Hastrup LH, et al. - Actual societal costs prior to and following initial borderline personality disorder (BPD) diagnosis was investigated via a register-based cohort study involving 2,756 patients with incident BPD (ICD F60.3) with spouses and 11,024 matched controls. Patients with BPD were identified to have total direct healthcare costs and lost productivity costs of €40,441, which was > 16 times higher than 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 showed an increase in healthcare costs and lost productivity before and after the initial diagnosis. The excess costs of BPD may partly be related to the early onset of BPD, suggesting that patients may be affected before they finish school and enter the labor market, as well as with the neurocognitive impairment and fundamental symptoms of BPD, eg, unstable, intense relationships, impulsivity, and lack of stable sense of self together with psychiatric and somatic comorbidity.