Borderline Personality Disorder in South Korea: A Narrative Review of Clinical Research and Future Directions

Abstract

South Korea has one of the highest suicide rates among developed countries, with suicide being the leading cause of death among individuals in their teens to 40s. Despite this serious situation, systematic interventions for suicide prevention remain limited, particularly concerning borderline personality disorder (BPD), which is strongly associated with suicidality. This narrative review examines 11 empirical studies involving clinically diagnosed BPD samples in South Korea, focusing on the prevalence, clinical characteristics, and treatment challenges of BPD within the Korean sociocultural context. The available evidence suggests that BPD is substantially underrecognized in South Korea, with a prevalence rate considerably lower than international estimates and a relatively older mean age of onset, likely reflecting the impact of mental health stigma and barriers to care. Korean individuals with BPD also demonstrate marked functional impairment and a strong association with suicidality, with sociocultural factors further complicating treatment engagement and outcomes. These findings highlight the need for earlier identification and timely diagnosis, broader implementation of evidence-based treatments, and greater dissemination of generalist treatment models and basic training for frontline clinicians. Such coordinated efforts may also contribute to suicide prevention efforts in the country.

Graphical Abstract

INTRODUCTION

For nearly two decades, South Korea has maintained one of the highest suicide rates among developed democratic countries supporting market economies.¹ Suicide remains the leading cause of death among Koreans in their teens (48.2%), 20s (54.0%), and 30s (44.4%), and in 2024, for the first time, also among those in their 40s (26.0%), surpassing cancer (24.5%).² A total of 14872 deaths by suicide were recorded during this period, corresponding to 26.2 per 100000 people, which is more than twice the OECD average (10.8).² Despite the magnitude of these figures, clinical awareness and systematic interventions for suicide prevention remain limited.

South Korea’s suicide epidemic is shaped by multiple interacting factors,³ with mental illness consistently identified as one of the strongest predictors of suicide. Personality disorders are among the psychiatric conditions strongly associated with suicidality.⁴,⁵ Borderline personality disorder (BPD) is particularly noteworthy because recurrent suicidality is included in its diagnostic criteria⁶ and suicidal behavior is highly prevalent in this population.⁷,⁸ Prior research has consistently demonstrated elevated suicidality in BPD. A recent meta-analysis found pooled prevalence rates of 80% for suicidal ideation, 52% for suicide attempts, and 6% for suicide deaths in BPD.⁷ In addition, 98.9% of individuals with BPD who died by suicide had contacted mental health services within the year prior to death, underscoring the substantial clinical and public health burden of suicidality in this population.⁹

Evidence from Korean samples similarly shows that BPD is most strongly associated with suicidality. A nationwide study of health-care service users reported a suicide rate of 364.2 per 100000 among individuals with BPD, the highest across diagnostic groups and exceeding rates observed in schizophrenia (308.0) and bipolar disorder (285.1).¹⁰ Among patients presenting with non-suicidal self-injury (NSSI) and/or suicide attempts, 44% of those engaging in both behaviors met criteria for BPD,¹¹ and clinical assessments indicate significantly higher suicide risk in patients with BPD compared with healthy controls.¹²

Despite the strong association between BPD and suicidality, Ih makes therapeutic intervention particularly critical, BPD is widely regarded by clinicians as difficult and complex to treat.¹³ Characterized by instability in self-identity, affect, and interpersonal relationships, individuals with BPD in clinical settings often report chronic emptiness and self-loathing and show high levels of dependency.⁶ They Ie heightened distress in response to minor interpersonal stressors, leading to rapid shifts in their evaluations of themselves and others, Iing therapists. In this context, impulsive behaviors such as suicidal behavior and aggression emerge, Ih can pose significant challenges for clinicians and complicate treatment engagement.¹³ The following vignette illustrates how these clinical features and treatment challenges often manifest in everyday clinical practice in South Korea.

Vignette

Ms. A, a 32-year-old woman, was referred after being brought to the emergency department following her fifth suicide attempt. She had engaged in self-harm since high school. After episodes of self-injury, she repeatedly sent photos of her wounds to friends and teachers, leading to school counseling; however, her parents declined psychiatric treatment due to concerns about academic and future career prospects. They expected her admission to a prestigious university and interpreted her distress as adolescent rebellion, responding with harsher discipline and tighter academic control. Overwhelmed by this pressure, she left the college entrance examination early, and after her mother told her that she was an embarrassment and that she was “giving up on her,” she made her first suicide attempt. She was later diagnosed with depressive and anxiety disorders, with limited response to medication.

