Comorbidity of Borderline Personality Disorder

Currently, personality disorders are capturing the interest of most researchers, giving rise to numerous studies, investigations, conferences... One of the possible causes of this is the various discussions about how to consider such disorders, that is In other words, where is the exact point of determining whether it is a proper disorder or a personality dysfunctional?

This gradient has been the subject of debate in various editions of the DSM. On the other hand also are known for their high comorbidity with other disorders, especially borderline personality disorder (TLP), a topic that we will talk about in this article.

• Related article: "Borderline Personality Disorder (BPD): causes, symptoms and treatment"

Generic comorbidity in BPD

Comorbidity is a medical term that means the presence of one or more disorders (or diseases) in addition to the primary disease or disorder, and the effect they cause. This phenomenon is so significant in BPD, that it is even more common and representative to see it together with other disorders, than alone. There are many studies and much variation in results as to which disorders it is comorbid with and with which it is not. but there is sufficient uniformity with those of Axis I (especially) and Axis II in both clinical and community.

Research indicates that 96.7% of people with BPD have at least one comorbid diagnosis with Axis I, and that 16.3% would have three or more, which is significantly higher than other disorders. On the other hand, it has also been studied that 84.5% of the patients met the criteria for having one or more Axis I disorders for at least 12 months, and 74.9% to have an Axis II disorder of per lifetime.

Regarding comorbidity with axis II, numerous studies indicate that there are differences between the sexes. Namely, men diagnosed with BPD are more likely to have axis II comorbidity with antisocial type disorders, paranoid Y narcissistic, while women with histrionic. On the other hand, the percentages for the dependent and avoidant disorders remained similar.

Specific comorbidity

Of the aforementioned axis I disorders, the one most commonly associated with BPD would be major depressive disorder, ranging between 40 and 87%. They would follow anxiety and affective disorders in general and we would highlight the relevance of post traumatic stress disorder by the amount of studies in this regard; with a lifetime prevalence of 39.2%, it is common but not universal in patients with BPD.

In the also very common eating and substance abuse disorders, there are differences between sexes, the former being more likely to be associated with women with BPD and the latter, mens. This impulsive substance abuse would lower the threshold for other self-destructive or sexually promiscuous behaviors. Depending on the severity of the patient's dependence, they would have to be referred to specialized services and even admission for detoxification as a priority.

In the case of personality disorders, we would have comorbidity dependence disorder with rates of 50%, the avoidant with 40%, the paranoid with 30%, the antisocial with 20-25%, the histrionic with rates ranging between 25 and 63%. Regarding the prevalence of ADHD it stands at 41.5% in childhood and 16.1% in adulthood.

Borderline Personality Disorder and Substance Abuse

The comorbidity of BPD with substance abuse would be 50-65%. On the other hand, as in society in general, the substance that is most often abused is alcohol. However, these patients are usually polydrug addicts with other substances, such as cannabis, amphetamines or cocaine, but it can be from any addictive substance in general, like some psychotropic drugs.

In addition, such consumption is usually done impulsively and episodically. Regarding comorbidity with alcohol in particular, the result was 47.41% for life, while 53.87% was obtained with nicotine addiction.

Following the same line, numerous studies have verified the relationship of BPD symptomatology with frequency of cannabis use and dependence. Patients have an ambivalent relationship with it, as it helps them relax, attenuate dysphoria or discomfort general that they usually have, better bear the loneliness to which they refer so much and focus their thinking on the here and now. However, it can also lead to binge eating (aggravating bulimic behaviors or binge eating disorder, example), increase pseudoparanoid symptoms and the possibility of derealization or depersonalization, which would be a circle vicious.

On the other hand, it is also interesting to highlight the analgesic properties of cannabis, relating it to the usual self harm by BPD patients.

BPD and eating disorders

Roughly, comorbidity with eating disorders with PD is high, ranges between 20 and 80% of cases. Although the disorder of anorexia nervosa restrictive disorder may have comorbidity with BPD, it is much more frequent to have it towards other passive-aggressive disorders, for example, while bulimia purgative is strongly associated with BPD, the proportion being 25%, added to binge eating disorders and unspecified eating disorders, of which it has also been found relationship.

At the same time, various authors have related as possible causes of the origin of eating disorders to stressful events in some early stage of life, such as physical, psychological or sexual abuse, excessive control... along with personality traits such as low self-esteem, impulsiveness or emotional instability, along with the beauty standards of society itself.

In conclusion…

It is important to note that the high comorbidity of BPD with other disorders makes early detection of disorders more difficult, making treatment difficult and clouding the therapeutic prognosis, in addition to being a criterion of diagnostic severity.

Finally, to conclude with the need for more research about BPD and personality disorders in general, since there is a lot of disparity of opinions and little data really empirically contrasted and with consensus in the health community mental.

Bibliographic references:

• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, Inc.

• Bellino, S., Patria, L., Paradiso, E., Di Lorenzo, R., Zanon, C., Zizza, M. & Bogetto, F. (2005). Major Depression in Patients With Borderline Personality Disorder: A Clinical Investigation. Can J Psychiatry. 50: 234–238.

• Biskin, R. & Paris, J. (2013). Comorbidities in Borderline Personality Disorder. Taken from: http://www.psychiatrictimes.com

• Del Río, C., Torres, I. & Borda, M. (2002). Comorbidity between purgative bulimia nervosa and personality disorders according to the Millon Clinical Multiaxial Inventory (MCMI-II). International Journal of Clinical and Health Psychology. 2(3): 425-438.

• Grant, B., Chou, S., Goldstein, R., Huang, B., Stinson, F., Saha, T., et al. (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 69 (4): 533-45.

• Lenzenweger, M., Lane, M., Loranger, A. & Kessler, R. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 62:553–64.

• Skodol, A., Gunderson, J., Pfohl, B., Widiger, T., Livesley, W., et al. (2002) The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biol Psychiat 51: 936–950.

• Szerman, B. & Peris, D (2008). Cannabis and personality disorders. In: Psychiatric aspects of cannabis use: clinical cases. Spanish Society for Cannabinoid Research. Madrid: CEMA. 89-103.

• Zanarini, M., Frankenburg, F., Hennen, J., Reich, D & Silk, K. (2004). Axis I Comorbidity in Patients With Borderline Personality Disorder: 6-Year Follow-Up and Prediction of Time to Remission. Am J Psychiatry. 161:2108–2114.