Borderline Personality Disorder and Child Custody: A Comprehensive Guide to Evaluating BPD in Family Law Cases
Table of Contents
By Dr. Lisa Long, Psy.D., David Luddy, and Dr. Leesandra Contreras-Gonzalez, Psy.D.
Dr. Long & Associates
When borderline personality disorder (BPD) emerges in custody litigation, family law attorneys face a complex clinical picture with significant implications for parenting capacity assessments. Understanding how BPD manifests in parent-child interactions—and what the research actually shows—is essential for developing effective case strategy and cross-examination of expert witnesses.
1. The Clinical Reality of BPD in Parenting Contexts
Borderline personality disorder is characterized by pervasive instability in interpersonal relationships, self-image, emotions, and marked impulsivity. These core features create predictable patterns in parenting behaviors that differ meaningfully from other psychiatric conditions, including other personality disorders.
Understanding Etiology: Why It Matters Forensically
BPD does not emerge in a vacuum. The disorder develops through a complex interaction of childhood adversity, dysfunctional relationships, genetic vulnerability, and environmental factors. Understanding this etiology is forensically relevant for several reasons:
First, parents with BPD often have histories of significant childhood trauma themselves—including sexual abuse, physical abuse, neglect, and parental hostility (Winsper et al., 2016). They may have experienced the same dysfunctional parent-child relationships characterized by low parental care, high overprotection, and parental inconsistency that they now risk perpetuating with their own children (Boucher et al., 2017). This intergenerational pattern is not an excuse for poor parenting, but it provides context for understanding both current parenting challenges and the importance of breaking the cycle through intervention.
Second, the developmental origins of BPD inform prognosis and treatment planning. A parent who has insight into their own childhood experiences and has engaged in trauma-focused therapy may have better capacity to recognize and interrupt problematic patterns with their children. Conversely, a parent who lacks insight or denies the impact of their disorder presents higher risk for intergenerational transmission and a continued experience of impactful symptoms.
Third, understanding that BPD emerges from both genetic vulnerability and environmental factors highlights the importance of mitigating environmental risks for children. Even when genetic risk cannot be eliminated, protective factors—stable caregiving from another parent, secure attachment relationships, reduced exposure to chaos and conflict—can substantially reduce the likelihood that children will develop BPD themselves.
The Research Base
Important Methodological Limitation: The research base on BPD and parenting is almost exclusively focused on mothers, with fathers and other caregivers significantly underrepresented (Steele et al., 2019; Kasiviswanathan et al., 2025; Rimmington et al., 2024). Despite evidence that BPD occurs at similar rates in men and women in the general population, systematic reviews consistently find that the vast majority of studies examine only maternal BPD and child outcomes (Petfield et al., 2015; Eyden et al., 2016). This represents a major gap in the literature that limits our understanding of how BPD may manifest differently across genders in the parenting context and restricts the generalizability of research findings to fathers with BPD.
While this limitation does not invalidate the existing research on maternal BPD—which remains robust and methodologically sound—it does require caution when extrapolating findings to paternal BPD or assuming gender-neutral applicability of observed parenting patterns. The mechanisms underlying BPD-related parenting difficulties (emotional dysregulation, interpersonal instability, fear of abandonment) are theoretically present regardless of gender, but the behavioral expression and impact on children may differ in ways current research cannot adequately address.
Parenting Patterns Associated with BPD and Impact on Children
Parents with BPD may exhibit distinct parenting challenges that reflect the core features of the disorder—emotional dysregulation, interpersonal instability, and difficulties with empathy and impulse control (Seeger et al., 2022; Salgado et al., 2020). These challenges can manifest in various ways depending on individual presentation, severity of symptoms, protective factors, and context.
Research has identified several patterns that may compromise parenting capacity in parents with BPD:
Emotional dysregulation in parenting: Difficulty managing emotions and stress during parent-child interactions, leading to affective instability that children experience as unpredictable and which contributes to attachment insecurity and disorganized attachment patterns in offspring (Rosenbach et al., 2022; May et al., 2023)
Inconsistent and insensitive parenting approaches: Shifts between permissive, authoritarian, or rejecting-neglecting styles rather than consistent authoritative parenting, which research links to higher rates of internalizing (anxiety, depression) and externalizing (behavioral dysregulation) symptoms in children (Seeger et al., 2022; Williams & Hill, 2023; Uher et al., 2023)
Interpersonal difficulties: Deficits in empathy, trust, and stable relationship patterns that may impair the parent's ability to attune to the child's emotional needs and provide consistent emotional responsiveness (Preti et al., 2023; Salgado et al., 2020)
Hostile or withdrawn parenting behaviors: Research documents increased hostility, intrusiveness, and overprotection alternating with emotional withdrawal and disengagement—behavioral extremes that create unpredictable caregiving environments (Stepp et al., 2012; Rosenbach et al., 2022; May et al., 2023)
Elevated risk of maltreatment: Parental BPD is associated with greater risk of child maltreatment, including emotional and physical abuse, which further compounds risk for psychopathology in offspring (Rosenbach et al., 2022; Senberg et al., 2023; Seeger et al., 2022; May et al., 2023)
Family environment instability: Families with a parent with BPD often experience low cohesion, interpersonal conflict, and additional stressors such as substance abuse or low social support, creating cumulative risk for children's development (Rosenbach et al., 2022; Seeger et al., 2022)
Intergenerational Transmission:
The impact of parental BPD extends beyond immediate parenting behaviors. Children of parents with BPD demonstrate higher rates of developing BPD themselves and other mental health disorders, reflecting both genetic vulnerability and environmental risk factors including inconsistent caregiving, maltreatment, and family instability (Williams & Hill, 2023; Uher et al., 2023; Bozzatello et al., 2021). This intergenerational transmission represents a well-documented phenomenon with both direct pathways (parenting behaviors, attachment disruption) and indirect pathways (family environment, exposure to maltreatment) contributing to offspring risk.
Important Considerations:
Not all parents with BPD exhibit these patterns to the same degree, and individual functioning can vary significantly based on:
Severity and type of BPD symptoms
Co-occurring mental health conditions
Treatment engagement and progress (evidence-based treatments such as DBT can improve parenting capacity)
Quality of social support networks, which can buffer negative outcomes (Seeger et al., 2022)
Socioeconomic resources and stressors
The developmental stage and needs of the child
Presence or absence of additional risk factors (substance abuse, domestic violence, severe mental illness)
The presence of BPD does not automatically indicate impaired parenting capacity. However, when these research-documented patterns are present and observable in a specific case, they create parenting challenges that differ in quality and presentation from those associated with other mental health conditions commonly encountered in family law cases. Clinical evaluation must assess the degree to which these patterns manifest in the individual parent's functioning and their specific impact on the child in question.
Impact on Children: What the Research Shows
Critical Clinical Caveat: A diagnosis of BPD does not automatically convey individual case risk, nor does it predict parenting capacity in any specific parent-child dyad. Like all mental health disorders, BPD exists on a spectrum of severity, with substantial variability in how core features manifest and impact functioning. Parenting capacity in an individual with BPD depends on multiple factors including: symptom severity, treatment engagement and response, degree of stabilization achieved, co-occurring conditions, quality of support systems, and the parent's age and stage of life. Research demonstrates that BPD symptoms often decrease with age and sustained treatment, particularly evidence-based interventions such as Dialectical Behavior Therapy (DBT). A parent with well-managed, stabilized BPD who has engaged in consistent therapeutic work may function very differently from a parent with acute, untreated symptoms. The research findings presented below represent aggregate risk patterns observed in studies of parental BPD—they describe population-level trends, not individual certainties. Clinical evaluation must assess the specific parent's current functioning, observable parenting behaviors, and documented impact on the child in question rather than relying solely on diagnostic status.