She currently lives with her parents and remains financially dependent. They urge her to prepare for civil service examinations and frequently criticize her as weak-willed and lazy, often escalating into severe conflicts. She forms intense relationships almost exclusively online, which frequently deteriorate after conflicts triggered by perceived neglect when responses are delayed. She describes herself as a source of shame to her family while also expressing intense resentment toward her parents, and reports that seeing peers’ lives on social media intensifies feelings that her life is beyond recovery, often escalating into suicidal urges. During these episodes, she often misses treatment sessions and repeatedly sends lengthy emails to her clinician.

Such clinical instability, combined with poor response to medication and traditional psychotherapies, has contributed to the long-standing view of BPD as a “treatment-resistant” condition. However, the development and systematic implementation of evidence-based treatments (EBTs) specifically designed for BPD have shifted this view, demonstrating that the disorder is highly responsive to intervention.¹⁴ EBTs refer to psychotherapeutic approaches whose efficacy has been established through randomized controlled trials and other rigorous clinical research. For BPD, the most established approaches include dialectical behavior therapy (DBT), a skills-based treatment focusing on emotion regulation and distress tolerance¹⁵; mentalization-based treatment (MBT), an attachment-based approach targeting the capacity to understand mental states underlying interpersonal behavior¹⁶; and transference-focused psychotherapy (TFP), a psychodynamic treatment addressing identity diffusion and maladaptive relational patterns.¹⁷

These treatments have demonstrated superiority over treatment as usual across multiple clinical outcomes, including overall symptom severity, functional impairment, and suicidal and self-harming behaviors.¹⁸,¹⁹ Nevertheless, compared with Western countries where these treatments have been extensively studied and widely implemented,²⁰,²¹,²²,²³ research and treatment infrastructure for BPD in Korea remain underdeveloped. Given the potential contribution of BPD to Korea’s high suicide rate, there is a pressing need for an up-to-date, empirically grounded understanding of BPD in the Korean context, together with prevention and treatment initiatives that reflect the realities of clinical practice and available resources. To advance such efforts, it is essential to deepen our understanding of the clinical characteristics of Korean individuals with BPD and to examine the current state of BPD treatment within the country’s mental-health system. Such knowledge will provide a critical foundation for identifying what is specifically required to develop effective prevention strategies and therapeutic interventions that are well aligned with the Korean sociocultural context.

Accordingly, the purpose of this article is to 1) review empirical studies that have investigated clinical samples of individuals with BPD in South Korea, 2) discuss their findings in relation to Korea’s sociocultural context, and 3) propose directions for future research, clinical practice, and education aimed at improving care for individuals with BPD.

METHOD

We searched PubMed and Google Scholar (September–October 2025) using “borderline personality disorder,” “South Korea,” and the Korean term for BPD. Studies were included if they involved clinically diagnosed BPD samples, whereas studies of non-clinical BPD traits were excluded. Nine studies met these criteria (seven international, two domestic), and two additional studies on NSSI or suicidality including BPD groups were also reviewed, yielding 11 studies in total.

A NARRATIVE REVIEW OF EMPIRICAL STUDIES ON BPD IN SOUTH KOREA

A total of 11 empirical studies have investigated clinically diagnosed BPD samples in South Korea, indicating a remarkably limited body of research. Table 1 summarizes the characteristics and key findings of the reviewed studies. The results are discussed in relation to two themes: the prevalence of BPD in South Korea and clinical characteristics identified in Korean samples.

Table 1. Summary of Clinical Studies on BPD in South Korea.

