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How Pathological Traits Thrive in a Broken Culture

Borders or Borderliners Part II

Hannah Spier, MD's avatar
Hannah Spier, MD
Jun 18, 2025
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We’re surrounded by the fallout. Viral videos of grown women throwing tantrums. Stories from partners, children, and bullied women describing the emotional wreckage typical of Cluster B behaviour. You would expect this to be reflected in research, so why hasn’t the official prevalence of Cluster B been updated in two decades?

A look behind the official prevalence rate

The estimate often cited comes from the NESARC study by Grant et al. (2008), which puts BPD prevalence at 5.9%. But there are several reasons this likely underestimates the real number. The study used rigid DSM-IV checklists, ignoring people just below the threshold or those with intermittent symptoms that still cause major dysfunction. It also excluded overlapping symptoms with mood or substance issues, despite growing evidence that these overlaps are central to Cluster B. The interviews were done by laypeople, missing the nuance needed to spot patterns like relational chaos or emotional dysregulation. And they depended o…

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