Children of parents with BPD experience significantly elevated risks across multiple developmental domains:
Attachment and Emotional Development:
Attachment insecurity and disorganized attachment patterns that compromise social-emotional development and relationship formation (Rosenbach et al., 2022; May et al., 2023)
Increased stress and difficulties in emotional regulation due to inconsistent, insensitive, or hostile parenting behaviors (Williams & Hill, 2023; May et al., 2023)
Emotional dysregulation and difficulty managing interpersonal relationships in childhood and beyond
Mental Health and Behavioral Outcomes:
Higher prevalence of internalizing symptoms including anxiety and depression (Williams & Hill, 2023; Uher et al., 2023; May et al., 2023)
Increased externalizing symptoms including behavioral dysregulation and conduct problems (Williams & Hill, 2023; May et al., 2023)
Substantially elevated risk for developing BPD themselves, reflecting intergenerational transmission through both genetic and environmental pathways (Williams & Hill, 2023; Uher et al., 2023; Bozzatello et al., 2021)
Higher overall rates of psychopathology compared to children of parents without personality disorders (Uher et al., 2023)
Risk of Maltreatment:
Elevated risk of child maltreatment, including emotional and physical abuse, which further compounds risk for psychopathology (Rosenbach et al., 2022; Senberg et al., 2023; Seeger et al., 2022; May et al., 2023)
Exposure to trauma and adverse childhood experiences that contribute to developmental difficulties and mental health vulnerabilities (Bozzatello et al., 2021)
Family Environment and Cumulative Risk:
Family instability, low cohesion, and interpersonal conflict (Rosenbach et al., 2022; Seeger et al., 2022)
Additional environmental stressors such as substance abuse, domestic instability, or inadequate social support that compound developmental risks (Rosenbach et al., 2022; Seeger et al., 2022)
These outcomes reflect both direct pathways (parenting behaviors, attachment disruption, maltreatment) and indirect pathways (family environment, chronic stress, modeling of dysregulation) through which parental BPD affects child development. The intergenerational transmission of BPD and related psychopathology is well-documented, with children facing elevated risk for developing the disorder and other mental health conditions themselves (Williams & Hill, 2023; Uher et al., 2023; Bozzatello et al., 2021).
2. Diagnostic Methodology
When evaluating parenting capacity in the context of BPD, forensic psychologists must conduct comprehensive assessments that meet rigorous methodological standards. Understanding what constitutes a quality BPD evaluation is essential for attorneys reviewing prior diagnoses, expert reports, or court-appointed evaluations—and for effective cross-examination of expert witnesses.
Methodology
The Longitudinal Requirement
A reliable BPD diagnosis cannot be made from a single clinical interview or crisis presentation. The assessment must examine behavioral patterns across time and multiple contexts to distinguish stable personality features from acute psychiatric symptoms (Leichsenring et al., 2024). This longitudinal perspective is particularly critical because BPD symptoms often overlap with mood disorders, anxiety conditions, and stress reactions that may temporarily mimic personality pathology.
The ideal diagnostic scenario involves evaluating the individual when acute psychiatric conditions have stabilized. A person experiencing severe depression, active substance use, or acute post-separation crisis may exhibit emotional instability, impulsivity, and relationship difficulties that appear to meet BPD criteria but actually reflect their current situational distress rather than enduring personality structure. Attorneys examining custody evaluations should therefore scrutinize when the diagnosis was made. Was the parent psychiatrically stable at the time of assessment, or was the evaluation conducted during hospitalization, immediately after separation, or amid other acute stressors that could distort the clinical picture?
The Comorbidity Complication
The diagnostic picture becomes even more complex when considering that BPD frequently occurs alongside other psychiatric conditions. Research demonstrates substantial overlap between BPD and mood disorders, anxiety disorders, and particularly substance use disorders (Zimmerman & Mattia, 1999; Parmar & Kaloiya, 2018; Trull et al., 2018). Moreover, BPD can actively worsen other psychiatric conditions, contributing to crisis escalations and psychiatric hospitalizations (Campbell et al., 2020).
This comorbidity creates forensic challenges that go beyond simple diagnostic accuracy. Symptoms initially attributed to BPD may actually stem from treatable comorbid conditions with different prognosis and intervention approaches. The reverse also occurs—what appears to be treatment-resistant depression may actually reflect underlying BPD that has not been adequately addressed. Forensic evaluators must therefore examine treatment history carefully to determine which symptoms have responded to various interventions and which have persisted despite multiple treatment attempts. This pattern of treatment response provides crucial information about the underlying clinical picture and likely prognosis.
Structured Assessment: The Gold Standard
In clinical settings, structured diagnostic interviews represent the gold standard for BPD assessment. Tools such as the Structured Clinical Interview for DSM Personality Disorders (SCID-II), Revised Diagnostic Interview for Borderlines (DIB-R), and Structured Interview for DSM Personality Disorders (SIDP-IV) systematically evaluate diagnostic criteria through semi-structured interview formats. These instruments were developed and validated primarily in clinical contexts where evaluators have limited time, minimal collateral information, and must rely heavily on patient self-report to establish diagnosis.
The Forensic Advantage: Objective Behavioral History
Forensic custody evaluations operate in a fundamentally different data environment that provides diagnostic information unavailable in typical clinical assessment. Rather than relying primarily on self-report—even highly structured self-report—forensic evaluators have access to extensive objective behavioral data spanning years or decades:
Legal and court records: Protective orders, police reports, criminal records, prior custody proceedings documenting actual behavioral patterns and third-party observations
Comprehensive treatment records: Medical records, psychiatric hospitalizations, therapy notes, medication trials documenting symptom patterns, treatment response, and clinician observations over time
Real-time behavioral evidence: Text messages, emails, social media posts capturing unfiltered interpersonal behavior, affective instability, and relationship patterns as they occurred
Child welfare documentation: CPS investigations, school reports, pediatric records providing objective data on child functioning and parental behavior
Extensive collateral interviews: Ex-partners, family members, treating clinicians, employers, and others who can describe functioning across different contexts and time periods
This wealth of objective data addresses the central challenge in BPD diagnosis: establishing that patterns are pervasive, persistent across contexts, and stable over time rather than situational reactions. A structured interview captures a single point in time through the filter of the individual's current self-perception and presentation management. Historical records capture actual behavior patterns as documented by multiple third parties across years.
