Comorbidity of borderline personality disorder

Currently, personality disorders capture the interest of most researchers, leading to many studies, research, conferences … One of the possible causes are the different discussions on how to consider these disorders, it is that is, where is the exact point of determining whether it is an actual disorder or a dysfunctional personality?

This gradient has been the subject of debate in several editions of the DSM. On the other hand also are known to be highly co-morbid with other disorders, particularly borderline personality disorder (TLP), a topic we will cover in this article.

    Generic comorbidity in borderline disorder

    Comorbidity is a medical term that signifies the presence of one or more disorders (Or diseases) in addition to the primary disease or disorder and the effect it causes. This phenomenon is so important in BPD that it is even more common and representative to see it alongside other disorders than on its own. There are many studies and variations in results on which disorders are comorbid and which are not, but there is sufficient consistency with those in Axis I (in particular) and Axis II in clinical and community samples.

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

    Regarding co-morbidity with axis II, many studies indicate that there are differences between the sexes. In other words, that is to say men diagnosed with BPD are more likely to have Axis II comorbidity with antisocial, paranoid and narcissistic disorders, while women with histrionics. In contrast, the percentages of dependent disorders and avoidance remained similar.

    specific comorbidity

    Of the Axis I disorders mentioned above, what would be the most common to associate with BPD is major depressive disorder, ranging from 40 to 87%. They would track anxiety and affective disorders in general and we would emphasize the relevance of post-traumatic stress disorder for the number of studies in this regard; with a lifetime prevalence of 39.2%, it is common but not universal in patients with BPD.

    In eating and substance abuse disorders that are also very common, there are differences between the sexes, the former being more likely to be associated with women with BPD and the latter with men. This addiction on an impulsive basis would lower the threshold of other self-destructive or sexually promiscuous behaviors. Depending on the severity of the patient’s addiction, the patient should be referred to specialized services and even admitted to detox as a priority.

    In the case of personality disorders, we would have a comorbid addiction disorder with rates of 50%, avoidance with 40%, a paranoid with 30%, an antisocial with 20-25%, a histrionic with rates oscillating between 25 and 63%. The prevalence of ADHD is 41.5% in childhood and 16.1% in adulthood.

    Borderline personality disorder and substance abuse

    TLP comorbidity with toxic abuse would be 50 to 65%. On the other hand, as in society in general, the substance consumed the most is alcohol. However, these patients are usually poly-drug addicts with other substances, such as cannabis, amphetamines or cocaine, but can come from any addictive substance in general, such as certain mind-altering drugs.

    More, such consumption is usually impulsive and episodic. Regarding co-morbidity with alcohol in particular, the result increased from 47.41% for life, while 53.87% was obtained with nicotine addiction.

    Similarly, numerous studies have verified the relationship between TLP symptomatology and frequency of cannabis use and dependence. Patients have an ambivalent relationship with this, as it helps them relax, alleviate the dysphoria or general discomfort they usually have, cope better with the loneliness they both refer to, and focus their minds. reflection on the here and now. However, it can also cause them to have binge eating (worsening binge eating disorder or binge eating disorder, for example), increased paranoid-like symptoms, and the possibility of derealization or depersonalization, which would be a vicious circle.

    On the other hand, it is also interesting to highlight the analgesic properties of cannabis, by linking it to the usual self-harm of patients with borderline disorder.

    BPD and eating disorders

    Widely, comorbidity with TCA and PT is high, Varies from 20 to 80% of cases. Although restrictive anorexia nervosa can co-morbidly with BPD, it is much more common to have it with other passive-aggressive disorders, for example, while purgative bulimia is strongly associated with TLP, being the proportion of 25%, added to disorders by binge and unspecified TCA, which also found the relation.

    At the same time, several authors have linked as possible causes of the origin of ADD to stressful events at certain early stages of life, such as physical, psychological or sexual abuse, excessive control … as well as traits personality such as low autonomy. esteem, impulsiveness or emotional instability, alongside society’s own beauty canons.

    In conclusion …

    It is important to note that the strong comorbidity of TLP with other disorders makes early detection of disorders more difficult, Making treatment difficult and obscuring the therapeutic prognosis, in addition to being a criterion of diagnostic seriousness.

    Finally, conclude with the need for further research on BPD and personality disorders in general, as there is a great disparity of opinions and little empirically contrasting and consensual data in the mental health community.

    Bibliographical 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. and Bogetto, F. (2005). Major depression in patients with borderline personality disorder: a clinical study. Can J Psychiatry 50: 234-238.
    • Biskin, R. and Paris, J. (2013). Comorbidities in borderline personality disorder. Retrieved from:
    • De el Riu, C., Torres, I. and Borda, M. (2002). Comorbidity between purgative bulimia nervosa and personality disorders according to the Millon multiaxial clinical 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 of the Wave 2 National Epidemiological Survey of 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 Replication of the National Comorbidity Survey (NCS-R). Psychiatry Biol. 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. and Peris, D (2008). Cannabis and personality disorders. In: Psychiatric aspects of cannabis use: clinical cases. Spanish Cannabinoid Research Society. 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. I am J Psychiatry. 161: 2108-2114.

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