Borderline personality disorder (BPD) is associated with substantial psychosocial impairment, morbidity, mortality and high health resource utilization. These data make a compelling case for developing prevention and early intervention strategies for BPD. This review examines the BPD diagnosis in young people, along with prospective risk factors for and precursors to the development of BPD. It then considers the prospects for and potential risks and benefits associated with prevention and early intervention for BPD. It concludes that the BPD diagnosis in young people has similar reliability, validity and prevalence to BPD in adults and that BPD in young people almost certainly has serious and pervasive negative repercussions over subsequent decades. Current data are inadequate to inform specific universal or selective prevention programs for BPD. However, they do support including BPD prevention as an outcome when evaluating universal and/or selective interventions for a variety of mental health problems and adverse psychosocial outcomes. The data are stronger for developing indicated preventive interventions but the strongest data support early intervention for the emerging BPD phenotype. Early intervention programs will need to be realistic in their aims, require change in clinician attitudes and service systems and must be mindful of the risk of iatrogenic harm.