The Self-Report Problem in Forensic BPD Assessment
Structured interviews, despite their systematization, remain fundamentally dependent on self-report. In forensic custody contexts, this creates significant limitations:
Impression management: High motivation to appear functional and minimize symptoms
Poor insight: BPD is characterized by identity disturbance and limited self-awareness; individuals may genuinely not recognize their patterns
Momentary stability: BPD symptoms often decrease during structured evaluation contexts or when the individual feels "understood" by the evaluator
Social desirability bias: Questions like "Do you have unstable relationships?" or "Do you engage in self-harm?" invite minimization in custody proceedings
Objective records eliminate these self-report vulnerabilities. A pattern of four protective orders across three relationships is not subject to reinterpretation. Six emergency room visits for self-inflicted injuries documented in medical records cannot be minimized. Text message threads showing idealization followed by devaluation within hours provide unfiltered behavioral data.
Integrating Clinical and Forensic Standards
This is not to suggest that structured interviews lack value in forensic assessment. When feasible and appropriate, structured diagnostic interviews can provide useful supplementary data, particularly for evaluating:
Current symptom presentation
Degree of insight and self-awareness
Treatment motivation and therapeutic alliance capacity
Consistency between self-report and objective records
However, in forensic BPD assessment, structured interviews should supplement rather than replace comprehensive review of objective behavioral history. The longitudinal requirement for reliable personality disorder diagnosis (Leichsenring et al., 2024) is actually better served by years of documented behavioral patterns than by a single structured interview—regardless of how systematically that interview is conducted.
What Comprehensive Forensic Assessment Requires
A thorough forensic BPD evaluation must prioritize multiple objective data sources (Leichsenring et al., 2024):
Historical behavioral patterns: Legal records, treatment records, employment history documenting pervasive patterns across time and contexts
Collateral information: Interviews with ex-partners, family, treating clinicians, and others with longitudinal knowledge of the individual's functioning
Real-time behavioral evidence: Communications, social media, and other contemporaneous documentation of interpersonal patterns
Clinical presentation: Mental status examination, direct observation during evaluation, and when appropriate, structured diagnostic interview
Treatment response patterns: Documentation of what interventions have been attempted, which were sustained, and which symptoms responded vs. persisted
The forensic evaluator's task is to synthesize these multiple data streams to establish whether the diagnostic criteria are met based on documented behavioral patterns, not self-reported perceptions.
The Role of Psychological Testing
Formal psychological testing can help verify personality pathology but is not always necessary when comprehensive historical information is available (Leichsenring et al., 2024). When testing is employed, appropriate instruments include the Minnesota Multiphasic Personality Inventory-3 (MMPI-3), which can identify personality disorder features and help differentiate personality pathology from acute psychiatric conditions (Sellbom et al., 2024).
The Personality Assessment Inventory (PAI) includes a borderline features scale that is widely used to assess borderline personality disorder, but research suggests its ability to differentiate BPD from other personality disorders is moderate and should be interpreted with caution. (Leichsenring et al., 2024).
What Comprehensive Assessment Actually Requires
A thorough forensic BPD evaluation must incorporate multiple data sources rather than relying on any single assessment method (Leichsenring et al., 2024):
Personal history: Developmental patterns, relationship trajectories over time, trauma exposure, previous psychiatric treatment attempts with documented responses
Collateral information: Psychiatric records, medical records, legal documents, third-party interviews with family members, previous therapists, or others who can describe functioning across different life periods
Mental status examination: Current presentation including thought processes, affect regulation capacity, interpersonal behavior during the evaluation
Multiple sources integration: No single source suffices; diagnosis requires triangulation across historical records, collateral reports, direct observation, and structured assessment
Countertransference: Diagnostic Signal or Bias?
Experienced forensic evaluators recognize that clinicians often develop strong emotional reactions when working with individuals who have BPD—reactions that may include frustration, feeling manipulated, emotional exhaustion, or intense rescue fantasies. This phenomenon, termed countertransference, arises from the challenging nature of interactions with individuals who may be demanding, aggressive, self-harming, or suicidal (Sansone & Sansone, 2013). Rather than representing evaluator bias, these reactions can provide important diagnostic information when properly recognized and interpreted (Parth et al., 2017).
The key distinction lies in the evaluator's self-awareness and training. An evaluator who reports feeling frustrated or emotionally drained after extended contact with a parent may be experiencing reactions typical of BPD interactions—reactions that provide confirmatory evidence for the diagnosis. However, this requires the evaluator to have sufficient clinical sophistication to recognize these feelings, understand their diagnostic significance, and prevent them from negatively affecting the assessment process. This is diagnostic data, not prejudice, but only when handled with appropriate clinical expertise.
Understanding DSM-5-TR Diagnostic Criteria
The Categorical Approach
The DSM-5-TR defines BPD through a categorical model requiring a pervasive pattern of instability across interpersonal relationships, self-image, and emotional regulation, combined with marked impulsivity. This pattern must begin by early adulthood and appear across various life contexts rather than only in specific situations. The diagnosis requires that at least five of nine specific criteria be present:
Frantic efforts to avoid real or imagined abandonment (excluding suicidal or self-injurious behavior)
Pattern of unstable and intense interpersonal relationships characterized by alternating between idealization and devaluation
Identity disturbance: Markedly and persistently unstable self-image or sense of self
Impulsivity in at least two potentially self-damaging areas (spending, substance abuse, reckless driving, sexual behavior, binge eating)—excluding suicidal or self-injurious behavior
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
Affective instability due to marked mood reactivity (intense episodic dysphoria, anxiety, or irritability), typically lasting hours rather than days
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (frequent temper displays, constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms
From a forensic perspective, attorneys should verify that expert reports specify exactly which criteria the parent meets and provide concrete behavioral examples demonstrating each criterion. Generic statements that someone "meets criteria for BPD" without this specificity prove forensically inadequate and vulnerable on cross-examination.
The Dimensional Alternative
The DSM-5-TR also offers a dimensional model that conceptualizes personality disorders through functional impairment and trait profiles rather than categorical present-or-absent diagnosis (Hopwood et al., 2012). This approach acknowledges clinical reality—that people rarely fit neatly into a single personality disorder category and that personality pathology exists on a continuum.
Under the dimensional model, BPD diagnosis requires demonstrating moderate or greater impairment in at least two domains of personality functioning:
Identity: Unstable self-image, excessive self-criticism, chronic feelings of emptiness
Self-direction: Instability in goals, aspirations, values, or career plans
Empathy: Compromised ability to recognize others' feelings and needs; hypersensitivity to perceived slights
Intimacy: Intense, unstable, conflicted close relationships; preoccupation with abandonment fears; alternation between over-involvement and withdrawal
Additionally, the individual must show at least four pathological personality traits, with at least one being impulsivity, risk-taking, or hostility:
Emotional lability (negative affectivity)
Anxiousness (negative affectivity)
Separation insecurity (negative affectivity)
Depressivity (negative affectivity)
Impulsivity (disinhibition)
Risk-taking (disinhibition)
Hostility (antagonism)
The dimensional model may offer a more nuanced assessment of personality functioning, specifically relevant to parenting capacity. An evaluator using this framework should specify which functional domains show impairment and to what degree, rather than simply checking whether diagnostic boxes are met.
Differential Diagnosis: Distinguishing BPD from Similar Conditions
Rigorous forensic assessment requires ruling out other conditions that may produce similar presentations. The differential diagnosis process begins with establishing whether the presentation is consistent with BPD's fundamental diagnostic requirements, then systematically considers alternative explanations.