Author	Area	Sample or data characteristics	Main findings
Shin, et al.24	Prevalence	NHIS database; inpatients and outpatients with BPD	• Prevalence increased from 0.96 to 1.06 per 10000 (2010–2019); mean onset age 33.2 years, highest incidence in the 20s.
Yun, et al.47	Clinical features	227 BPD patients	• Highest centrality: maladaptive defense, followed by schizotypal PD, dependent PD, narcissistic PD, and image-distorting defense.
Ha, et al.52	Clinical features	First-year female high school students • BPD group: n=48 (baseline), 46 (1 y), 44 (2 y), 40 (3 y) • HC group: n=45 (baseline), 44 (2 y), 42 (3 y)	• Baseline: BPD>NS, HA; BPD<SD • SD and CO increased only in HC and remained stable (with lower CO at 2–3 years) in BPD, while ST increased only in HC with no group differences.
Kim, et al.45	Clinical features	30 BPD–MDD group, 25 MDD group, 25 HCs	• Compared with HC and MDD, the BPD–MDD group showed higher BDI and PAI-BOR scores, greater early life stress (especially emotional abuse), lower resilience, and greater emotion dysregulation. • Emotional abuse and impaired self-regulation predicted both BPD comorbidity and severity.
Park, et al.12	Clinical features	Adults aged 19–50 years: 37 BPD group, 22 HCs	• Compared with HCs, the BPD group showed poorer mentalization, higher depression/suicide risk, lower resilience, and a maladaptive temperament profile (↑NS/HA, ↓SD/CO). • Within BPD, poorer mentalization was predicted by higher borderline features and persistence.
Lee, et al.48	Clinical features	125 BPD patients: 42 SA, 83 NSA	• SA>NSA: ↑ hostility/paranoia, psychotic features; ↑ paranoid PD; altered defense styles (splitting, projective identification).
Choi, et al.79	Treatment effectiveness	Treatment effects in 21 BPD patients (≥6 months of treatment)	• Over the course of MBT, depressive symptoms decreased and self-disclosure increased; at longer-term follow-up, improvements were observed in SD, CO, and self-regulation, along with a reduction in ST.
Lyoo, et al.46	Neuroimaging	25 BPD group, 25 HCs	• Reduced frontal lobe volume was observed in the BPD group on structural MRI.
Yun, et al.47	Neuroimaging	45 BPD group, 15 HCs	• The BPD group showed lower EEG spectral power during eyes-closed resting state, higher early life stress, and greater mentalization difficulties (emotional unawareness, psychic equivalence) compared with HCs.
Bae, et al.11	Suicidality	27 NSSI+SA group, 14 NSSI-only group, 39 SA-only group	• Cluster B personality disorders more frequent in the NSSI+SA group: NSSI+SA, NSSI, SA • 44% of the NSSI+SA group and 21% of the NSSI-only group were diagnosed with BPD.
Lee, et al.10	Suicidality	Nationwide medical claim data from Korea’s compulsory health care insurance system	• BPD showed the highest suicide rate, followed by SZ, BD, PTSD, DD, and OAD.

BPD, borderline personality disorder; HC, healthy control; NHIS, National Health Insurance Service; NS, novelty seeking; HA, harm avoidance; SD, self-directedness; CO, cooperativeness; ST, self-transcendence; MDD, major depressive disorder; MBT, mentalization-based treatment; MRI, magnetic resonance imaging; EEG, electroencephalography; NSSI, non-suicidal self-injury; SA, suicide attempt; NSA, non-suicide attempt; SZ, schizophrenia; BD, bipolar disorder; DD, depressive disorders; OAD, other affective disorders; PTSD, post-traumatic stress disorder.

Prevalence of BPD in South Korea

Using the National Health Insurance Service Customized Database, Shin and collaborators²⁴ estimated nationwide BPD prevalence in South Korea at approximately 0.01%, substantially lower than international estimates (2.7%–5.9%²⁵,²⁶). In this study, although incidence peaked among individuals in their 20s, a substantial proportion were diagnosed in their 30s and 40s, resulting in a mean age of onset of 33.2 years (SD=14.6; range: 20s–70s or older). This contrasts with prior findings that BPD is typically identified in adolescence or early adulthood in other populations.²⁷,²⁸ Shin and collaborators²⁴ suggest that this unusually low prevalence and elevated mean onset age probably does not capture the true epidemiological onset of BPD, but rather likely reflects the impact of strong mental-health stigma in South Korea and the accompanying reluctance to seek psychiatric services, which may delay help-seeking and diagnosis.

Although stigma and help-seeking behavior specific to BPD have not been directly studied in Korea, national data indicate substantial barriers to mental health care. In the 2024 National Survey on Mental Health Knowledge and Attitudes,²⁹ 73.6% of respondents reported experiencing mental health problems, yet 73% did not seek professional help, and help-seeking was particularly low among youth. Service avoidance was largely driven by fear of social stigma and concerns about social disadvantages. Mental health literacy was also limited: more than half of respondents attributed depression to stress or burnout, and many attributed severe mental illnesses such as schizophrenia to personality problems or weak will.

Given this context, barriers to recognition and treatment are likely to be particularly pronounced for BPD. Even in Western countries, BPD is consistently associated with negative attitudes among both the public and mental health professionals, which can limit access to effective care and delay diagnosis.⁸,³⁰ Expert consensus indicates that earlier identification is associated with shorter and less complex interventions, whereas later-stage presentations require more intensive, long-term treatment and are linked to poorer outcomes.³¹ Although empirical data from Korea are lacking, evidence from Japan, another East Asian country, suggests greater reliance on pharmacotherapy and social resources than on EBTs,³² raising concern that similar implementation gaps may exist in Korea.

