Is BPD More Common In Some Societies than Others?


Borderline personality disorder (BPD) is a serious mental health condition that usually develops during late adolescence. BPD affects the way that young people see themselves and relate to others around them. They may experience intense and quickly changing emotions, often caused by their relationships with other people.

Young people with BPD may have an unstable or incoherent sense of self, an intense fear of abandonment, and patterns of unstable or destructive relationships.

Young people across the world live with BPD. However, research suggests that BPD is more common in some countries than others. In particular, countries with greater wealth inequality seem to have higher rates of BPD.

Experts aren’t clear exactly what causes these differences, and several factors may play a role. But some researchers think that the social conditions that inequality brings may make the development of BPD (and other mental health problems) more likely.

This blog looks into how different social conditions could make the development of BPD more likely, and why it might be more common in some countries than others. 

Understanding Borderline Personality Disorder

Having a personality disorder doesn’t mean there’s something wrong with someone’s personality. It just means that the way they see themselves and interact with the world around them can make it hard to navigate parts of everyday life, such as social situations, close relationships, or work.

While living with BPD can be hard, BPD is treatable, and effective support can help young people reduce and manage symptoms of the disorder. Many people with a BPD diagnosis go on to live normal and fulfilling lives.

Scientists still aren’t sure exactly what causes BPD. However, they think that someone’s life experiences, particularly during childhood, may play a key role.

Research has found that people with BPD are much more likely to have experienced childhood trauma than other people, including childhood emotional abuse and neglect.

Some experts think that the behaviours and thought patterns of people with BPD actually represent a normal response to difficult life events.

They suggest that young people may develop these behaviours as a way to protect themselves from harm when they have experienced ongoing maltreatment by caregivers or other people.

However, these learned thought patterns and behaviours, while protective in situations of maltreatment or abuse, prevent them from forming trusting, stable relationships with other, trustworthy people.

Without these relationships, young people are not able to learn more helpful responses to social situations or ways to understand their own and others’ emotions.

Is BPD More Common in Western Societies?

BPD is common in young people and adults in the US and Europe. Data suggests about 1% of people in the UK and USA live with BPD.

While BPD has mostly been studied in Western societies, cases of BPD have been reported across the world, including in India, China, and Turkey. However, while we know that BPD exists in these societies, there is not enough data to estimate the prevalence of the disorder. 

Without direct data on how common BPD is in different societies and cultures, some researchers have used indirect measures to try and gain a better picture. They suggest that symptoms associated with a BPD diagnosis (such as self-harm or suicide) are more common in developed societies than in less developed ones – and that this means that BPD is probably also more common.

These differences could have several explanations. Two possible reasons are different social conditions and changing ‘symptom banks’.

Individualism, Social Isolation, and Inequality

Some evidence suggests that certain characteristics of modern Western societies make it more likely that people will develop BPD.

These societies typically have more individualistic values than traditional societies or many non-Western communities that put more emphasis on community and social support. 

Research suggests that BPD may develop, and be sustained by, a lack of trust in other people and the things they say or do.

In societies with more community support, mutual trust between community members may be higher, making it more likely that young people will be able to trust and learn from others, even when they have experienced maltreatment or abuse. 

This may be especially important during adolescence, the period when BPD usually develops. In modern Western societies, adolescents are often expected to become independent and self-reliant, sometimes moving away from their previous support systems.

Without support, they may be more likely to use impulsive behaviours to cope with emotional distress and be at a greater risk of harming themselves.

Research shows a powerful association between social inequality and mental health and social problems.

Countries with greater levels of inequality have higher levels of drug and alcohol abuse, teenage pregnancies, and other mental health or social issues that are common among people with BPD.

More specifically, experts have found that measures of inequality can accurately predict the prevalence of BPD in that society.

Individualism and a lack of social support are also linked to social inequality. This may partly explain why countries with greater wealth inequality have a higher prevalence of BPD. 

What Is A ‘Symptom Bank’ and How Is It Significant?

A symptom bank describes the ways that people usually express emotional distress in any particular environment.

Some experts think that in different cultures, societies, historical periods, or social settings, people tend to express distress in different ways. This might happen because they are culturally accepted behaviours, more easily accessible, or normalised through media and socialisation. 

For example, historians have suggested that in older societies, people were more likely to express emotional distress through somatic symptoms, such as pains or discomforts in their bodies.

On the other hand, impulsive behaviours such as self-harm that are common in European societies today were almost unreported (other than in religious contexts).

Symptom banks are important because they show us that while certain symptoms may vary greatly between societies, the underlying traits, emotions, and thought patterns might be the same.

That is, the same essential features of a disorder might give rise to specific and distinct mental health disorders in different societies. Symptom banks may partly explain why some disorders appear specific to certain cultures or are much more common in some than others.

Turning back to borderline personality disorder, it means that higher levels of self-harm, drug or alcohol abuse, and other symptoms of BPD in modern Western societies (or more unequal societies) might not show that the basic traits of BPD are more common.

It might also happen because people in other societies express emotional distress differently or interpersonal difficulties manifest in other ways.

Without further research, we can’t be certain about exactly what causes BPD to be more common in some societies than others. Different social conditions, such as levels of social inequality and social connection, and changing symptom banks may both play a role.

When it comes to the prevention and treatment of BPD, these ideas are important. Many experts emphasise the need to support people with BPD through social support, rather than only psychological care.

Working with young people to develop wider social networks and build stronger community support may go some way to preventing the development of BPD – and help young people manage and recover from the disorder.

The Wave Clinic: Making a Difference in the Lives of Young People

The Wave Clinic offers transformative recovery programs for teenagers, adolescents, and young adults from our centre in Malaysia.

Our world-leading programs combine exceptional clinical care with education, social responsibility, and a gap year experience, supporting young people to plan and build fulfilling futures.

The Wave is a place of exciting and enriching experiences where young people connect with others, form lifelong friendships and develop their sense of self.

We understand the importance of specialist, dedicated mental healthcare for young people. Adolescents have unique needs, and treatment needs to reflect this.

At The Wave, our team members are specialists in adolescent mental health care, including experts from across the world who apply their incredible experience and expertise to young people’s recovery journeys. 

If you’re interested in finding out more about our programs, get in touch today. We’re here to make a difference.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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