Establishing the Pattern: Age of Onset and Chronicity
Before considering differential diagnoses or medical workups, the evaluator must establish whether the behavioral pattern is consistent with personality disorder at all. BPD, by diagnostic definition, requires:
Early onset: Pattern must be traceable to adolescence or early adulthood (typically by age 18-25)
Pervasive and persistent: Symptoms across multiple life domains (relationships, work, family) sustained over years
Long-standing stability of the pattern: Not a recent change in personality or functioning
When the clinical presentation doesn't fit this temporal pattern—particularly late onset (after age 30), sudden personality change, or symptoms emerging only in specific recent circumstances—BPD should not be the primary diagnostic consideration. Late-onset personality change suggests medical or neurological conditions, late-onset mood disorders, dementia, or situational reactions rather than personality disorder.
This temporal analysis is forensically essential: A parent with documented relationship instability, emotional dysregulation, and impulsivity dating to adolescence requires different diagnostic consideration than a parent whose behavioral problems emerged suddenly at age 42 following a traumatic event or medical condition.
Medical Conditions: When Workup Is Indicated
If the presentation shows atypical features for BPD—particularly late or sudden onset—medical evaluation becomes essential to exclude organic causes (Leppla et al., 2021). Personality changes can arise from various medical and neurological conditions:
Head trauma and traumatic brain injury
Cerebrovascular accident (stroke)
Central nervous system neoplasms (brain tumors)
Epilepsy, particularly temporal lobe forms
Neurosyphilis
Multiple sclerosis
Endocrine disorders (thyroid dysfunction, Cushing's syndrome)
Heavy metal poisoning
HIV-associated neurocognitive disorders
Medical evaluation is particularly indicated when:
Personality change onset occurs after age 30 with no prior psychiatric history
Sudden onset rather than long-standing pattern
Neurological signs accompany behavioral changes (memory problems, motor symptoms, speech changes, coordination difficulties)
Cognitive decline or confusion present
Treatment-resistant symptoms or atypical treatment response
However, when comprehensive historical records document a long-standing pattern consistent with BPD beginning in adolescence or early adulthood, expensive medical workups become clinically and financially unjustified. A 35-year-old with documented emotional dysregulation, unstable relationships, and impulsivity since age 16 does not require neuroimaging to rule out a brain tumor—the chronicity of the pattern rules out acute medical causes by its very nature.
Primary Psychiatric Differential Diagnoses
Once organic causes are appropriately ruled out or ruled in based on temporal pattern, the evaluator must distinguish BPD from other psychiatric conditions that share overlapping features. Research identifies three primary differential diagnoses that most commonly create diagnostic confusion (Jørgensen et al., 2024; Bozzatello et al., 2024; Qian et al., 2022):
1. Bipolar Disorder: The Most Common Misdiagnosis
Bipolar disorder and BPD both present with mood instability and impulsivity, making them frequently confused (Jørgensen et al., 2024; Bozzatello et al., 2024). The critical distinctions lie in the pattern, duration, and triggers of mood changes:
Bipolar Disorder:
Distinct episodes of mania or hypomania lasting days to weeks
Mood changes are more autonomous (less reactive to external events)
Elevated or expansive mood, grandiosity, decreased need for sleep during manic phases
Episodes have clear onset and offset
Mood stabilizers and mood-focused treatments typically effective
BPD:
Rapid mood shifts lasting hours, rarely more than a day
Mood changes highly reactive to interpersonal events (perceived rejection, abandonment, conflict)
Mood shifts between dysphoria, anxiety, and anger rather than euphoric mania
Chronic pattern without distinct episodes
Mood stabilizers generally less effective than treatments targeting emotion regulation
Forensic significance: Misdiagnosis has profound treatment and prognosis implications. Bipolar disorder typically responds to mood stabilizers and has better long-term prognosis with proper medication management. BPD requires psychotherapy-focused treatment and has variable prognosis depending on treatment engagement. A parent successfully managing bipolar disorder with medication may have minimal parenting impairment; a parent with untreated or treatment-resistant BPD presents different risk considerations.
BPD commonly co-occurs with both depressive and bipolar disorders, and when both are present, both should be diagnosed. However, BPD exacerbations can closely resemble mood episodes, creating diagnostic confusion. The critical distinction rests on pattern duration and consistency—BPD should only be diagnosed based on documented long-standing behavioral patterns rather than time-limited mood disturbances (Leichsenring et al., 2024). A parent diagnosed with BPD during acute depression or mania requires re-evaluation after psychiatric stabilization, as mood-driven behavior during acute episodes may not reflect underlying personality structure.
2. Other Personality Disorders
BPD shares overlapping features with other personality disorders, particularly within Cluster B (dramatic, emotional, erratic). Research demonstrates that antisocial, narcissistic, and paranoid personality disorders are frequently comorbid or confused with BPD, with notable sex differences in presentation patterns (Bozzatello et al., 2024; Qian et al., 2022). When an individual meets criteria for multiple personality disorders, all applicable diagnoses can be assigned.
Key differentiations:
Antisocial Personality Disorder: Shares impulsivity and relationship problems, but focuses on violating others' rights and lacks the intense abandonment fears and frantic efforts to maintain relationships characteristic of BPD. More common in males with BPD (Bozzatello et al., 2024). The combination of BPD and antisocial features presents elevated risk in custody contexts.
Narcissistic Personality Disorder: Shares interpersonal dysfunction, but characterized by grandiosity and sense of entitlement with a more stable (if inflated) self-image. BPD shows identity disturbance and moment-to-moment affective instability that narcissistic PD typically lacks.
Histrionic Personality Disorder: Shares attention-seeking and emotional expressiveness, but lacks the intense anger, self-harm, suicidal behavior, and profound abandonment fears central to BPD. More common in females (Bozzatello et al., 2024).
Paranoid Personality Disorder: May share interpersonal mistrust and suspiciousness, but paranoid PD lacks the affective instability, impulsivity, and identity disturbance of BPD.
What distinguishes BPD: The combination of affective instability, impulsivity, and the specific pattern of alternating between idealization and devaluation in relationships distinguishes BPD from other personality pathology (Leichsenring et al., 2024). The frantic efforts to avoid real or imagined abandonment and the chronic feelings of emptiness are particularly characteristic of BPD.
3. Substance Use Disorders: Temporal Relationship Is Critical
Substance use disorders are highly comorbid with BPD (41-82% depending on sex) and can mimic or exacerbate BPD symptoms including impulsivity, emotional dysregulation, and interpersonal difficulties (Qian et al., 2022; Mattingley et al., 2022; Bozzatello et al., 2024). This overlap creates significant diagnostic complexity in forensic evaluations.
Chronic substance use produces symptoms remarkably similar to BPD—impulsivity, mood instability, relationship chaos, and self-destructive behavior. Evaluators must carefully determine the temporal relationship between substance use and personality features:
Did personality pathology exist before substance use began, or did these features only emerge after chronic use was established?
Do BPD features persist during sustained sobriety periods? (Historical periods of sobriety documented in treatment records provide critical data)
Is substance use a consequence of attempting to manage pre-existing BPD-related emotional dysregulation (self-medication), or is apparent BPD behavior actually a consequence of substance effects and lifestyle?
Have BPD-like symptoms resolved with sustained sobriety, suggesting substance-induced personality change rather than true personality disorder?
