Borderline personality disorder in East Asian adolescents: a comprehensive review of research on assessment, etiology, and treatment

Borderline personality disorder (BPD) is a severe mental disorder marked by instability in affect, impulse control, interpersonal relationships, and behaviors. Its symptoms typically appear during adolescence and may predict adverse long-term outcomes. In East Asia, research focusing on this population is growing. This review aims to comprehensively summarize these findings to provide an overall profile of adolescents with BPD in East Asia. Studies show the prevalence of BPD among East Asian adolescents ranges from 2% to 14%, depending on the assessment instruments and the study population. Several diagnostic instruments have been developed and validated accordingly. Childhood trauma, especially emotional abuse, constitutes a significant risk factor for BPD. Other contributing factors include ineffective family environments, maladaptive parenting practices, peer aggression, and urban-rural disparities. Emotional dysregulation is a core symptom, along with interpersonal and identity disturbances. Self-injury and suicidal behaviors may show certain different patterns, and BPD features frequently overlap with other psychiatric disorders, especially when comorbid. Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT) are increasingly implemented, though their adoption varies across East Asia, and high-quality intervention research remains limited. Future studies should consider the East Asian cultural context, develop early identification methods and intervention strategies, integrate family and school systems, and explore individualized treatment pathways.