2025.03.28ブログ
境界性パーソナリティ障害（BPD)はそれほど頻度が高い疾患ではない、神奈川県厚木市の児童精神科医が解説
境界性パーソナリティ障害（BPD)はそれほど頻度が高い疾患ではない、神奈川県厚木市の児童精神科医が解説
こんにちは、神奈川県厚木市の児童精神科専門クリニック、きもとメンタルクリニックです。
今回は、境界性パーソナリティ障害（BPD)はそれほど頻度が高い疾患ではない、について解説します。
BPDと他院で診断されている方が紹介受診することがありますが、実際にBPDの診断がつくことは少ないです。
それくらいBPDとは診断基準はしっかりしており、重症な疾患です。
BPDの要素の一部があることは多いですが、すべての診断基準を満たすことは多くないです。
BPDは、易刺激性+生育歴（不認証環境）でできる疾患です。
易刺激性、irritability、気分の変調、易変性といったところでしょうか。
これは器質的な問題であり、生来の特性です。
そこに、不認証環境が加わり、BPDが作られます。
治療はこの二つに対して行います。
易刺激性に対しては内服を、不認証環境に関しては、心理療法を行います。
アメリカでは、弁証法的認知行動療法（DBT)がおこなわれていますが、日本では保険治療ではそれはできません。
カウンセリングの中で、結果としてDBTと同じような現象を発生させます。
そして非常に時間のかかる治療となります。
本人のモチベーションも高くないと、続けることはできないでしょう。
BPD的なものがある方も、治療はこれに準じることになります。
なるべく早く、治療を開始するのにこしたことはないので、少しでも気になることがあれば当院へご相談ください。
Today, I’d like to explain why Borderline Personality Disorder (BPD) is not as common a diagnosis as it is often assumed to be.
BPD Is a Rare and Severe Disorder
It’s not uncommon for patients referred to our clinic to say they were previously diagnosed with BPD at another facility. However, in reality, few cases actually meet the full diagnostic criteria for BPD upon thorough assessment.
BPD is a serious psychiatric condition with clearly defined diagnostic criteria. While many individuals may exhibit some borderline traits, very few fulfill the entire set of criteria required for a formal diagnosis.
The Roots of BPD: A Combination of Biological and Environmental Factors
BPD typically develops through a combination of two factors:
Irritability or emotional instability – a biological or temperamental trait
An invalidating environment during childhood or adolescence
Irritability refers to a temperament characterized by rapid mood shifts, emotional sensitivity, and difficulty regulating emotions — this is a neurobiological trait that is often present from early in life.
When this inherent irritability is met with a lack of emotional validation from caregivers or the surrounding environment (e.g., being constantly dismissed or criticized), it may lead to the development of BPD.
Treatment Approach
Treatment targets both of the core components:
For irritability, medication can be effective.
For the invalidating environment and emotional regulation, psychotherapy is essential.
In the U.S., Dialectical Behavior Therapy (DBT) is a well-established, evidence-based treatment for BPD. Unfortunately, DBT is not covered under Japan’s national health insurance system.
However, similar therapeutic effects can be achieved through counseling that incorporates DBT-like principles, especially in a supportive, long-term therapeutic relationship.
It's important to understand that this is a time-intensive process and requires strong motivation and commitment from the patient. Without that, treatment is unlikely to continue successfully.
For Those With Borderline Traits
Even if someone does not meet the full criteria for BPD but exhibits borderline-like features, the treatment approach remains largely the same.
In Summary
✅ BPD is not a frequent diagnosis, but when present, it is a severe condition with strict diagnostic criteria.
✅ It develops from a combination of emotional sensitivity and invalidating experiences.
✅ Treatment involves both medication and psychotherapy, particularly approaches similar to DBT.
✅ Early intervention is key. The sooner treatment begins, the better the outcomes.
If you or a loved one have concerns about emotional instability, self-image issues, or difficulties in interpersonal relationships, please don’t hesitate to consult with us at our clinic.