These questions prove forensically essential for treatment planning and prognosis. A parent whose relationship instability and impulsivity emerged only after years of methamphetamine use and who demonstrates improved functioning with sustained sobriety has a different clinical picture than a parent with documented BPD features since adolescence who later developed substance dependence as a maladaptive coping mechanism.
Additional Diagnostic Considerations
Dissociative Identity Disorder:
Dissociative identity disorder involves two or more distinct personality states, each with its own enduring pattern of perceiving and relating to the world. In BPD, identity problems manifest as unstable, fluctuating self-image and sense of self rather than distinct alternate personalities or identity states (Leichsenring et al., 2024). While both conditions may involve dissociative symptoms, the presence of distinct identity states differentiates DID from BPD's identity diffusion.
Autism Spectrum Disorder:
Recent research demonstrates that autism spectrum disorder (ASD) is not a significant source of BPD misdiagnosis. The prevalence of ASD in BPD populations is only approximately 3%, and the overlap is limited and not a primary clinical concern in differential diagnosis (May et al., 2021). While both conditions may involve interpersonal difficulties, the nature and quality of these difficulties differ substantially—ASD involves social communication deficits and restricted interests, while BPD centers on abandonment fears, affective instability, and tumultuous interpersonal relationships.
Forensic Application: Diagnostic Precision Matters
In custody evaluations, differential diagnosis is not merely an academic exercise—it has direct implications for:
Treatment planning: Different conditions require different evidence-based interventions
Prognosis: Some conditions (e.g., bipolar disorder with medication compliance) have better functional outcomes than others
Parenting risk assessment: A parent with well-managed bipolar disorder presents different risks than a parent with severe untreated BPD
Intervention recommendations: Court-ordered treatment must target the actual underlying condition
Forensic evaluators must document the reasoning process for differential diagnosis, showing how they systematically considered and ruled out alternative explanations before reaching diagnostic conclusions. This methodological rigor protects the evaluation's credibility and provides the court with clinically sound foundations for decision-making.
3. Functional Assessment
Severity Assessment and Functional Impact
Not all parents carrying a BPD diagnosis demonstrate equivalent impairment. Forensic assessment must determine current functional status rather than merely noting diagnostic presence or absence.
Current Symptom Status Matters More Than Historical Diagnosis
Clinicians categorize symptom status along a continuum:
Active symptoms: Currently meeting full diagnostic criteria with ongoing dysfunction
Partial remission: Showing improvement but residual symptoms continue affecting functioning
Full remission: No longer meeting full criteria with substantial symptom reduction
Longitudinal research indicates that many individuals with BPD achieve symptom remission over time, particularly with sustained treatment engagement (Gunderson et al., 2011; Biskin, 2015). However, functional impairment in interpersonal relationships may persist even after formal diagnostic criteria are no longer met.
This creates an important forensic distinction. A parent who received a BPD diagnosis years ago but has maintained sustained remission presents vastly different risk than a parent with active, untreated symptoms. Evaluators must document current functional status using recent behavioral examples rather than relying on historical diagnosis alone. The question is not "does this person have a history of BPD?" but rather "how is this person functioning now, and how do current symptoms affect parenting capacity?"
Identifying Specific Parenting Impairments
Assessment must specify which parenting domains show impairment:
Sensitivity and attunement: Can the parent accurately read and respond to the child's emotional cues?
Emotional availability: Is the parent emotionally present and accessible to the child, or withdrawn and preoccupied?
Consistency: Does the parent provide predictable caregiving, or oscillate between over-involvement and aloofness?
Boundary maintenance: Can the parent maintain appropriate parent-child boundaries, or does role-reversal occur with the child managing the parent's emotional state?
Conflict management: Can the parent handle co-parenting conflict without involving the child in adult disputes?
These specific functional assessments prove far more useful for custody decision-making than general diagnostic labels.
Treatment Engagement and Response
When a parent reports being in BPD treatment, forensic evaluation must examine both the nature and effectiveness of that treatment. Documentation should specify the treatment modality and its evidence base. The gold-standard evidence-based treatments for BPD include:
Dialectical Behavior Therapy (DBT) - A structured cognitive-behavioral approach targeting emotional dysregulation, interpersonal effectiveness, distress tolerance, and mindfulness through individual therapy, skills training groups, and coaching
Mentalization-Based Treatment (MBT) - A psychodynamic approach focused on improving the capacity to understand one's own and others' mental states, enhancing reflective functioning and interpersonal relationships
Transference-Focused Psychotherapy (TFP) - A psychodynamic treatment addressing identity diffusion, primitive defense mechanisms, and unstable object relations through analysis of the therapeutic relationship
Schema Therapy - An integrative approach combining cognitive-behavioral, attachment, and psychodynamic elements to address maladaptive schemas and modes developed from early experiences
These modalities differ substantially from general supportive counseling, crisis intervention, or non-specialized psychotherapy in their structure, treatment targets, and demonstrated efficacy for BPD symptom reduction.
Critical questions for forensic evaluation include: Is the parent engaged in one of these evidence-based modalities, or is treatment limited to general supportive therapy? How long has treatment been sustained consistently? What specific gains have been documented? Therapist reports should address measurable progress and current functional capacity—particularly parenting-relevant skills such as emotion regulation, impulse control, and interpersonal stability—rather than simply confirming attendance or therapeutic alliance. Objective measures of symptom change through standardized assessment scales (e.g., Zanarini Rating Scale for BPD, Borderline Symptom List, Difficulties in Emotion Regulation Scale) provide more reliable data than self-report alone and allow for quantification of treatment response over time.
Pharmacotherapy: Limited Role
No medications are FDA-approved for the treatment of BPD, and there is no evidence that pharmacotherapy is efficacious for BPD core symptoms (Leichsenring et al., 2024). Despite clinical guidelines recommending against routine medication use, up to 96% of patients with BPD receive at least one psychotropic medication, and polypharmacy is common.
Medications such as selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and antipsychotics show limited effectiveness in controlling transient symptoms such as anxiety, sleep disturbance, depression, or agitation. Pharmacotherapy is recommended only for treatment of comorbid disorders (severe depression, anxiety disorders) or management of acute symptoms (transient psychotic symptoms, severe agitation, aggressive behavior) (Leichsenring et al., 2024).
Forensic Significance:
A parent taking multiple psychotropic medications for BPD is not necessarily receiving evidence-based treatment—polypharmacy can be associated with iatrogenic harm and may contribute to functional impairment (Leichsenring et al., 2024)
Evaluators should assess whether medication regimens serve a legitimate clinical purpose or reflect treatment attempts without empirical support
Medication compliance alone does not indicate adequate treatment engagement for BPD-related parenting concerns
Risk and Protective Factors
Several factors complicate treatment and affect prognosis in BPD cases:
Self-Injurious Behavior and Suicidality: Self-harm, boundary violations, and suicidal ideation present ongoing treatment challenges. While most patients with BPD do not require hospitalization, inpatient care may be necessary for imminent high-lethality suicidal behavior, intense negative thoughts with agitation or transient psychosis, rapid escalation in self-harm severity, or exacerbation of comorbid disorders or substance use (Leichsenring et al., 2024).
Forensic Implication: Parents with ongoing self-injurious behavior or repeated psychiatric hospitalizations may lack the emotional stability necessary for consistent caregiving. Courts must consider whether acute psychiatric crises expose children to trauma, role-reversal (child as caregiver), or disrupted attachment.