Delays in identifying and treating BPD are clinically consequential, as they are associated with cumulative functional impairments that hinder recovery and social reintegration, as shown in longitudinal studies. Among boys hospitalized with childhood BPD, only 25% were regularly attending school or working at 10–20-year follow-up.³³ In a 2-year follow-up study of first-year college students, BPD traits independently predicted poorer functioning across multiple domains, including lower GPA, more semesters on academic probation, and greater social maladjustment.³⁴ Similarly, a 20-year longitudinal study found that adolescents with diagnostic-level BPD symptoms demonstrated one full educational level lower attainment (e.g., high school vs. associate’s degree), occupational positions 1.5 levels lower, less stable relationships, fewer life milestones, and threefold higher reliance on public assistance.³⁵ These findings indicate that when BPD is not addressed during key developmental periods, repeated failures in interpersonal, academic, and vocational domains may compound symptom severity and impede recovery.

These issues may be particularly salient in South Korea, where intense academic competition and social comparison magnify the psychological impact of perceived failure. Poor academic functioning is associated with higher depression, anxiety, and suicidal behaviors among Korean youth,³⁶,³⁷,³⁸ suggesting that BPD-related developmental disruptions may increase vulnerability to comorbid psychopathology and contribute to more severe clinical trajectories.

Clinical characteristics identified in Korean BPD samples

The core features of BPD include unstable identity, marked emotional reactivity and emotion dysregulation, associated impulsive behaviors, and interpersonal dysfunction driven by fear of abandonment.⁶ These characteristics have been consistently documented in Western samples³⁹,⁴⁰,⁴¹,⁴²,⁴³ and are similarly observed among individuals with BPD in Korea (Table 1).

Specifically, difficulties in emotion regulation and impairments in mentalization—the capacity to understand the emotions, intentions, and thoughts underlying one’s own and others’ behavior in emotionally salient interpersonal situations¹⁶—are prominent in Korean individuals with BPD.¹²,⁴⁴,⁴⁵,⁴⁶,⁴⁷ Clinically, this is reflected in heightened interpersonal sensitivity, such that minor relational cues are experienced as clear evidence of abandonment or rejection, and intense experiences of self-defectiveness or self-loathing are felt as concrete realities rather than transient emotional states.¹⁶ These processes contribute not only to rapid shifts between idealization and devaluation, but also to instability in self-concept and intense reactions to perceived separation, which may escalate into anger, aggression, clinging behaviors, and, in some cases, self-harm or suicidal threats,⁶ patterns that have likewise been documented in Korean samples.⁴⁸,⁴⁹ These behaviors often elicit avoidance, criticism, or controlling responses from others, thereby reinforcing maladaptive interpersonal cycles.

Early caregiving experiences and family relationships play an important role in both the onset and maintenance of BPD by shaping the development of emotion regulation and mentalization.⁵⁰ In clinical settings, many patients report adverse experiences within their family of origin, with emotional abuse showing particularly strong associations with BPD.⁴⁵ Transactional models propose that heightened emotional sensitivity interacts over time with invalidating or abusive caregiving responses, with each process amplifying the other.⁵¹ As illustrated in the vignette presented above, within the collectivistic and family-centered sociocultural context of South Korea, these processes may be further reinforced and more persistently maintained.

In South Korea, individual performance tends to influence a family’s social status. Impairments in self-functioning,¹²,⁵² including academic and occupational difficulties, may therefore be experienced not only as personal struggles but also as sources of family shame. Limited mental health literacy and persistent stigma may further encourage interpretations of psychological distress as a sign of weak will rather than a treatable condition.²⁹,⁵³ Within hierarchical family structures, expressions of distress may also be perceived as challenges to parental authority or filial expectations. These dynamics can increase family stress, evoke more blaming or controlling responses,⁵⁴,⁵⁵ and intensify patients’ own shame. Moreover, prolonged co-residence with parents into adulthood is common due to socioeconomic constraints,⁴⁴ which may result in sustained exposure to relational stress within the family. Given that family understanding, cooperation, and environmental stability are important treatment-related factors in BPD,⁵⁶ these sociocultural and structural conditions may further complicate recovery and the treatment process.

