2026 Borderline Personality Disorder (BPD) Revised (FREE SEMINAR in November!)

My YouTube channel is booming like never before. We have just crossed the 450,000 subscribers line and 100 million views. As you well know, this was the first channel ever on narcissistic abuse, a phrase I coined. And this leads me to the November seminar. Initially, there were 160 places reserved, but we have had 180 reservations. So, we have added 20 places. I've contracted for another 20 places, expanding the space of the lecture hall. These 20 spaces are available to you. If you want to reserve your seat in the November seminar in Ohrid, that's a city in North Macedonia, the seminar is in person, so you need to write to me, samvaknin@gmail.com. The seminar deals with borderline personalities and there's a bonus lecture on the sexuality of cluster B personality disorders. No, no demonstrations included. >> [laughter] >> Okay, shoshanim and shoshanot, I want to give you a foretaste of what's expecting you in the seminar. I want to discuss the latest on borderline personality disorder, cutting edge, bleeding edge, pardon the pun, 2026 studies on this much maligned and much debated disorder. The term borderline originated in the 1930s. It was meant to describe to describe patients that are precariously balanced on the border line between neurosis and psychosis. Formally, we no longer believe this. It's not the consensus, but it is still the view of many practitioners and theoreticians, myself included. The Borderline Alliance and Tara, t a r a, they call for a name change. They think borderline, the word borderline, is stigmatizing and also that it is clinically misleading. I beg to differ. I think there are strong elements in borderline personality disorder which could easily be described as neurotic and definitely border people with borderline personality disorder have strong psychotic features such as hyperreflexivity and they experience psychotic micro episodes, the famous switching. Okay. In younger patients, borderline-like symptoms are common. Impulsivity, mood lability, an unstable self-concept, what Erikson called moratorium, acute sensitivity to rejection. These are all features of borderline personality disorder and that's why we are very hesitant to diagnose someone younger than 18, 21 with borderline personality disorder because many adolescents have these features. They they they they are borderline-like, but this is widely considered a very healthy part of growing up. Ever since the third edition, >> [clears throat] >> the Diagnostic and Statistical Manual offered several nine diagnostic criteria for borderline personality disorder. They included a fear of abandonment, unstable relationships, identity disturbance, impulsivity, self-harm or recurrent suicidal behavior, emotional reactivity, chronic emptiness, intense anger, and transient stress-related paranoia or dissociation. But here's the problem. It takes five of these nine criteria to be diagnosed with borderline personality disorder. So if we diagnose someone based on five out of nine diagnostic criteria in the DSM we create a polythetic problem. Allow me to explain. Two individuals could be diagnosed with borderline personality disorder but have only one diagnostic criterion in common. So you could have someone diagnosed with BPD based on criteria 1 2 3 4 5 and you can have someone diagnosed with BPD based on criteria 5 6 7 8 9. And the only thing they will have in common is criterion five. This is known as the polythetic problem. Borderline personality disorder is highly prevalent in clinical settings. 22% that's 1/4 of psychiatric inpatients suffer from borderline personality disorder and 12% 1/8 of outpatients have a primary diagnosis of borderline personality disorder. A 2026 meta-analysis estimated a global community prevalence of 2.4%. That's much higher than we thought. And borderline personality disorder occurs equally in men and women but it is diagnosed three times more often in women. Now this is very telling and also very worrisome. If we know for sure that half of all borderline are men and half are women, why are women diagnosed so massively more than men? Well, possibly owing to gender bias and to stereotypes. Men with borderline personality disorder are more likely to be to be diagnosed with substance use disorder or treated for isolated problem behaviors. It seems that diagnosticians and clinicians are loath are resistant to assigning a diagnosis of borderline personality disorder to a man. And that's a great definition of stereotype. My proposed diagnosis of covert borderline addresses this gap, but I will not go into it right now. Borderline personality disorder is a very disruptive condition. There are repeated hospitalizations, powerful debilitating medications, years of psychotherapy. Like other personality disorders, borderline personality disorder is uh all pervasive. Every aspect of the patient's life is affected. A sense of identity and self, emotions, relationships, and behaviors which are often self-harmful. Marsha Linehan, the developer of dialectical behavior therapy, DBT, described borderline personality disorder, the condition, as lacking an emotional skin. When every contact with an another human being is excruciatingly painful, consequently, suicidal ideation is very