It’s time to smash taboo and talk about BPD

The common symptoms of BPD mimic or overlap those of other mental illnesses – and, as is the case with any mental illness, those with BPD may even have one or more related conditions.

The co-existence of mental illnesses with BPD affects the course of BPD. Although more acute crises need to be treated first with a combination of medication and therapy. Unfortunately, it is often that symptoms of other illnesses “hide” the BPD symptoms, so are more easily recognised and more regularly treated whereas the BPD symptoms go undiagnosed and untreated. Patients with both a personality disorder and another diagnosed mental illness have poorer responses to treatment than those with one disorder. Fortunately, research shows that with the support of a skilled team, patients with BPD and co-occurring disorders see improvement to symptoms when treated holistically rather than solely for the more obvious mental health conditions. Therefore it is important that BPD is recognised with other mental disorders.

MedCircle – Borderline Personality Disorder and Co-Occurring Disorders

Mood disorders occur in more than 90% of people with BPD.

One study found that about 96% of patients with BPD met criteria for a mood disorder. Mood disorders can include: major depressive disorders, dysthymia and bipolar disorders. This same study found up to 83% of patients with BPD also met criteria for major depressive disorder. Also, So it is important to distinguish whether decrease in mood associated is with BPD or a bipolar disorder-depression or major depressive disorder for the most appropriate treatment. Since BPD is a disorder of emotion dysregulation it is not uncommon that there are co-occurring mood disorders and needs to be well-managed to effectively treat BPD.

TH McGlashan, CM Grilo, AE Skodol, JG Gunderson, MT Shea, LC Morey, MZ Zanarini, and RL Stout, ‘The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.’, vol. 102, no. 4, 2000, pp. 256-564. 

Anxiety disorders occur in about 88% of people with BPD.

There are several anxiety disorders that can co-occur with BPD: panic disorder, phobias, obsessive compulsive disorder, social anxiety disorder, agoraphobia and separation anxiety. The rates for co-occurrence vary among the anxiety disorders and studies have shown that evidence-based psychotherapies such as Dialectical Behaviour Therapy in combination with Cognitive Behavioural Therapy would be useful. Pharmacological strategies are not recommended for BPD but may be of short-term relief for anxiety disorder symptoms.

TH McGlashan, CM Grilo, AE Skodol, JG Gunderson, MT Shea, LC Morey, MZ Zanarini, and RL Stout, ‘The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.’, vol. 102, no. 4, 2000, pp. 256-564. 

AB Bulbena-Cabré, MM Perez-Rodriguez, S Porges, A Bulbena, and M Goodman, ‘Understanding Anxiety in Borderline Personality Disorder’, vol. 4, no. 4, 2017, pp. 281-294.

Substance use disorder occurs in about 45% of people with BPD

A review has shown that BPD co-occurring with current substance use disorders is 45%; co-occurring with current alcohol use disorder is 46%; and co-occurring with drug use disorder is 39%. The presence of substance use disorder with BPD is problematic and some research suggesting that a substance use disorder is associated with more severe BPD symptoms of impulsivity, suicidality, and self-harm. No medication has been recommended whereas specialised BPD psychotherapies can be tailored to treat substance use disorders and BPD together.

TJ Trull, LK Freeman, TJ Vebares, AM Choate, AC Helle, and AM Wycoff, ‘Borderline Personality Disorder and Substance Use Disorder: An Updated Review’, vol. 5, issue 15, 2018.

Substance Abuse and Mental Health Services Administration, ‘An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders’, vol. 8, no. 3, 2014.

Posttraumatic disorder occurs in about 33-79% of people with BPD.

Both BPD and PTSD have both been found to stem from the experience of traumatic events. In fact, people with both BPD and PTSD report earlier experience of trauma as compared to people with just PTSD. Some of the overlapping symptoms of BPD and PTSD include: anger, emotional regulation problems, mood swings, fear of abandonment and dissociation. Recommended treatment is only evidence-based psychotherapies such as a combination of Dialectical Behavioural Therapy and Cognitive Behaviour Therapy.

Á Frias, and C Palma, ‘Comorbidity between Post-Traumatic Stress Disorder and Borderline Personality Disorder: A Review’, vol. 48, no. 1, 2015.

Eating disorders occurs in more than 20% of people with BPD.

Bulimia co-exists in 26% cases of BPD and anorexia nervosa co-occurs in 21% of individuals with BPD. Serious weight loss from an eating disorder should be treated before therapy targeted for BPD. Binging and purging behaviours of eating disorders can be focused similarly as for impulsive behaviours targeted in specialised psychotherapies for BPD.

MC Zanarini, CA Reichman, FR Frankenburg, DB Reich, and G Fitzmaurice, ‘The Course of Eating Disorders in Patients with Borderline Personality Disorder: A 10-Year Follow-up Study’, vol. 43, no. 3, pp. 226-232.

For more information

Psychiatric Times – Comorbidities in BPD

Borderline in the ACT – Co-occurring disorders