![]() DSM-5, like DSM-IV, permits diagnosing a PD (other than antisocial PD) in someone under 18 years of age if the symptoms are “pervasive, persistent, and unlikely to be limited to a particular developmental stage or another mental disorder,” 8, p 647 as long as symptoms have been present for 1 year or longer. DSM-5 also indicates that the pattern of behaviour begins in adolescence or early adulthood, if not earlier. Like all PDs, BPD requires that patients have difficulties that are pervasive, inflexible, impairing, and outside the norm for their cultural background. 6, 7 Patients with BPD do suffer intensely, but their prognosis is often better than expected and the outcomes are further improved with appropriate treatment. 5 This has given many the impression that patients with BPD are always in crisis and never recover from their illness, leading to this group of patients being highly stigmatized in the mental health care system. 4 If they are not seen as part of a long-term follow-up or a treatment program, they are typically seen when in crisis. 4 In the community, there is an equal gender ratio, despite women being seen 3 to 4 times more frequently in clinical settings. They account for 10% of outpatients, 1 20% of inpatients, 2 and 6% of patients presenting to family medicine, 3 despite a community prevalence of 1% to 2%. ![]() Patients with BPD are very frequently seen in all types of clinical settings.
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