Substance Use Comorbidity: BPD and substance use disorders frequently co-occur (Trull et al., 2018). Combined substance use and BPD substantially elevates risk for parenting impairment and child maltreatment beyond either condition alone.
Treatment Dropout: Patients with BPD have high rates of treatment dropout and difficulty maintaining therapeutic relationships, reflecting the interpersonal instability characteristic of the disorder. A parent who has cycled through multiple therapists or treatment programs presents different risk considerations than one who has sustained engagement with evidence-based treatment.
The Role of Insight and Self-Awareness
Parental insight significantly affects prognosis and risk assessment. Does the parent recognize:
How their BPD symptoms affect their parenting?
Which situations or stressors trigger emotional dysregulation?
The need for ongoing treatment and support?
The impact of their behavior on the child's emotional well-being?
Parents demonstrating good insight and active treatment engagement present better prognosis than those who deny problems, attribute all difficulties to the other parent or external circumstances, or lack awareness of how their emotional volatility affects their children. This insight dimension often proves more predictive of parenting outcomes than raw symptom severity.
Contextual Risk Factors and Social Support
BPD rarely occurs in isolation, and comorbid conditions significantly compound parenting-related risks. Research documents clear patterns and sex-specific differences in comorbidity profiles:
Major Depressive Disorder (>80-90% comorbidity): The combination of BPD and depression is associated with more severe symptomatology and poorer treatment outcomes (Bozzatello et al., 2024; Ceresa et al., 2020). This comorbidity substantially increases parenting impairment and risk for emotional withdrawal, neglect, or inability to meet children's emotional and physical needs during depressive episodes.
Substance Use Disorders (41-82% comorbidity, with marked sex differences): Alcohol and drug abuse/dependence rates reach 74-82% in men with BPD and 41-59% in women with BPD (Qian et al., 2022; Bozzatello et al., 2024). When BPD and substance use disorders co-occur, child maltreatment risk elevates dramatically beyond either condition alone, with compounded effects on impulse control, emotional regulation, and judgment during parenting.
Anxiety Disorders and PTSD (34-61% for PTSD): Anxiety disorders are frequently comorbid with BPD, with PTSD prevalence ranging from 34-61% and strongly linked to childhood trauma history and elevated suicide risk (Qian et al., 2022; Bozzatello et al., 2024; Slotema et al., 2020). These conditions may exacerbate abandonment fears and lead to overprotective, intrusive, or hypervigilant parenting that interferes with developmentally appropriate autonomy and secure attachment formation.
Eating Disorders (21-62% comorbidity, more common in females): Up to 62% of women with BPD present with comorbid eating disorders compared to 21% of men, with affective instability as the primary linking symptom (Miller et al., 2022; Qian et al., 2022; Bozzatello et al., 2024). Eating disorder comorbidity can affect parenting capacity through preoccupation with food, body image, and control, potentially modeling disordered eating behaviors or imposing rigid food-related rules on children.
Other Personality Disorders: BPD frequently co-occurs with antisocial personality disorder (more common in males), and histrionic or dependent personality disorders (more common in females), creating additional layers of interpersonal dysfunction that compound parenting difficulties (Bozzatello et al., 2024).
Sex-Specific Comorbidity Patterns: Males with BPD demonstrate higher rates of externalizing comorbidities (substance use, antisocial behavior), while females show higher rates of internalizing comorbidities (mood, anxiety, eating disorders) (Qian et al., 2022; Bozzatello et al., 2024). These patterns have distinct implications for parenting risk assessment and require sex-informed clinical evaluation.
Trauma and Violence Considerations
Childhood Trauma History: BPD development is frequently rooted in adverse childhood experiences, including abuse, neglect, and attachment disruption (Bozzatello et al., 2021). Unresolved trauma may perpetuate intergenerational cycles of maltreatment or compromised attachment.
Post-Traumatic Stress Disorder: With PTSD prevalence of 34-61% in BPD populations, trauma-related symptoms (hypervigilance, emotional numbing, intrusive memories, avoidance) can significantly impair parenting presence, emotional availability, and ability to provide consistent caregiving (Qian et al., 2022; Slotema et al., 2020).
Domestic Violence: Current or historical domestic violence—whether as victim, perpetrator, or both—represents a critical risk factor. BPD is associated with both victimization and perpetration of intimate partner violence, creating unsafe environments for children and modeling maladaptive relationship patterns.
Active Safety Concerns: Protective orders, documented violent incidents, threats, or ongoing safety concerns indicate elevated risk requiring immediate attention in custody determinations.
The Social Support Assessment
The interpersonal instability characteristic of BPD frequently extends beyond the parent-child relationship to affect the broader social support network. Parents with BPD often struggle to maintain stable, supportive relationships with extended family, friends, and community resources—precisely the supports that could buffer against parenting stress and provide alternative attachment figures for children (Ibrahim et al., 2018).
Forensic evaluation must examine several dimensions:
Quality of support relationships: Are supports functional and appropriate, or chaotic and crisis-oriented?
Stability over time: Has the parent maintained long-term relationships, or is there a pattern of ruptures and estrangements?
Availability during crises: Does the parent have appropriate people to turn to for help without involving the child in adult problems?
Alternative attachment figures: Are there stable adults in the child's life who can provide consistent caregiving when the parent experiences dysregulation?
A parent with BPD who lacks functional social support faces compounded challenges. Without appropriate supports, they must manage parenting stress alone, handle crises without appropriate adult assistance, and have no one to turn to during periods of emotional dysregulation—circumstances that increase the likelihood of involving children inappropriately in their emotional struggles. Conversely, a parent with intact social supports and positive family involvement presents lower risk and better prognosis, as these supports can buffer stress and provide stability for children even during the parent's difficult periods.
Environmental Stressors Compound Risk
Financial instability or housing insecurity
Chaotic family lifestyle with frequent moves or residential instability
Employment problems or frequent job changes
Ongoing litigation or legal problems
While these stressors affect any parent's capacity, they prove particularly challenging for parents with BPD who have limited distress tolerance and emotion regulation capacity.
5. Conclusion
Borderline personality disorder represents a complex clinical entity with significant variability in presentation, severity, and functional impact. While research documents elevated population-level risks to parenting capacity—including patterns of emotional dysregulation, inconsistent caregiving, and adverse child outcomes—these research findings describe aggregate trends, not individual certainties.
The Critical Distinction: Diagnosis vs. Individual Functioning
A diagnosis of BPD does not automatically indicate impaired parenting capacity. Individual functioning exists on a spectrum influenced by multiple factors:
Symptom severity and stability: The difference between acute, unstabilized BPD and well-managed, treatment-responsive BPD is profound
Treatment engagement and response: Evidence-based treatments (DBT, MBT, TFP, Schema Therapy) can produce meaningful improvements in emotion regulation, interpersonal functioning, and behavioral control
Insight and self-awareness: Parents who recognize their patterns, understand their triggers, and actively work to prevent negative impacts on children function very differently from those lacking insight
Life stage and symptom trajectory: BPD symptoms often decrease with age and sustained treatment; a parent at 40 may function markedly better than that same parent at 25
Protective factors: Strong social support, financial stability, co-parent involvement, and absence of severe comorbidities (particularly substance use) can substantially buffer risk
Parenting-specific functioning: Some individuals with BPD maintain significant impairment in romantic relationships while demonstrating adequate or even strong parent-child relationships
Many parents with BPD are capable, loving, and effective parents, particularly when they have engaged in consistent treatment, developed insight into their patterns, established support systems, and achieved symptom stability. The intergenerational nature of BPD—where parents with BPD often experienced the dysfunctional parenting they now risk perpetuating—can also serve as motivation for breaking cycles and providing better care for their children than they themselves received.
