Hastrup LH, et al. - In this register-based cohort study involving 2,756 patients with incident borderline personality disorder (BPD) (ICD F60.3) with spouses and 11,024 matched controls, researchers examined factual societal costs before and after initial BPD diagnosis. Among patients with BPD, total direct healthcare costs and lost productivity costs amounted €40,441, which was more than 16 times higher than the matched controls. During 5 years before the initial diagnosis of BPD, there was an increase in somatic and psychiatric healthcare costs and costs of lost productivity. Spouses of patients with BPD displayed an increase in healthcare costs and lost productivity before and after the initial diagnosis. In addition to the early onset of BPD, which means that patients were impaired before finishing school and joining the labor market, the neurocognitive disorder and fundamental symptoms of BPD, eg, unstable, intense relationships, impulsiveness and loss of stable sense of self along with psychological and somatic comorbidity, are part of the explanation of BPD's excess costs.