Overall, the reviewed literature suggests that although BPD in Korea is associated with substantial self and interpersonal dysfunction and elevated suicidality, the disorder remains underrecognized and is often diagnosed at later stages. These difficulties may be compounded by sociocultural and structural factors specific to the Korean context, underscoring the need for earlier identification and for systematic implementation of interventions that directly target core features of BPD.

SUGGESTIONS FOR CLINICAL PRACTICE AND FUTURE RESEARCH

This narrative review synthesized 11 studies examining clinically diagnosed BPD samples in South Korea. Based on the reviewed literature, several implications for clinical practice and future research can be identified.

The need for early identification and timely diagnosis of BPD

The markedly higher mean age of onset and the extremely low prevalence of BPD observed in South Korea²⁴ likely reflect delayed or missed identification, underscoring the critical importance of early detection. Delayed intervention is associated with greater treatment burden³¹,⁵⁷,⁵⁸ and increased risk of secondary difficulties resulting from functional impairments across multiple life domains, including academic functioning.³³,³⁴,⁵⁹ In South Korea, where educational attainment—particularly university entrance—strongly determines social status and future security,⁶⁰ BPD-related functional impairments during adolescence and early adulthood may severely undermine self-concept and have enduring social consequences. Moreover, given the close link between academic functioning and suicidality during this developmental period,³⁷ early identification and accurate diagnosis are critical not only from a clinical standpoint but also from a public health perspective.

To strengthen early identification, active screening is needed not only in tertiary hospitals but also in settings where adolescents and young adults are more likely to seek help, such as school and university counseling centers and primary care. This requires brief, psychometrically sound screening tools that are feasible in routine practice. However, the current landscape in Korea presents substantial limitations. In clinical settings, diagnosis largely relies on the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders,⁶¹ which, although considered the gold standard, is time-intensive and requires specialized training. Commonly used self-report measures (e.g., Personality Assessment Inventory–Borderline Features Scale,⁶² Borderline Symptom List–Short Version,⁶³ Personality Diagnostic Questionnaire–4+⁶⁴) lack adequate validation and established clinical cutoff scores in Korean samples, and several have been tested only in small or non-clinical samples.⁶⁵,⁶⁶ Further research is therefore needed to establish clinical validity and appropriate cutoff thresholds for Korean versions of these tools.

In addition, because these instruments are relatively lengthy, brief and reliable screening tools are needed to support early identification across accessible clinical and community settings. The McLean Screening Instrument for BPD (MSI-BPD),⁶⁷ a validated 10-item tool, has shown good psychometric properties across clinical⁶⁸,⁶⁹ and community settings⁷⁰ and across Western and East Asian populations.⁷¹,⁷² The Level of Personality Functioning Scale–Brief Form 2.0 (LPFS-BF 2.0),⁵⁹ a 12-item dimensional measure based on the DSM-5 Alternative Model for Personality Disorders, may also be useful as a brief dimensional measure of core personality functioning.

Beyond identifying individuals at elevated risk, the issue of making a formal diagnosis of BPD and communicating it transparently to patients also warrants careful consideration. Clinicians often hesitate to diagnose BPD, particularly in younger individuals, due to concerns about stigma or potential negative effects on self-concept.⁷³ However, delaying diagnosis may prolong distress and inadvertently reinforce stigma by treating the disorder as too problematic to name.⁷⁴,⁷⁵ In addition, diagnostic hesitation increases the risk of misdiagnosing BPD as bipolar disorder, Ih may lead to greater reliance on pharmacological treatment despite limited evidence for medication efficacy in addressing core BPD symptoms,¹⁹ raising concerns about inappropriate prescribing and potential iatrogenic harm.⁷⁶ Reports from individuals with BPD indicate that receiving an accurate diagnosis can be helpful in understanding and contextualizing their difficulties and in reducing feelings of isolation.⁷⁷ Taken together, these considerations indicate that accurate identification of BPD and transparent diagnostic communication are likely to be critical components of facilitating appropriate treatment, engagement, and continuity of care.

The need to strengthen implementation systems and effectiveness research for EBTs

Findings from this review indicate that the symptomatic and maladaptive patterns observed in Korean patients with BPD are largely consistent with those reported in Western research, suggesting that EBTs targeting these core symptoms of BPD may be similarly necessary and beneficial within the Korean clinical context.