The Forensic Challenge: Case-Specific Risk Assessment
The central challenge in custody evaluations is distinguishing population-level risk from individual case risk. The research presented in this document provides a framework for understanding potential concerns, but should never be applied mechanistically as a checklist that predetermines outcomes based solely on diagnosis.
Forensic assessment must examine:
Current functional parenting capacity through direct observation, not historical diagnosis
Observable parent-child interactions and attachment quality
Documented behavioral patterns in the specific parent-child relationship at issue
Treatment history and response, including sustained engagement vs. sporadic participation
Protective factors and support systems that modify risk
Child's actual functioning and adjustment, which provides the most direct evidence of parenting impact
Capacity for insight and behavior change, which predicts future functioning
A comprehensive evaluation should answer: Does this specific parent, with this specific presentation of BPD, at this specific point in their treatment and life trajectory, demonstrate observable functional parenting impairments that create risk for this specific child?
For Family Law Attorneys: Ensuring Comprehensive Evaluation
The work presented here is intended to arm family law attorneys with the knowledge base to:
Ensure evaluation quality: Demand methodologically rigorous assessments that examine current functioning, not just diagnostic labels
Identify inadequate evaluations: Recognize when evaluators have conflated diagnosis with functional impairment or failed to assess protective factors
Challenge overgeneralization: Question experts who apply population statistics to individual cases without demonstrating case-specific risks
Advocate for appropriate interventions: Recommend evidence-based BPD treatments rather than generic counseling when parenting concerns are identified
Contextualize risk appropriately: Understand when BPD-related concerns rise to the level of custody modification vs. when they can be managed through appropriate safeguards
Final Perspective
BPD in parenting contexts demands evaluation that is methodologically sound, empirically grounded, appropriately nuanced, and fundamentally focused on the child's best interests. The complexity of this disorder—its spectrum of severity, its responsiveness to treatment, its capacity for improvement over time—requires forensic evaluators and attorneys to resist oversimplification in either direction. Neither "BPD means this parent can't parent" nor "BPD is irrelevant to parenting" represents an appropriate conclusion. The only defensible approach is thorough, individualized assessment of how this parent's specific presentation affects this child's specific needs.
Quick reference | BPD Diagnosis Quality checklist for family law practitioners
BPD Diagnosis Quality Assessment
About the Authors
Dr. Lisa Long, Psy.D. is the Owner and Psychological Director of Dr. Long & Associates, a nationally recognized provider of forensic and clinical psychological evaluations. She serves as a court-appointed expert in family law and federal immigration proceedings and provides expert consultation to attorneys across complex psycho-legal matters.
Before founding her private practice, Dr. Long served as Lead Forensic Psychologist at a maximum-security forensic psychiatric hospital in Georgia and as Director of Psychological Services for the 422nd Medical Squadron at RAF Croughton in the United Kingdom. In 2025, she co-presented original research at the American Academy of Forensic Sciences (AAFS) Annual Scientific Meeting examining intimate partner violence dynamics in VAWA and family law evaluations.
Dr. Long is fluent in Spanish and proficient in Arabic and Russian, enabling culturally competent psychological evaluations for diverse national clientele. She is the clinical expert responsible for the diagnostic and assessment frameworks presented in this article.
Dr. Leesandra Contreras-Gonzalez, Psy.D. serves as a Post-doctoral Fellow at Dr. Long & Associates, specializing in forensic psychology, trauma-informed care, and bicultural mental health. She completed her APA-accredited internship at the Superior Court of the District of Columbia's Child Guidance Clinic, conducting advanced forensic assessments under the supervision of a board-certified forensic psychologist.
Dr. Contreras-Gonzalez's doctoral dissertation utilized Critical Race Theory and Intersectional Feminism to explore the lived experiences of Latinas with law enforcement. As a native Spanish speaker with dual degrees in Psychology and Spanish, she provides culturally and linguistically congruent evaluations and contributed clinical perspectives on trauma and cultural factors in parenting capacity assessment.
David Luddy serves as Managing Partner of Dr. Long & Associates, where he leads strategic initiatives to expand the firm's national reach across forensic and clinical psychological evaluation services. He is responsible for optimizing operational workflows, integrating advanced technologies, and supporting the development of innovative service models.
Mr. Luddy brings a research-informed approach to organizational development and applied his expertise in systems analysis and legal strategy to this article's framework for attorney application. His contributions focused on literature review, research synthesis, and translating clinical concepts into practical guidance for family law practitioners
References
Biskin, R. S. (2015). The lifetime course of borderline personality disorder. Canadian Journal of Psychiatry, 60(7), 303-308. https://doi.org/10.1177/070674371506000702 Cited by 281+
Boucher, M. E., et al. (2017). Parent-child relationship associated with the development of borderline personality disorder: A systematic review. Personality and Mental Health, 11(2), 75-91. https://doi.org/10.1002/pmh.1385 Cited by 148
Bozzatello, P., Rocca, P., Baldassarri, L., Bosia, M., & Bellino, S. (2021). The role of trauma in early onset borderline personality disorder: A biopsychosocial perspective. Frontiers in Psychiatry, 12, 721361. https://doi.org/10.3389/fpsyt.2021.721361 Cited by 147
Bozzatello, P., Blua, C., Brandellero, D., Baldassarri, L., Brasso, C., Rocca, P., & Bellino, S. (2024). Gender differences in borderline personality disorder: A narrative review. Frontiers in Psychiatry, 15, 1320546. https://doi.org/10.3389/fpsyt.2024.1320546 Cited by 74
Campbell, K., et al. (2020). Borderline personality disorder: To diagnose or not to diagnose? That is the question. International Journal of Mental Health Nursing, 29(5), 972-981. https://doi.org/10.1111/inm.12737 Cited by 119
Ceresa, A., Esposito, C., & Buoli, M. (2020). How does borderline personality disorder affect management and treatment response of patients with major depressive disorder? A comprehensive review. Journal of Affective Disorders, 281, 991-998. https://doi.org/10.1016/j.jad.2020.11.111 Cited by 20+
Eyden, J., et al. (2016). A systematic review of the parenting and outcomes experienced by offspring of mothers with borderline personality pathology: Potential mechanisms and clinical implications. Clinical Psychology Review, 47, 85-105. https://doi.org/10.1016/j.cpr.2016.04.002 Cited by 236
