Borderline Personality Disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD), is a complex psychiatric disorder, characterised by dichotomous thinking, extreme emotional instability and mood swings, intense persistent fear of abandonment and interpersonal relationship difficulties. Women and men are equally affected by BPD, but women are more frequently diagnosed (Grant et al., 2008). There is much debate regarding BPD, and diagnosis can depend greatly upon the physician who is seen. Sometimes BPD can be misdiagnosed in place of PTSD, as both conditions share some common symptomatology. Furthermore, autism may also be misdiagnosed as BPD in some cases, due to the way autism manifests differently in women ,and some of the social and emotional overlap between the two conditions (Dudas et al., 2017; Ford and Courtois, 2014). Diagnosis of BPD is more prevalent in individuals who have experienced domestic abuse as children or adults (de Aquino Ferriera et al., 2018; Mainali et al., 2020). Further, emotional abuse in childhood has been particularly strongly associated with BPD development, and childhood abuse of all kinds has been suggested to be present in the personal histories of 90% of all individuals who are diagnosed with BPD (Battle et al., 2004; Kuo et al., 2015). Presently, the treatment offered may involve CBT (cognitive behavioural therapy), mentalisation therapy group therapy and art therapy offerings, and there are no specific medications prescribed presently to treat BPD (NHS, 2022).
In terms of biochemical imbalances, presently research has identified that gut-brain axis disruption, neurotransmitter imbalances and fluctuations in oestrogen levels appear to play a role (Bertsch et al., 2013; Grant et al., 2008; Mainali et al., 2020). Moreover, a further interesting observation made by one paper suggested that women with BPD have been indicated to be at higher risk of developing bone disorders, such as osteoporosis (Kahl et al., 2005).
Very little research to date has been conducted with regards to how nutrition may support individuals with BPD. Some evidence has indicated that omega 3 may help to
reduce the severity of symptoms in women with BPD, particularly with relation to impulsivity (Karaszewska et al., 2021). Omega 3 has also been suggested to be beneficial in conjunction with valproic acid, with beneficial effects continuing to be observed following cessation of supplementation in a follow up study, particularly for outbursts of anger (Bellino et al., 2014; Bozzatello et al., 2018). Moreover, another study indicated that omega 3 supplementation, in the form of EPA, was beneficial for reducing symptoms of aggression in women with BPD (Zanarini et al., 2003).
Although Vitamin D has not been studied with relation to BPD, lower levels have been commonly observed in individuals experiencing suicidality, which is a key feature of the condition (Grudet et al., 2014). Interestingly, magnesium deficiency has also been observed in samples of women with BPD, although this area remains under researched (Kopitsyna et al., 2015).
Notably, all these nutrients play a key role in brain function and mood stability, as well as bone health and structure, which could account for the observed link between BPD and osteoporosis (Kahl et al., 2005). It is also interesting to consider the shared mechanism of changes in oestrogen levels in both BPD and osteoporosis (Eisenlohr-Moul et al., 2015; Li and Wang, 2018). Moreover, other nutrients associated with bone health that have been studied with regards to osteoporosis, such as calcium and vitamin D (Weaver et al., 2016), magnesium (Rondanelli et al., 2021), B vitamins (Dai and Koh, 2015), vitamin K (Fusaro et al., 2010), manganese, iron, selenium and copper (Wei et al., 2022) , as well as omega 3 (Sharma and Mandal et al., 2020) could be key targets for further research in this area.
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