Although efforts to introduce EBTs have been underway in South Korea for the past 10–20 years, research on their effectiveness remains extremely limited, and only a small proportion of patients with BPD appear to receive these specialized treatments. DBT is the most widely recognized approach, yet no studies have evaluated its effectiveness in Korean clinical samples, and most existing research involves non-clinical or community populations using modified protocols.⁷⁸ MBT has been implemented at only a single institution with promising pilot results,⁷⁹ but Korea lacks certified supervisors, sustained training pathways, and additional clinical sites. For TFP, despite available Korean translations of major manuals,¹⁷,⁸⁰ there are no formal training programs, supervised services, or effectiveness studies, and dissemination remains minimal. Overall, despite initial efforts to disseminate specialist-driven EBTs in Korea, substantial gaps remain before these models can achieve meaningful population-level clinical impact. To address this, we propose three key directions that go beyond the current introductory stage of implementation.

First, increasing public awareness and improving pathways to care are critical. Given the persistent stigma surrounding mental illness in Korea,²⁹ public education is essential to promote earlier help-seeking and access to evidence-based care. Enhancing public understanding of BPD and disseminating accurate information about treatments can reduce misconceptions and lower barriers to access timely and effective professional support.

Second, expanding specialist clinical education and building institutional infrastructure are essential. Since EBTs require formal training, supervision, and structured programs, limited domestic training opportunities and organizational support constrain real-world implementation.

Third, rigorous effectiveness studies using Korean clinical samples are needed, along with research on culturally sensitive adaptation. Because most EBTs for BPD were developed in Western contexts and are grounded in Western assumptions about therapeutic processes, it is essential to establish their effectiveness within the Korean cultural context, and to calibrate interventions to ensure cultural fit while preserving core mechanisms of change.

Expanding BPD care in South Korea: why a generalist approach is needed

Although specialist EBTs for BPD such as DBT and MBT have been introduced in Korea, these models require extensive training, sustained supervision, and substantial institutional support, making large-scale implementation slow and resource-intensive. This raises concerns about whether specialist treatments alone can meet current clinical demand, highlighting the need for complementary models that can be more readily implemented in routine clinical settings.

Moreover, given the strong association of BPD with suicidality, impulsivity, and crisis-driven help-seeking,⁹,¹⁰,¹² individuals with BPD are more likely to present to frontline and easily accessible services—such as emergency departments, school or university counseling centers, community clinics, and private outpatient settings—rather than through planned referral to specialized programs.⁵⁴ This pattern is reinforced by Korea’s health care system, where psychotherapy is not covered by national insurance and specialist treatments are financially inaccessible for many patients. These frontline services typically provide brief, low-cost interventions (often 5–15 sessions) and are largely staffed by generalist clinicians without specialized training in BPD.

Given these structural constraints, generalist treatment models may play a critical role in expanding access to care for individuals with BPD. good psychiatric management (GPM)⁸¹ represents a prominent generalist-oriented EBT designed as a lower-intensity, lower-cost intervention that can be delivered by general clinicians in routine care settings.⁸² Despite its relatively simple structure, randomized trials indicate that GPM achieves clinical outcomes comparable to specialist treatments such as DBT, including reductions in BPD symptoms, self-harm, and emergency department use.²³ By emphasizing academic and occupational functioning rather than symptom reduction alone, GPM may be particularly well suited to the Korean context, where performance-related stress is a major source of distress.

In addition, GPM requires less intensive training than specialist psychotherapies and has been associated with improved clinician attitudes and reduced stigma toward BPD, supporting its feasibility and acceptability in frontline settings.⁸³,⁸⁴,⁸⁵ In the Korean context, where stigma and diagnostic hesitation remain concerns, such improvements in clinician attitudes may directly translate into more consistent and supportive care for patients with BPD.

Together, the introduction of generalist treatments such as GPM, along with foundational training for frontline clinicians, appears to be a pragmatic option for improving BPD care in Korea. Although specialist treatments like DBT and MBT remain essential, relatively few patients can realistically access and sustain such intensive interventions. Generalist treatments can be implemented alongside specialist models or serve as feasible alternatives in settings where specialist care is not available. Accordingly, expanding generalist treatment may be a critical step toward addressing unmet clinical needs and improving access to BPD care in Korea.

CONCLUSION

In Korea, BPD appears to be underrecognized and diagnosed late, despite being associated with substantial functional impairment across multiple domains and strong links to suicidality, while implementation of EBTs and domestic effectiveness data remain limited. These gaps highlight the need for improved public and professional awareness, earlier identification, stronger dissemination of existing EBTs, and development of local evidence. Given structural constraints, scaling generalist models with basic training for frontline clinicians may be a practical strategy to improve access to effective care.