Gunderson, J. G., et al. (2011). Ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of General Psychiatry, 68(8), 827-837. https://doi.org/10.1001/archgenpsychiatry.2011.37 Cited by 1,203
Hopwood, C. J., Thomas, K. M., Markon, K. E., Wright, A. G., & Krueger, R. F. (2012). DSM-5 personality traits and DSM–IV personality disorders. Journal of Abnormal Psychology, 121(2), 424-432. https://doi.org/10.1037/a0026656 Cited by 535
Ibrahim, J., et al. (2018). Childhood maltreatment and its link to borderline personality disorder features in children: A systematic review approach. Clinical Child Psychology and Psychiatry, 23(1), 15-27. https://doi.org/10.1177/1359104517715451 Cited by 161
Jørgensen, M., et al. (2024). The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study. Comprehensive Psychiatry, 132, 152478. https://doi.org/10.1016/j.comppsych.2024.152478 Cited by 25
Kasiviswanathan, K., Lee, J., Rao, S., & Broadbear, J. (2025). Navigating parenthood in people living with borderline personality disorder: A meta-ethnography. Borderline Personality Disorder and Emotion Dysregulation, 12. https://doi.org/10.1186/s40479-025-00291-6
Leichsenring, F., et al. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry, 23(1), 4-25. https://doi.org/10.1002/wps.21156 Cited by 242
Leppla, I., et al. (2021). Clinical approach to personality change due to another medical condition. Journal of the Academy of Consultation-Liaison Psychiatry, 62(1), 14-21. https://doi.org/10.1016/j.psym.2020.08.003 Cited by 10+
Mattingley, S., Youssef, G., Manning, V., Graeme, L., & Hall, K. (2022). Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. Journal of Affective Disorders, 300, 289-299. https://doi.org/10.1016/j.jad.2021.12.126 Cited by 96
May, A., Balzan, R., Williams, A., Wade, T., & Paranjothy, S. (2023). Interventions for perinatal borderline personality disorder and complex trauma: A systematic review. Archives of Women's Mental Health, 26, 295-309. https://doi.org/10.1007/s00737-023-01313-4 Cited by 20
May, T., Pilkington, P., Younan, R., & Williams, K. (2021). Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Research, 14, 2688-2710. https://doi.org/10.1002/aur.2619 Cited by 17+
Miller, A., Trolio, V., Halicki-Asakawa, A., & Racine, S. (2022). Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses. The International Journal of Eating Disorders, 55(11), 1534-1550. https://doi.org/10.1002/eat.23731 Cited by 44
Parmar, A., & Kaloiya, G. (2018). Comorbidity of personality disorder among substance use disorder patients: A narrative review. Indian Journal of Psychological Medicine, 40(6), 517-527. https://doi.org/10.4103/IJPSYM.IJPSYM_88_18 Cited by 126
Parth, K., et al. (2017). Transference and countertransference: A review. Bulletin of the Menninger Clinic, 81(2), 167-211. https://doi.org/10.1521/bumc.2017.81.2.167 Cited by 20+
Petfield, L., et al. (2015). Parenting in mothers with borderline personality disorder and impact on child outcomes. Evidence-Based Mental Health, 18, 67-75. https://doi.org/10.1136/eb-2015-102163 Cited by 156
Preti, E., Richetin, J., Poggi, A., & Fertuck, E. (2023). A model of trust processes in borderline personality disorder: A systematic review. Current Psychiatry Reports, 25, 555-567. https://doi.org/10.1007/s11920-023-01468-y Cited by 10+
Qian, X., Townsend, M., Tan, W., & Grenyer, B. (2022). Sex differences in borderline personality disorder: A scoping review. PLOS ONE, 17. https://doi.org/10.1371/journal.pone.0279015 Cited by 85
Rimmington, D., Roberts, R., Sawyer, A., & Sved-Williams, A. (2024). Dissociation in mothers with borderline personality disorder: A possible mechanism for transmission of intergenerational trauma? A scoping review. Borderline Personality Disorder and Emotion Dysregulation, 11. https://doi.org/10.1186/s40479-024-00250-7
Rosenbach, C., Heinrichs, N., Kumsta, R., Schneider, S., & Renneberg, B. (2022). Study protocol for a multi-center RCT testing a group-based parenting intervention tailored to mothers with borderline personality disorder against a waiting control group (ProChild-SP1). Trials, 23. https://doi.org/10.1186/s13063-022-06531-2 Cited by 22
Salgado, R., Pedrosa, R., & Bastos-Leite, A. (2020). Dysfunction of empathy and related processes in borderline personality disorder: A systematic review. Harvard Review of Psychiatry, 28, 238-254. https://doi.org/10.1097/hrp.0000000000000260 Cited by 79
Sansone, R. A., & Sansone, L. A. (2013). Responses of mental health clinicians to patients with borderline personality disorder. Innovations in Clinical Neuroscience, 10(5-6), 39-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719460/ Cited by 53+
Seeger, F., Neukel, C., Williams, K., Wenigmann, M., Fleck, L., Georg, A., Bermpohl, F., Taubner, S., Kaess, M., & Herpertz, S. (2022). Parental mental illness, borderline personality disorder, and parenting behavior: The moderating role of social support. Current Psychiatry Reports, 24, 591-601. https://doi.org/10.1007/s11920-022-01367-8 Cited by 34
Sellbom, M., Waugh, M. H., & Hopwood, C. J. (2024). Development and initial validation of Personality Disorder Syndrome scales for the MMPI-3. Psychological Assessment. https://doi.org/10.1037/pas0001311
Senberg, A., Schmucker, M., Oster, A., & Zumbach, J. (2023). Parental personality disorder and child maltreatment: A systematic review and meta-analysis. Child Abuse & Neglect, 140, 106148. https://doi.org/10.1016/j.chiabu.2023.106148 Cited by 12
Slotema, C., et al. (2020). Psychotherapy for posttraumatic stress disorder in patients with borderline personality disorder: A systematic review and meta-analysis of its efficacy and safety. European Journal of Psychotraumatology, 11. https://doi.org/10.1080/20008198.2020.1796188 Cited by 28+
Steele, K. R., et al. (2019). Parenting and personality disorder: An overview and meta-synthesis of systematic reviews. PLOS ONE, 14. https://doi.org/10.1371/journal.pone.0223038 Cited by 173
Stepp, S., et al. (2012). Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders, 3(1), 76-91. https://doi.org/10.1037/a0023081 Cited by 310
Trull, T., et al. (2018). Borderline personality disorder and substance use disorders: An updated review. Borderline Personality Disorder and Emotion Dysregulation, 5, 5. https://doi.org/10.1186/s40479-018-0093-9 Cited by 155
Uher, R., et al. (2023). Transdiagnostic risk of mental disorders in offspring of affected parents: A meta-analysis of family high-risk and registry studies. World Psychiatry, 22, 433-448. https://doi.org/10.1002/wps.21147 Cited by 90
Williams, A., & Hill, R. (2023). The management of perinatal borderline personality disorder. Journal of Clinical Medicine, 12. https://doi.org/10.3390/jcm12216850 Cited by 10+
Winsper, C., et al. (2016). The aetiological and psychopathological validity of borderline personality disorder in youth: A systematic review and meta-analysis. Clinical Psychology Review, 44, 13-24. https://doi.org/10.1016/j.cpr.2015.12.001 Cited by 225
Zimmerman, M., & Mattia, J. I. (1999). Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry, 40(4), 245-252. https://doi.org/10.1016/s0010-440x(99)90123-2 Cited by 587
This article is for educational purposes and does not constitute legal or clinical advice. Custody determinations require individualized assessment by qualified forensic mental health professionals.