common in borderline personality disorder. More than 80% of the 35,000 subjects in a meta-analysis were found to have experienced suicidal ideation. More than 50% of them actually attempted suicide. And 6% ended their lives. The population-wide number is 11%. Borderline personality disorder is the sing- single most potent independent predictor of suicide risk across all psychiatric conditions. Substance use and self-harm are also very prevalent. Gerald Kreisman suggests that BPD is a chameleon effect. Identity diffusion, which is reflexively reactive to the environment, colludes with mimicry of conditions such as depression, PTSD, and bipolar disorder, and this misleads diagnosticians. It's not so easy to diagnose BPD because it resembles so many other mental health issues. And because of the fluctuations in identity and a sense of self and continuity, there's a lot of dissociation involved. But as distinct from bipolar disorder, in borderline personality disorder, mood swings and shifts are rapid, shallow, and triggered by stressors. 40% of bipolar patients are misdiagnosed and actually suffer from borderline personality disorder. Luckily, borderline personality disorder is highly responsive to treatments such as DBT, MBT, or TFP. And borderline personality disorder remits with age. Now, DBT is dialectical behavior therapy. MBT is mentalization-based therapy and TFP is transference-focused psychotherapy. In 2024, the American Psychiatric Association, which is also the publisher of the Diagnostic and Statistical Manual of Mental Disorders, so in 2024, this association published updated practice standards for borderline personality disorder. The new guidelines are revolutionary. Talk therapy is in. Long-term medications for core symptoms is out. There is no evidence that drugs or medications resolve clinical features of borderline personality disorder. [clears throat] None. Not one of them. Psychotropic medications should only be used as adjuncts or anxiolytics to reduce anxiety or for co-occurrent comorbid conditions. Clinicians, say the guidelines, should communicate openly with their patients. They should discuss the diagnosis, track progress, and construct treatment plans as a collaborative effort. The education of clinicians on borderline personality disorder is paramount. Most patients wait for a decade or more for the correct diagnosis. In 2026, the Journal of Psychiatric Research published a study that found a median delay of 13 and 1/2 years between symptom onset and formal diagnosis. When lived experience is explored in targeted surveys, the number ratchets up to 18 years. 18 years from the moment you report symptoms, moment of presentation, to the moment that you're correctly diagnosed with borderline personality disorder. The late Gunderson, the father of borderline personality disorder study, uh was aware of this situation. And he constructed a framework for the treatment of borderline personality disorder by nurses, primary care providers, and social workers. He called it the general psychiatric management framework. It is now being applied to young patients. He described it this way. GPM emphasizes psychoeducation, practical problem solving, and getting a life. A central priority is building real-world stability, holding down a job, staying in a school, and navigating healthy relationships. Clinicians learn to discuss the diagnosis openly, connect emotional crises to immediate stressors, manage suicidality and self-harm proactively, and use psychiatric medications sparingly for targeted symptoms. Zanarini and others of the famous the the designer of the famous test for borderline personality disorder, the Zan BPD. So, Zanarini led the McLean study of adult development. Of 300 participants with borderline personality disorder who were tracked longitudinally over 24 years, almost all exhibited symptom remission for at least 12 years. For at least 2 years, I'm sorry. Listen to this again. It's the kernel, the nucleus of hope for borderline personality disorder. The prognosis is excellent, actually. There were 300 participants in the study, and of these 300 participants, over 24 years, almost all of them exhibited symptom remission for at least 2 years. And more than 77% of them sustained remission for 12 years. Similar [snorts] results emerged from the multi-site collaborative longitudinal personality disorders study. The study followed 668 subjects over eight over 10 years. 85% of them achieved remission for at least 1 year and only 12% relapsed. Remission starts with the amelioration of impulsivity and self-harm. But inner processes and clinical features regrettably remain largely untouched. Sense of emptiness, chronic loneliness, anxiety, and depressive episodes. According to the McLean study, at the 24-year mark, only 37 to 60% of patients are fully functionally recovered. What did we learn from all this? A lack of a cohesive self undermines life goals and accomplishments. This should be the emphasis of long-term treatment to allow the borderline patient to finally get a life. I give you a foretaste, a morsel, from the forthcoming November seminar on borderline personalities held in Ohrid, North Macedonia. And it's free. And reserve your seat in person by writing to samvaknin@gmail.com. I'm looking forward to meeting all of you there.