNA damage in borderline personality disorder (BPD).

This cross-sectional case–control study compared three groups matched for age and body mass index: women with acute BPD, remitted BPD, and female healthy controls (n = 32, 15, 29). Peripheral blood mononuclear cells were investigated for differences in mitochondrial respiration, density, and markers of oxidative DNA damage.

Participants with acute BPD showed significantly reduced and less efficient mitochondrial ATP production compared to both remitted individuals and controls. Mitochondrial coupling and respiration were inversely associated with oxidative DNA damage, although DNA damage levels did not differ significantly across diagnostic groups. Sensitivity analyses indicated that comorbid major depressive episodes and antidepressant use did not account for the results.

These findings indicate mitochondrial alterations accompany acute symptom severity in BPD and may improve with remission. Unraveling causes and consequences of mitochondrial downregulation and its interplay with DNA maintenance in the context of stress and psychopathology could contribute to novel models and treatment strategies in BPD and related severe psychiatric disorders.

Structural imaging studies of borderline personality disorder (BPD) have identified regions of reduced and increased cortical volume, as well as volume reductions in the hippocampus and amygdala, although with considerable variability across studies. Examining adolescent patients with the disorder can reduce potential confounding effects such as later development of affective and other comorbid disorders.

Fifty-one adolescents (48 females, 3 males) with BPD and without comorbid disorders and with 43 matched healthy controls underwent whole-brain voxel-based morphometry (VBM). Hippocampus and amygdala volumes were also measured using conventional volumetric techniques.

At a threshold of p = 0.05 corrected, the BPD patients exhibited a cluster of grey matter volume reduction in the left temporo-parietal junction (TPJ). No evidence of volume reductions in the hippocampus or amygdala was found. Comparison between the female-only subsamples (48 BPD patients and 37 controls) yielded similar findings. The cluster of volume reduction in the left TPJ continued to be seen in 37 drug-naïve patients.

According to this study, the initial stage of BPD is characterized by decreased grey matter volume in the left TPJ, a region that is implicated in various aspects of social cognition. Given that the volume loss was detected prior to adulthood, in individuals without comorbidities, and among patients who were drug naïve, this finding could be significant for understanding the developmental trajectory of the disease.

To determine the most acceptable term for borderline personality disorder (BPD). We conducted a cross-sectional study of patients who know what it feels like to be diagnosed with a mental disorder. The main outcome measures were the proportion of participants offended and confused by alternative terms for BPD.

Seventy-two people participated in the study. Being diagnosed with a condition was more offensive than being diagnosed with a disorder (χ2 = 41.18, d.f. = 1, P < 0.01). Fluxithymia offended the fewest participants (13%), but was the most confusing term (31%). Emotionally unstable personality disorder was the most offensive term (63%). After fluxithymia, emotional intensity disorder was the least offensive term, and not especially confusing (11%). Changing BPD to emotional intensity disorder would avoid an offensive event every 3.6 diagnostic announcements.

The diagnostic term BPD should be replaced with emotional intensity disorder, because this term provides a balance of clarity and inoffensiveness.